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Scalp and nail involvement


Scalp and nail psoriasis in PsA: impact on QoL


Scalp and nail psoriasis are risk factors of PsA and they strongly impair patients' quality of life, limiting their daily activities, social contact and impacting on body image


Laurent Misery MD PhD Professor of Dermatology, University of Western Brittany; Head of the Department of Dermatology, University Hospital of Brest, France


Psoriasis is a disease that affects all areas of the skin. Among these areas, scalp and nail psoriasis are especially unpleasant and can deeply impair quality of life (QoL) in some patients.


Psoriasis and PsA are known to deeply impair QoL.1


Patients with psoriasis


report physical discomfort, impaired emotional functioning, a negative body and self-image, limitations in daily activities, social contact and (skin- exposing) activities, and work. There is a tendency for increased age to be associated with slightly lower levels of physical functioning and slightly higher levels of psychological functioning and overall QoL, but gender and QoL were found to be unrelated. More severe psoriasis, as assessed by Psoriasis Area Severity Index (PASI) and other measurement tools, is associated with lower levels of QoL. Nonetheless, there is no strict correlation with these scales, which are mainly related to the measurement of the involved surface, and many patients have a severe impact of psoriasis on their quality of life due to some locations: hands; feet; nails; genital areas; face and scalp.


Scalp psoriasis


Scalp psoriasis does not involve hairs but the skin around them. Symptoms of scalp


psoriasis are mainly scaling, with a dandruff-like flaking. However, erythema and itching (sometimes burning or soreness) are also present. Temporary hair loss is also possible. The falling dandruff on clothes is very visible. Scratching is very frequent.


The frequent use of topical treatments is necessary: shampoos, creams, gels, oils, ointments, etc. Systemic treatments could be necessary in cases of severe scalp psoriasis or in cases of an associated moderate to severe generalised psoriasis or PsA.


A systematic literature review showed an increased risk of developing PsA when a patient presents with scalp psoriasis.2


In


one cohort study, this risk was fourtimes higher in case of scalp psoriasis compared with other localisations of psoriasis (hazard ratio (HR) 3.89; 95% confidence interval (CI): 2.18–6.94).3


A similar


association was found in two cross- sectional studies. These studies included 19284


and 4595 psoriasis patients,


respectively, and also showed an increased prevalence of PsA in patients with scalp lesions compared with patients without (90.2% versus 76.4%, p = 0.001 and 87% versus 72%, p = 0.0237, respectively).


Although the impairment of QoL related to scalp psoriasis is obvious, it has been poorly studied. Some studies on the


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