Nail Psoriasis

Excerpt

Psoriasis is a common chronic inflammatory skin condition; however, a subtype of psoriasis can include nail involvement, systemic involvement (eg, joints), or both nail and systemic involvement; nail psoriasis can be the first presentation of cutaneous psoriasis, a sequela of cutaneous psoriasis, or a concurrent presentation of psoriasis. Psoriatic involvement of the nail bed or nail matrix is the purported cause of nail psoriasis. Nail involvement is a visible indicator to predict concomitant or future inflammatory joint activity, most prominently in the distal interphalangeal joint, where psoriatic arthritis classically presents.

Nail psoriasis can manifest clinically as a wide variety of nail changes, like nail discoloration (eg, oil drops), subungual hyperkeratosis, pitting (ie, punctate nail depressions), and onycholysis (ie, distal nail plate separation from nail bed), depending on the part of the nail unit affected (see Image. Nail Psoriasis). Patients with nail psoriasis may have impaired quality of life due to the appearance of their nails, and significant morbidity and functional impairments may arise in some cases. Nail psoriasis management is challenging since prolonged treatment is required and may not be able to control disease activity entirely. Educating patients on the prognosis and outcomes of treatment is most important to set expectations and prepare for a successful treatment approach.