Dermatology: Practical and Conceptual Research Letter | Dermatol Pract Concept. 2025;15(1):4797 1 Patients with Isolated Nail Psoriasis Are at Increased Risk for Asthma Compared to Controls in a Retrospective Cohort Study at a Single Academic Institution Rachel C. Hill1, Rhiannon C. Miller2, Shari R. Lipner2 1 Weill Cornell Medical College, New York, USA 2 Weill Cornell Medicine, Department of Dermatology, New York, USA Key words: Nail Psoriasis, Asthma, Eczema, Rhinitis, Atopy, Atopic Conditions Citation: Hill RC, Miller RC, Lipner SR. Patients With Isolated Nail Psoriasis Are at Increased Risk for Asthma Compared to Controls in a Retrospective Cohort Study at a Single Academic Institution. Dermatol Pract Concept. 2025;15(1):4797. DOI: https://doi.org/10.5826/ dpc.1501a4797 Accepted: October 2, 2024; Published: January 2025 Copyright: ©2024 Hill et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding Author: Shari R. Lipner MD, PhD, Weill Cornell Medicine, Department of Dermatology, 1305 York Avenue, NY 10021; Phone: 646-962-3376; E-mail: shl9032@med.cornell.edu Introduction Nearly all patients with psoriasis have nail changes during their lifetimes, with 5%-10% having isolated nail psoriasis (NP), with limited or no cutaneous involvement (<5% body surface area [BSA]) [1]. Previous studies demonstrated an as- sociation between psoriasis and asthma [2-4], but isolated NP patients were either not included or not specified. There- fore, we sought to analyze the relationship between NP and atopic conditions. Case Presentation Following Institutional Review Board approval, Weill Cornell Medicine’s EPIC database was queried for isolated NP pa- tients and a control group of patients without psoriasis with previous encounter for total body skin examination. Out- come variables included history of asthma, chronic rhinitis, and atopic dermatitis (AD). Categorical data was described as frequencies and percentages. Continuous data was de- scribed as median and interquartile range (IQR). Chi-square and Kruskal-Wallis Rank Sum tests compared NP patients vs. controls for categorical and continuous variables, re- spectively. Logistic regression was performed and reported as odds ratios (OR) with 95% confidence intervals (CI). Age at diagnosis and sex were used as adjustment variables. P values <0.05 were considered statistically significant. A total of 266 isolated NP and 1000 control patients were included (Table 1). Median age at diagnosis for the NP cohort was 43 years [IQR 33.00-55.00], with 56.9% fe- male, which was similar to the control cohort (P = 0.967 and P = 0.455, respectively). The cohorts differed by race and 2 Research Letter | Dermatol Pract Concept. 2025;15(1):4797 Table 1. Study Population Nail Controls P-Value Study Population* N 266 1000 Age at Diagnosis (median [IQR]) 43.00 [33.00, 55.00] 42.00 [32.00, 60.00] 0.967 Male sex, N (%) 62 (43.1) 394 (39.4) 0.455 Race, N (%) <0.001 White 55 (37.9) 609 (60.9) Asian 9 (6.2) 51 (5.1) Black 5 (3.4) 35 (3.5) Other 9 (6.2) 74 (7.4) Unknown 67 (46.2) 231 (23.1) Ethnicity, N (%) <0.001 Hispanic or Latino 11 (7.6) 69 (6.9) Not Hispanic or Latino 63 (43.4) 626 (62.6) Declined or Unknown 71 (49.0) 305 (30.5) Unadjusted Outcomes Asthma, N (%) 21 (14.5) 70 (7.0) 0.003 Rhinitis, N (%) 25 (17.2) 156 (15.6) 0.701 Eczema, N (%) 29 (20.0) 204 (20.4) 0.999 Figure 1. Adjusted outcomes between patients with nail psoriasis and patients presenting for TBSE. The following terminology was used as part of the chart review to identify patients with relevant diagnoses: “asthma, asthmatic, inhaler,” “rhinitis,” and “eczema, eczematous, atopic dermatitis.” ethnicity (both P < 0.001). NP versus controls were more often diagnosed with asthma (OR 2.27, 95% CI 1.32-3.78, P = 0.002), with no differences in odds of rhinitis (OR 1.14, 95% CI 0.70-1.78, P = 0.585) or AD (OR 0.99, 95% CI 0.63-1.51, P = 0.950) (Figure 1). Conclusions We report on the novel finding that isolated NP patients had increased odds of asthma compared to controls, which builds on prior studies showing an association between psoriasis Research Letter | Dermatol Pract Concept. 2025;15(1):4797 3 and asthma [2-4]. For example, in a National Health and Nutrition Examination Survey study of 17,518 adults, pso- riasis vs. non-psoriasis patients were 1.67 times more likely to have asthma (95% CI 1.26-2.21) [2]. Similarly, in a meta-analysis of six studies, psoriasis patients were 1.32 times as likely to have asthma vs. the general population (95% CI 1.20-1.46, P < 0.00001) [3]. In a retrospective study of 5165 patients with psoriasis and 230,386 matched controls without psoriasis, psoriasis vs. non-psoriasis pa- tients were 2.22 times more likely to have asthma (95% CI 2.08-2.37) and 2.57 times more likely to have allergic rhini- tis (95% CI 2.42-2.73) [4]. Limitations include retrospective study design, and lack of control for comorbidities and lifestyle risk factors. We were unable to match for race/ethnicity due to missing data. In summary, we showed that isolated NP patients were more likely to have asthma co-diagnosis compared to con- trols. We suggest that NP patients be counseled on poten- tial increased risk for asthma. Large, prospective studies are needed to compare prevalence of asthma, rhinitis, and AD in patients with isolated NP, psoriasis, and patients with both NP and psoriasis to define the burden of atopic co- morbidities in these patient populations. Future studies are needed to examine whether psoriasis and NP severity pre- dicts asthma risk. Acknowledgement We would like to thank Thomas Chandler, MPH for his assistance in providing consultation services to develop the statistical analysis plan. References 1. Chang MJ, Lee D, Desai AD, Lipner SR. The untold burden of isolated nail psoriasis: Delayed diagnosis and significant risk of psoriatic arthritis in a retrospective study at an academic center.  J Am Acad Dermatol. 2023;88(5):1192-1194. DOI: 10.1016 /j.jaad.2022.12.031. PMID: 36621466. 2. Martin A, Thatiparthi A, Liu J, Ge S, Egeberg A, Wu JJ. Associa- tion between psoriasis and asthma among United States adults in the 2009-2014 National Health and Nutrition Examination Sur- vey. J Am Acad Dermatol. 2022;86(3):709-712. DOI: 10.1016 /j.jaad.2021.04.027. PMID: 33882277. 3. Wang J, Ke R, Shi W, et al. Association between psoriasis and asthma risk: A meta-analysis.  Allergy Asthma Proc. 2018;39(2): 103-109. DOI: 10.2500/aap.2018.39.4109. PMID: 29490768. PMCID: PMC5827153. 4. Joel MZ, Fan R, Damsky W, Cohen JM. Psoriasis associated with asthma and allergic rhinitis: a US-based cross-sectional study using the All of US Research Program. Arch Dermatol Res. 2023;315(6):1823-1826. DOI: 10.1007/s00403-023-02539-z. PMID: 36707438.