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nail psoriasis
Etiology:
- typically occurs in patients with psoriasis
- nail changes may preceed skin changes [1]
Pathology:
- subungual hyperkeratosis suggests nail psoriasis [2]
- neutrophils in the nail bed stratum corneum (pathognomonic) [2]
Genetics:
- family history of psoriasis helpful [1] Clinical manfestations:
- onycholysis: separation of the nail plate from the nail bed
- areas of white nail at the lateral or proximal edge of the nail plate
- nail pitting: small indentations on the nail surface
- 'oil spots': areas of yellow-tan discoloration at the distal end of the nail plate
- often involves multiple fingernails &/or toenails
- fingernails involved more frequently than toenails [1]
- toenails may be yellow & thickened with subungual hyperkeratosis
- thickened hallux nails may grow over the edge of the toe & abrade skin of adjacent 2nd toe [2]
Complications:
- associated with psoriatic arthritis [1]
Differential diagnosis:
- see onychomycosis
Management:
- screen for psoriatic arthritis [1]
General
psoriasis
nail disease
References
- Medical Knowledge Self Assessment Program (MKSAP) 17, 19.
American College of Physicians, Philadelphia 2015, 2022
- Geriatric Review Syllabus, 9th edition (GRS9)
Medinal-Walpole A, Pacala JT, Porter JF (eds)
American Geriatrics Society, 2016
- Geriatric Review Syllabus, 11th edition (GRS11)
Harper GM, Lyons WL, Potter JF (eds)
American Geriatrics Society, 2022
- Jiaravuthisan MM, Sasseville D, Vender RB, Murphy F, Muhn CY.
Psoriasis of the nail: anatomy, pathology, clinical presentation,
and a review of the literature on therapy.
J Am Acad Dermatol. 2007 Jul;57(1):1-27. Review.
PMID: 17572277