Optical coherence tomography: a new tool to assess nail disease in psoriasis?

Abstract

Background: Nail disease is a characteristic manifestation of the psoriatic disease spectrum but is poorly understood.

Objective: Given the intrinsically high spatial resolution imaging capabilities of optical coherence tomography (OCT), we assessed its value in psoriatic nail disease compared to high-resolution ultrasonography (US).

Methods: All fingernails in a psoriatic arthritis patient with nail changes were scanned with OCT, and findings were compared with high-resolution US.

Results: US showed loss of trilaminar appearance in all nails, resulting in the nail plate being visualized as a single hyperechoic layer with inhomogeneous thickness. The OCT images showed much higher-resolution changes with prominent thickening in the ventral plate at the nail bed which was grossly inhomogeneous, 'eroded' and irregularly fused with the underlying epidermis, which correlated with the clinical observation of subungal hyperakeratosis.

Conclusion: OCT has considerable potential for the evaluation of psoriatic nail disease and may be superior to US.