NAIL PSORIACIC

DESCRIPTION

• Psoriasis is auto-immune chronic disease. 
• Symptoms can vary from mild to severe.
• Nail psoriasis also known as psoriatic nail dystrophy. It is due to psoriasis involving the nail matrix resulting in specific and non-specific changes occur in the nail.
• Usually skin cells reproduce every 28–30 days. 
• When people has plaque psoriasis their immune system is overactive and causes cells to reproduce every 3–4 days. As a result visible sections of skin are thick, red, and itchy.

SIGNS OF NAILS PSORIATIC

• pitting, which involves dents or holes forming in the nail
• white spots on the nail
• grooves across the nail
• a change in the nail’s shape or size
• thickening of the nail
• separation of the nail from the nail bed
• crumbling nails
• discoloration, in which the nail may become yellow or brown, for example
• blood under the nail

CLINICAL SIGNS OF NAIL BED INVOLVEMENT

• Oil-drop sign and salmon patch
• Onycholysis 
• Subungual hyperkeratosis
• Splinter haemorrhages under the distal third of the nail plate
  

OTHER CLINICAL SIGNS OF PSORIATIC NAILS

• Paronychia due to periungual psoriasis
• Acrodermatitis continua of Hallopeau
• Twenty-nail dystrophy

WHAT ARE THE COMPLICATIONS OF NAIL PSORIASIS?

• Secondary onychomycosis in the damaged nail plate
• Psychosocial effects impacting social relationships and work-related activities
• Association with psoriatic arthritis and metabolic syndrome.
  

WHAT IS THE DIFFERENTIAL DIAGNOSIS FOR NAIL PSORIASIS?

• Onychomycosis
• Nail trauma
• Lichen planus of the nail
• Parakeratosis pustulosa
  

WHAT IS THE TREATMENT FOR NAIL PSORIASIS?

General measures

• Minimise nail trauma, keep affected nails short
• Treat associated onychomycosis first for at least three months

Specific measures

Topical treatments

• Topical steroids — betamethasone dipropionate, clobetasol propionate
• Topical calcipotriol
• Topical calcineurin inhibitors
  

Systemic treatments

• Methotrexate
• Acitretin
• Biological agents for psoriasis — infliximab, adalimumab, etanercept, ustekinumab
• Novel small molecules — apremilast, tofacitinib
  

Nonpharmacological treatments

• Phototherapy
• Lasers
• Photodynamic therapy
  

PREVENTION OF NAIL PSORIASIS

• Keep your nails trimmed short.
• Use a nail file to keep nail edges smooth.
• Wear gloves to clean and do other work with your hands.
• Moisturize your nails and cuticles every day and after they’ve been in contact with water.
• Wear comfortable shoes with enough room for your toes.