Quadrant-Based Comparison of Ultraviolet-Fluorescence Dermoscopy, Standard Dermoscopy, and Clinical Examination in Adults with Nail Psoriasis: A Prospective Pilot Study of 35 Patients
Dermatology, cilt.242, sa.1, ss.16-22, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 242 Sayı: 1
- Basım Tarihi: 2026
- Doi Numarası: 10.1159/000549051
- Dergi Adı: Dermatology
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, CINAHL, EMBASE, MEDLINE, Health Research Premium Collection (ProQuest), Pharma Collection (ProQuest)
- Sayfa Sayıları: ss.16-22
- Anahtar Kelimeler: Psoriasis, Nail, Dermoscopy, Nail psoriasis severity index, Ultraviolet-fluorescence dermoscopy
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Introduction: Accurate visualization of nail‐matrix psoriasis remains challenging. Ultraviolet-fluorescence dermoscopy (UVF-D) may enhance detection, yet rigorous comparative data are scarce. The aim of this study was to compare the diagnostic yield of UVF-D with standard dermoscopy and naked-eye clinical examination for matrix and bed involvement in nail psoriasis. Methods: In this single-centre prospective pilot study (March–July 2024), 35 consecutive adults with plaque psoriasis underwent triplicate assessment (clinical, dermoscopy, UVF-D) of all fingernails. Each nail quadrant was scored for matrix-Nail Psoriasis Severity Index (NAPSI) and bed-NAPSI by two blinded dermatologists in randomized order. The study was powered (80%, α = 0.05) to detect a ≥3-point mean difference in matrix-NAPSI between modalities. Results: UVF-D identified matrix involvement in 550/1, 400 quadrants (39.3%) versus 448/1, 400 (32.0%) with standard dermoscopy and 441/1, 400 (31.5%) clinically (p < 0.001; Kendall’s W = 0.42). Mean ± SD matrix-NAPSI scores were 15.7 ± 5.3 (UVF-D), 12.8 ± 5.2 (dermoscopy), and 12.6 ± 4.8 (clinical). Thus, UVF-D detected roughly one additional matrix-affected quadrant for every seven examined and produced a higher matrix-NAPSI, underscoring its added sensitivity over conventional methods. Conclusions: UVF-D significantly improves visualization of nail-matrix psoriasis versus standard approaches. Larger multicentre studies should validate its diagnostic and longitudinal utility. Plain Language Summary: Nail psoriasis damages the fingernails of many people with psoriasis and can appear as small dents (pitting), white specks (leukonychia), tiny streaks of blood (splinter haemorrhages), or the nail lifting from the skin (onycholysis). Early signs are hard to spot. Doctors usually rely on the naked eye or a dermatoscope – a hand-held lens with white light – for a closer look. We tested a newer tool called ultraviolet-fluorescence dermoscopy (UVF-D). UVF-D shines safe ultraviolet light onto the nail; abnormal nail tissue glows, revealing details that are invisible under normal light. In a pilot study, we examined 35 adults with nail psoriasis. Each fingernail was divided into four quarters, giving 1, 400 small areas to assess. Three methods were used on every nail: ordinary inspection, white light dermoscopy, and UVF-D. For each method, we scored disease severity with the Nail Psoriasis Severity Index (NAPSI). UVF-D uncovered matrix-level changes – the earliest damage – in 39% of nail quarters, compared with 32% under white light and 32% by eye. On average, it added three extra points to the NAPSI score and revealed one hidden lesion for every seven quarters inspected. Fluorescence made pitting, white spots, and splinter haemorrhages stand out clearly, while larger changes such as onycholysis were recognized equally well by all techniques. These findings show that adding UVF-D to routine nail examinations can expose subtle disease that standard methods miss, allowing earlier and more accurate assessment of nail psoriasis and supporting better-timed treatment decisions.