New diagnostic tool for nail psoriasis: Galeazzi-(G) N-NAIL

The Galeazzi-(G) N-NAIL remarkably improved the examination of nail psoriasis severity, especially in complex cases involving onychotillomania and onychophagy, the results of a recently published multicenter prospective observational study concluded.

As teledermatology became the primary mode of evaluating nail psoriasis, dermatologists encountered challenges in accurately rating the condition alongside other nail disorders. The GN-NAIL was developed to refine existing severity scores and validate its effectiveness across different clinical settings, including in-person evaluations and via video or pictures.

This study assessed patients with nail psoriasis, screening for onychophagy and onychotillomania through telemedicine. For 9 months, patients were monitored using both the established Nijmegen-Nail Psoriasis Activity Index and the innovative GN-NAIL, which also tracks changes in nail dimensions. The study aimed to assess the precision and dependability of these tools across diverse clinical settings.

After evaluation of 382 patients, 5.24% had nail biting (also called as onychophagy) and 4.45% had onychotillomania (nail picking disorder). Key findings specified that onycholysis and crumbling, followed by subungual hyperkeratosis (deposition of chalky substance under the nail beds), were the most troublesome clinical signs for patients. Both intra- and interobserver agreement for the N-NAIL score was moderate. The GN-NAIL demonstrated a strong correlation with the N-NAIL at all-time points, endorsing its reliability and effectiveness in diverse clinical scenarios.