Baran developed an index for describing the severity of nail involvement in psoriasis. The author is from the Nail Disease Center in Cannes, France.
Involvement of proximal matrix: pitting, Beau's lines, onychomadesis, trachyonychia
Involvement of intermediate matrix: leuconychia
Involvement of subungual tissues distal to lunula: subungual hyperkeratosis, onycholysis, splinter hemorrhages, oily spots
Each finger and toe nail is evaluated separately.
Parameters:
(1) pitting
(2) "Beau's lines" (transverse grooves formed by contiguous pits)
(3) subungual hyperkeratosis (measured using a measuring caliper)
(4) percent of nail showing onycholysis
(5) percent of nail showing trachyonychia (roughness)
(6) percent of nail showing leuconychia
(7) percent of nail showing oily spots
Splinter hemorrhages and nail loss (onychomadesis) are not graded.
|
Parameter |
Finding |
Points |
|---|---|---|
|
pitting |
none |
0 |
|
|
1 - 9 (slight) |
1 |
|
|
10 - 20 (moderate) |
2 |
|
|
>= 21 (severe) |
3 |
|
transverse grooves |
none |
0 |
|
|
1 |
1 |
|
|
2 or 3 |
2 |
|
|
4 or more |
3 |
|
subungual hyperkeratosis |
none |
0 |
|
|
0.01 to 1.99 mm |
1 |
|
|
2.00 - 3.00 mm |
2 |
|
|
>= 3.01 mm |
3 |
|
onycholysis |
none |
0 |
|
|
0.1 - 24.9% |
1 |
|
|
25 - 50% |
2 |
|
|
>= 50.1% |
3 |
|
trachyonychia |
none |
0 |
|
|
0.1 - 24.9% |
1 |
|
|
25 - 50% |
2 |
|
|
>= 50.1% |
3 |
|
leuconychia |
none |
0 |
|
|
0.1 - 24.9% |
1 |
|
|
25 - 50% |
2 |
|
|
>= 50.1% |
3 |
|
oily spots |
none |
0 |
|
|
0.1 - 24.9% |
1 |
|
|
25 - 50% |
2 |
|
|
>= 50.1% |
3 |
where:
• An area of involvement can be measured by dividing the nail into 8 sectors (running a line down the middle of the nail, then dividing the length into quarters). Each sector would be 12.5% of the nail area.
index =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: 0
• maximum score: 21
• The higher the score the more severe the nail involvement
Purpose: To evaluate the severity of nail involvement in psoriasis using the nail psoriasis severity index of Baran.
Specialty: Dermatology, Immunology/Rheumatology
Objective: severity, prognosis, stage
ICD-10: L40,
