Patients with nail psoriasis can develop a wide variety of nail changes, such as pitting, onycholysis, subungual hyperkeratosis, and nail discoloration. In the absence of trauma or psoriasis, onycholysis should prompt a search for symptoms of hyperthyroidism. The finding of Beau’s lines may indicate previous severe illness, trauma, or exposure to cold temperatures in patients with Raynaud’s disease. This syndrome may be seen in patients with chronic bronchiectasis or sinusitis, pleural effusions, internal malignancies, immunodeficiency syndromes, and rheumatoid arthritis. Nail psoriasis is a common condition seen in about 10-78 of patients with psoriasis vulgaris and 70-80 of patients with psoriatic arthritis. Eight features of nail psoriasis have been identified for the NAPSI score: Four involve the nail matrix (pitting, leukonychia, red spots in the lunula, nail plate crumbling) and four of the nail bed (onycholysis, splinter hemorrhages, subungual hyperkeratosis, oil spot/salmon patch).
Psoriatic nail disease can be difficult to treat and severe nail changes can severely affect quality of life. Characteristic nail changes include pitting (small irregularly spaced depressions measuring less than 1 mm in diameter), discolouration (circular areas resembling an oil drop), subungual hyperkeratosis, crumbling of the nail plate and onycholysis (separation of the nail plate from the nail bed). The biological therapies adalimumab, efalizumab, etanercept, infliximab and ustekinumab have shown clinically important nail psoriasis improvements using the Nail Psoriasis Severity Index. Nail changes are often seen, with pitting, onycholysis, subungual hyperkeratosis, or the oil-drop sign (yellow-red discolouration of the nail bed looking like a drop of oil beneath the nail). The Nail Psoriasis Severity Index (NAPSI) is a numeric, reproducible, objective, simple tool for evaluation of nail psoriasis.
Nail Psoriasis Symptoms and Signs. Little pits in the nails or pitting of the nail matrix. Nail psoriasis. Psoriasis can affect fingernails and toenails, causing pitting, abnormal nail growth and discoloration. Pitting of the nails the surface of the nail develops small pits, looking rather like the surface of a thimble. Discolouration this may be seen as unusual nail colouration, such as yellow-brown.
Psoriatic Nail Disease. Free Professional Reference
Nail psoriasis involvement is associated with significant physical and psychological consequences for a substantial number of psoriasis patients. Commonly seen on fingernails than on toenails (2). The symptoms of nail psoriasis and nail fungus are similar. Telling the two conditions apart is important so that you can treat your condition. When you have discoloration, pitting, or cracking of your nails, you should probably seek a medical opinion. That’s especially important if you have psoriasis or diabetes. If you have psoriasis and you notice some changes in your nails, there are many treatments you can turn to for help. Nail psoriasis alters the way your toenails and fingernails look. You may get ridges or grooves in your nails, or pitting (small pinprick holes) on the nail surface. There are many abnormal nail findings in Psoriatic nails and they depend on the exact location of the Psoriatic involvement in the nail. Horizontal indentations called Beau’s Lines can be seen in the nail plate due to temporary arrest of the nail plate growth. The symptoms of psoriatic arthritis are similar to those of three other arthritic diseases: rheumatoid arthritis, gout and reactive arthritis. The simultaneous presence of psoriasis on the skin and nail changes supports a diagnosis of psoriatic arthritis. Nail Pitting. Non-specific sign for psoriasis (additional signs include onycholysis, thickening, and ‘oilspot’ lesions which are yellow patches on the nail).