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Psoriatic Nail Disease — SCE Dermatology MCQ

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HardNail DisordersPsoriatic Nail DiseaseSCE Dermatology

A patient has psoriasis confined to several nails, but pain and onycholysis prevent keyboard work. Topical treatment has failed; PASI is 0.8 and body surface area is below 1%. Which statement best reflects NICE systemic-treatment criteria?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Severe localised nail disease can justify specialist systemic treatment despite a low PASI

Explanation lettering: B = shown as A · D = shown as B · E = shown as C · A = shown as D · C = shown as E

E is correct. NICE allows conventional systemic treatment when psoriasis is uncontrolled topically, substantially affects wellbeing and is either extensive or localised with major functional impairment or distress; severe nail disease is the explicit example. PASI and surface area can underestimate high-impact localised disease. NICE does not impose a NAPSI threshold of 80, require arthritis, or insist on phototherapy when it cannot appropriately treat the affected site. Specialist assessment should quantify nail disease and exclude mimics such as onychomycosis before systemic escalation.

Reference: NICE CG153 psoriasis recommendations: https://www.nice.org.uk/guidance/cg153/chapter/Recommendations