Body surface area (BSA) BSA is a commonly used measure of severity of skin disease defned as the percentage of the total body surface area affected by psoriasis. 1% BSA represents a one handprint size of the patient, and it ranges from 0% to 100%. Nail psoriasis Moderate psoriasis Severe psoriasis Less than 3% 3%-10% of the More than of the body has body has psoriasis 10% of the body * psoriasis has psoriasis Nail psoriasis severity index (NAPSI) The target nail is graded for nail matrix psoriasis (any of the following: pitting, leukonychia, red spots in the lunula, and nail plate crumbling) and nail bed psoriasis (any of the following: onycholysis, splinter hemorrhages, oil drop (salmon patch) discoloration, and nail bed hyperkeratosis). The sum of these two scores is the total for that nail. Nail Matrix Psoriasis Score for Nail Matrix Psoriasis Indicated by: pitting, leukonychia, 0 = none red spoes in the lunula, or nail plate 1 = present in 1/4 nail crumbling 2 = present in 2/4 nail 3 = present in 3/4 nail 4 = present in 4/4 nail Ref: Rich P. J Am Acad Dermatol 2003;49;206–22 Nail Psoriasis: Diagnosis, Assessment, Treatment Options, and Unmet Clinical Needs, Gurjit S. Kaeley, Lihi Eder, Sibel Zehra Aydin, Phoebe Rich and Catherine J. Bakewell, The Journal of Rheumatology August 2021, 48 (8) 1208-1220; DOI: Images courtesy of Phoebe Rich, MD. Nail Bed Psoriasis Score for Nail Psoriasis Indicated by: presence/absence of: onycholysis, 0 = none splinter hemorrhages, oil drop, discoloration, or 1 = present in 1/4 nail nail bed hyperkeratosis 2 = present in 2/4 nail 3 = present in 3/4 nail 4 = present in 4/4 nail Total for Each Nail______ (0-8) * Coates L. Rheum Dis Clin N Am 41 (2015) 699–710. Pitting, leukonychia Leukonychia Red macules in lunula Crumbling Trachyonychia Splinter hemorrhages Hyperkeratosis and Salmon patch or oil Onycholysis and onycholysis splinter hemorrhages spot dyschromia and salmon patch dyschromia 16
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