NAPSI: Nail Psoriasis Severity Index

The Nail Psoriasis Severity Index (NAPSI) is a valuable physician-administered tool used to evaluate the severity of nail psoriasis, which can significantly affect patients’ quality of life. Nail involvement in psoriasis is common and can present unique treatment challenges. The NAPSI helps clinicians assess the extent and severity of nail psoriasis and monitor the effectiveness of treatment over time.

The NAPSI scoring system evaluates the nail matrix and nail bed separately for each fingernail, focusing on characteristic features such as pitting, leukonychia, crumbling, and red spots in the lunula for the matrix, and onycholysis, splinter hemorrhages, subungual hyperkeratosis, and oil drop (salmon patch) discoloration for the nail bed. Each nail is scored from 0 to 8, providing a comprehensive assessment of nail psoriasis severity.

Assessment of Nail Psoriasis:

• Nail Matrix:
  • Pitting
  • Leukonychia (whitening of the nail)
  • Crumbling
  • Red spots in lunula
• Nail Bed:
  • Onycholysis (separation of the nail from the nail bed)
  • Splinter hemorrhages
  • Subungual hyperkeratosis (scaling under the nail)
  • Oil drop (salmon patch) discoloration

Each characteristic is scored based on presence or absence, with higher scores indicating more severe nail psoriasis.