Onychomycosis is a nail infection caused by dermatophyte and non-dermatophyte molds and yeasts. The nail involvement is a feature of psoriasis, although skin manifestations are the most principal findings in psoriasis. Onychomycosis and psoriasis are both common disorders in communities. It is possible that in some patients these two diseases are present at the same time. A review was performed using the keywords including nail psoriasis, onychomycoses, dermatophytes, non-dermatophyte molds and yeasts in valid medical databases, such as PubMed, Google scholar, Scopus and Science direct. Articles that were most relevant to the purpose of the study were selected and studied. We investigated the incidence and pathogenic function of fungal agents in causing fungal infections in psoriasis nails.

Introduction and objective: psoriasis is a chronic, recurrent, and common inflammatory skin disease, characterized by skin and nail involvements. Onychomycosis is a common disease of the nails. The relationship between psoriasis and onychomycosis is ambiguous. We studied this relationship in psoriasis patients with any nail involvement.Materials and methods: The nail specimens were prepared by scraping and clippings from the patients with nail changes of psoriasis, which referred to the Department of Dermatology of Ahvaz Jundishapur University of Medical Sciences during 2008-2009. These samples were studied through smear preparing and culture.Result: Totally, we studied 60 eligible cases (27 men and 33 women). The mean age was 32±8 years. The most common clinical form of psoriasis was psoriasis vulgaris (63.3%). Only one patient showed yeast in direct microscopy examination, whose culture was negative.Conclusion: This study revealed no statistically significant association between nail psoriasis and fungal infection.

Objective: psoriasis is a common skin disease in which occurrence rates of clinical features of nail psoriasis vary considerably in the literature. The present study was undertaken to evaluate the frequency of nail involvement in psoriatic patients, to assess the types of nail changes in psoriasis, furthermore to find eventual relationships between nail involvement and some clinical parameters, and finally compare our clinical findings with the few reports available in the literature.Subjects and Methods: From January 2003 to October 2005, patients suffering from psoriasis with nail involvement, attending at a private dermatology clinic, and at the outpatient Clinic of Dermatology in Imam Khoumeini Hospital, Ahwaz, southwest of Iran, were included in the study. The diagnosis was made clinically and in some cases based on histopathological studies.Results: In our study, 500 patients were studied and 296 (59.2%) patients, 177 males (59.8%) and 119 women (40.2%), had nail changes. The mean age of patients was 35±16.95 years and the mean duration of the nail involvement was 6.9±6.88 years. Men involvement percent was a little more than women (59.8% vs 40.2%). The most common clinical type of psoriasis was plaque type psoriasis (67.2%). The most common nail abnormality observed on both finger nails and toe nails was onycholysis (82.8%), followed by pitting (72.6%); subungual hyperkeratosis (72%), nail thickening (37.5%), discoloration of the nail (36.5%), onychodystrophy (12.8%), oil spot (3.7%), Beau's line (7.8%), nail loss (1%), and splinter hemorrhage (0.7%). Of the 296 patients, 227 patients (76.7%) had not involvement of the proximal and lateral nail folds, and 69 (23.7%) had involvement of the proximal and lateral nail folds.Conclusion: The frequency of nail involvement and nail changes in our patients is nearly similar to those in textbooks of dermatology and literatures. About, a third our patients with nail changes, had nail fold involvement, resulting in increased severity of nail changes in these patients.

Background: Psoriatic arthopathy is a seronegatiye arthropathy seen in some patients with   psoriasis, a self limited and genetically determined skin disease. Objective: To determine the prevalence and risk factors of arthropathy in patients, with psonasis. Patients & Methods: In a prospective, cross-sectional study, psoriatic patients referred to Razi Skin Hospital in Tehran, Iran in 2002 were evaluated for the presence of arthropathy, and were referred to a rheumatologist for confirmation of arthropathy. The relationship between and nail involvement were evaluated using chi-square and t tests. Results: Among 320 patients with psoriasis, 29 (9.1%) had joint diseases. The most common was asymmetric polyarthritis. Patients with joint diseases had more nail involvement (96.5% vs. 73.1%, p< 0.05) and higher mean PASI scores (24.33 +/-10.35 vs. 10.70 +/- 8.44, p<0.05) than those without arthropathy, but the age and sex distribution of two groups were not significantly different. Conclusion: The prevalence of joint diseases in psoriatic patients in this study was similar to other reports. nail involvement and more extensive disease are risk factors for joint diseases in these patients.      

