NAPSI Scoring — SCE Dermatology MCQ
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Correct answer: C — Each nail is divided into quadrants; each quadrant is assessed for nail matrix signs (pitting, leukonychia, red spots, crumbling) and nail bed signs (onycholysis, splinter haemorrhages, oil drop, hyperkeratosis); total score 0-160 for all 20 nails
NAPSI divides each nail into quadrants (using imaginary longitudinal and transverse lines). Each quadrant is assessed for nail matrix features (pitting, leukonychia, red spots in lunula, nail plate crumbling — scored 0-1 per feature per quadrant) and nail bed features (onycholysis, splinter haemorrhages, oil drop discolouration, subungual hyperkeratosis — scored 0-1 per feature per quadrant). Maximum score per nail = 8 (4 matrix + 4 bed). Total NAPSI for all 20 nails = 0-160. NAPSI is the primary outcome measure in nail psoriasis clinical trials and is used to monitor treatment response. Modified NAPSI (mNAPSI) uses a simplified scoring without quadrant division.
Reference: BAD 2020 Psoriasis Guidelines; NAPSI Scoring System