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Year : 1995  |  Volume : 61  |  Issue : 3  |  Page : 182-183

Psoriasis and nail involvement

Correspondence Address:
Raj Narayan

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Source of Support: None, Conflict of Interest: None

PMID: 20952948

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How to cite this article:
Narayan R, Kar H K, Gautam R K, Jain R K, Bagga G R. Psoriasis and nail involvement. Indian J Dermatol Venereol Leprol 1995;61:182-3

How to cite this URL:
Narayan R, Kar H K, Gautam R K, Jain R K, Bagga G R. Psoriasis and nail involvement. Indian J Dermatol Venereol Leprol [serial online] 1995 [cited 2020 Feb 20];61:182-3. Available from: http://www.ijdvl.com/text.asp?1995/61/3/182/4201

  To the Editor, Top

The association of psoriasis with inflammatory polyarthritis has been recognized since long.[1] Nail involvement has been reported more frequently when psoriasis is complicated by arthritis (81%) than when it is not (31%). Furthermore, nail changes always occur in patients who have involvement of the terminal interphalangeal (TIP) joints.[2][3][4]

We saw a 28-year-old female who had swelling, pain and stiffness of most TIP joints of both hands for the past seven months. The pain and swelling were intially noticed in both ring fingers and two weeks later in the other TIP joints along with stiffness of both the fingers. After another fortnight, she noticed a slight brownish discolouration of the nail plates of the corresponding fingers which was followed by progressive nail changes leading to gross dystrophy. There was no history of skin lesions, drug intake or any illness prior to the onset of disease.

Examination revealed swollen TIP joints of both hands except the middle finger of the right hand and both little fingers. The affected nails showed pitting, longitudinal striations brownish discolouration and dystrophy. The results of investigations were within normal limits except for the X-ray of both hands which showed a soft tissue swelling and lytic lesions with periosteal reaction on the ulnar side of the base of the distal phalanx of the thumb. There were multiple erosions at the base of the distal and proximal phalanges.

The diagnosis of psoriasis was made entirely on clinical grounds and was aided by the radiological changes. Rheumatoid arthritis and onychomycosis were excluded by a negative rheumatoid factor and the absence of fungus in a KOH preparation.

Nail changes in psoriasis may vary from mild pitting to gross destruction of the nail plate. Interestingly these may not be related to the distribution of joint involvement.[4] In our case, there was arthritis affecting the TIP joint accompanied by nail changes of the corresponding digits. The sparing of nails of the fingers not affected by arthritis is in contrast to the findings of Baker et al[4] who observed that TIP joint involvement and nail disease is the "exception rather than the rule". Our findings support the widespread belief that there may be a direct causal relationship between TIP joint involvement and adjacent nail dystrophy probably because of inflammatory changes extending from nail matrix to the synovium of adjacent joints. The association of arthritis of the TIP joints with nail changes of the same digit in the absence of skin lesions of psoriasis is quite intriguing. Finally, one must follow such patients to ascertain the nature of skin disease whenever cutaneous lesions appear.

  References Top

1.Gribble MDE. Rheumatoid arthritis and psoriasis. Ann Rheum Dis 1955;14:198.  Back to cited text no. 1    
2.Sherman MS. Psoriatic arthritis: Observation on the clinical, roentgenographic, and pathological changes. J Bone Jt Surg 1952;34:83.  Back to cited text no. 2  [PUBMED]  
3.Wright V. Psoriasis and arthritis. Br J Dermatol 1957;69:1-10.  Back to cited text no. 3  [PUBMED]  
4.Baker H, Golding DN, Thompson M. The nails in psoriatic arthritis. Br J Dermatol 1964;76:549-54.  Back to cited text no. 4  [PUBMED]  


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