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„Stiefkind“ Nagelpsoriasis

Pathogenese, Diagnostik, Therapie

Nail psoriasis—an ignored disorder

Pathogenesis, diagnosis and therapy

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Zusammenfassung

Etwa 50% aller Psoriasispatienten weisen eine Nagelbeteiligung als klinisches Korrelat einer psoriatischen Entzündung der Nagelmatrix und/oder des Nagelbettes auf. Die häufigsten Zeichen einer Nagelpsoriasis sind Tüpfel und distale Onycholysen. Der derzeit am häufigsten eingesetzte Score zur Erfassung der Schwere einer Nagelbeteiligung ist der Nail Psoriasis Severity Index (NAPSI). Allerdings werden patientenbezogene Symptome in diesem Index nicht berücksichtigt, obwohl mehr als die Hälfte der Betroffenen zum Teil unter deutlichen physischen und psychischen Einschränkungen leiden. Auffällig ist der Zusammenhang zwischen einer Nagelpsoriasis und dem Risiko einer Gelenkbeteiligung. Die Prävalenz einer Nagelpsoriasis beträgt bei Patienten mit Psoriasisarthritis etwa 70%. Ursächlich für diese Wechselbeziehung scheint der über die Fasern der Strecksehne vermittelte enge anatomische Kontakt zwischen Nagelapparat und distalem Interphalangealgelenk zu sein. Eine Enthesitis kann damit in der Erkrankung des Nagels sichtbar werden. Nagelveränderungen werden aktuell im Therapiemanagement oft nicht ausreichend berücksichtigt. Es gibt nur begrenzte Evidenz zur Wirksamkeit lokaler Therapieformen, mittlerweile liegen aber gute Daten insbesondere zur Wirksamkeit der Biologics und neuerdings auch zu Methotrexat in der Behandlung der Nagelpsoriasis vor.

Abstract

Approximately 50% of all patients with psoriasis develop characteristic nail changes as a clinical correlate of psoriatic inflammation of the nail matrix and/or nail bed. The most frequent signs of nail psoriasis are pitting and distal onycholysis. The most commonly used score to assess the severity of nail involvement at present is the Nail Psoriasis Severity Index (NAPSI). Although more than half of affected patients experience a significant physical and mental impairment, this index does not include patient-reported symptoms. There is a striking association between nail psoriasis and a higher risk of psoriatic arthritis with a prevalence of nail involvement among patients with psoriatic arthritis as high as 70%. A possible explanation is the close anatomical link between the nail apparatus and the distal interphalangeal joint; enthesitis of the latter is carried by fibers to the nail and becomes clinically visible as nail psoriasis. Nail involvement is not adequately reflected in current concepts of disease management. There is limited evidence for the efficacy of topical therapies in nail psoriasis. A number of large studies document an improvement of nail psoriasis in response to biologics and, more recently, also to methotrexate.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Prof. Kristian Reich wirkte an klinischen Studien mit und arbeitete als Berater, Referent und Beiratsmitglied von Abbott, AMGEN, Biogen-Idec, Celgene, Centocor, Forward Pharma, Galderma, Janssen-Cilag, LEO Pharma, Medac, MSD, Novartis und Pfizer. Dr. Christina Kahl hat an klinischen Studien, gesponsert von Abbott, AMGEN, Biogen-Idec, Celgene, Centocor, Forward Pharma, Galderma, Janssen-Cilag, LEO Pharma, MSD, Novartis und Pfizer, mitgewirkt. Für Bente Hansen liegt kein Interessenkonflikt vor.

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Authors and Affiliations

  1. Dermatologikum Hamburg, Stephansplatz 5, 20354, Hamburg, Deutschland

    C. Kahl, B. Hansen &  K. Reich

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  1. C. Kahl
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  2. B. Hansen
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  3. K. Reich
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Correspondence to K. Reich.

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Kahl, C., Hansen, B. & Reich, K. „Stiefkind“ Nagelpsoriasis. Hautarzt 63, 184–191 (2012). https://doi.org/10.1007/s00105-011-2228-4

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