Background and Aim: psoriasis is a chronic skin disorder involving many parts of the body including skin, nails and joints with severe negative effects on patient’s quality of life. nail involvement is one of the most difficult involvements of this disease to treat. Psoriatic arthritis categorized in sero-negative spondilo-arthropaties with some deforming characteristics. The aim of the present study was to evaluate the relationship between psoriatic arthritis and nail involvement based on standard psoriatic nail involvement score (NAPSI).Methods: Psoriatic patients visiting dermatology clinic of Razi hospital were selected. Patients with arthritis enrolled as the case group while patients that had no joint involvement participated in control group. After matching, demographic data of both groups as well as NAPSI score and nail involvement characteristics collected through special questionnaires and analyzed with SPSS version 14.Results: A total of 30 patients with psoriatic arthritis and 75 patients without arthritis were enrolled the study. Analysis of collected data demonstrated that nail involvement among patients with psoriatic arthritis (mean NAPSI score=46) was more common and severe than patients without joint involvement (mean NAPSI score=9.23) (P<0.05).Conclusion: It seems that there is a significant difference between psoriatic patients presenting with or without arthritis and presence of arthritis probably can determine occurrence and extension of nail involvement.

Introduction: The treatment of nail psoriasis is often difficult and unsatisfactory due to therapy resistance. This study aimed to compare the efficacy of clobetasol 0. 05% ointment and photodynamic therapy (PDT) using aminolevulinic acid (ALA) and red light in the treatment of severe nail psoriasis. Methods: This open-trial study included 69 nails of 8 patients with severe nail psoriasis. Thirty-four nails were treated with clobetasol 0. 05% ointment and 35 nails were treated with ALA-PDT. ALA-PDT treatment was performed every 3 weeks for 5 cycles; the nails were treated with clobetasol under occlusion every day during the study. All the patients were followed up after 24 weeks. The severity of nail involvement was measured by the nail psoriasis Severity Index (NAPSI) scores at the baseline and during the treatment. Results: There were no significant differences in the NAPSI scores between the treatment groups in the baseline and weeks 3, 6 and 9 (all P > 0. 05), although significant differences were found in weeks 12, 15 and 24 (follow-up) (P < 0. 001). A significant time-effect improvement was found in all the nail-matrix, nail-bed and total NAPSI scores in both treatment groups (all P < 0. 001). The patients did not report intense pain and discomfort during irradiation. Conclusion: Clobetasol 0. 05% ointment seems to be effective in treating nail psoriasis after a treatment period of 15 weeks. However, the efficacy of ALA-PDT at a 24-week follow-up was greater than that of clobetasol.

Background: Stress is an important factor in development and exacerbation of symptoms of most of the skin diseases including psoriasis. This study was designed to assess the effectiveness of mindfulness-based stress reduction program on physical symptoms in patients with psoriasis.Methods: This study was designed as a quasi-experimental study. Experimental group received 10 sessions of mindfulness training. psoriasis Area Severity Index (PASI) was measured before, at the end, and 45 days after treatment in all recruited patients. Data were analyzed using SPSS software.Findings: There was a significant differences in physical symptoms of psoriasis (PASI score) between experimental and control groups both at the end of the treatment, and 45-days follow-up period (P<0.05 for both).Conclusion: Based on these results, mindfulness-based stress reduction program could potentially be considered as an effective method to relief physical symptoms in patients with psoriatic.