Klaassen et al reported the Nijmegen Nail Psoriasis Activity Index (N-NAIL) for evaluating a patient with nail psoriasis. The authors are from Radboud University in Nijmegen, TweeSteden Ziekenhuis in Tiburg, Red Cross Hospital in Beverwijk and the Nail Disease Center in Cannes.
Patient selection: nail psoriasis
Each finger nail is assessed separately.
Parameters for each nail:
(1) onycholysis/oil-drop discoloration in percent (both reflect parakeratotic changes in the nail bed)
(2) pitting
(3) crumbling
(4) Beau lines
(5) subungual hypkeratosis in mm
Parameter
Finding
Points
onycholysis/oil-drop discoloration
absent
0
0 to 25%
1
25 to 50%
2
> 50%
3
pitting
absent
0
mild
1
moderate
2
severe
3
crumbling
absent
0
mild
1
moderate
2
severe
3
Beau lines
0
0
1
1
2
2
>=3
3
subungual hyperkeratosis
0
0
1
1
2
2
>=3 mm
3
subtotal score for each nail =
= SUM(points for all 5 parameters)
total score for all 10 nails =
= SUM(subscores)
Interpretation:
• minimum subscore: 0
• maximum subscore: 15
• minimum total score: 0
• maximum total score: 150
• The higher the score the worse the nail psoriasis.
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