Investigation of the effect of nail involvement on vestibular system in psoriasis patients

Psoriasis is known to involve the inner ear. There is evidence that the vestibular system is severely affected, especially in patients with psoriatic arthritis. It is known that 32% to 97% of psoriatic arthritis patients have nail involvement. Since the distal phalangeal joint and the nail are in close proximity, it is thought that nail involvement is an important finding that affects the vestibular system. Therefore, our study was conducted to investigate the effect of nail involvement on the vestibular system in psoriasis patients. Our study was designed as a prospective, randomized parallel double-arm (1:1) experimental study. The population of our study consisted of patients diagnosed with psoriasis who applied to the Skin and Venereal Diseases Outpatient Clinic of Selçuk University Faculty of Medicine Hospital between May 2024 and May 2025. The study sample consisted of 31 patients with nail involvement and 30 patients without nail involvement (control group) between the ages of 18-65 who had no known hearing and balance system pathology and had not received phototherapy, acitretin and methotrexate treatment in the last six months. Patients admitted to the dermatology outpatient clinic were evaluated comprehensively for psoriasis. Psoriasis Follow-up Form, Psoriasis Area Severity Index (PASI) to determine the severity of psoriasis and Nail Psoriasis Severity Index (NAPSI) to determine the severity of nail involvement were used in the evaluation. Patients were then evaluated by an otolaryngologist. The vestibular evaluation of patients who met the inclusion criteria was performed with cervical Vestibular Evoked Myogenic Potential test (cVEMP), ocular Vestibular Evoked Myogenic Potential test (oVEMP) and Video Head Thrust Test (vHIT). Patients were randomly assigned to the groups based on the time of presentation to the outpatient clinic. As a result of our study, it was determined that there was no statistically significant difference between the nail involvement and control group in cVEMP test results (p>0.05). In oVEMP test, the difference in right P1 Latency (p=0.009), right P1-N1 Latency (p=0.043) and left P1-N1 Latency (p=0. In oVEMP test, there was a weak negative correlation between left P1 Latency duration and PASI score (p<0.05). There was no statistically significant difference between nail involvement and control group in vHIT test results (p>0.05). In our study, we concluded that nail involvement is an important finding for subclinical vestibular system pathologies among psoriasis patients. Accordingly, it is recommended that patients with nail involvement should be evaluated for possible consequences of vestibular system pathologies such as falls.