Psoriasis - Nail and Distal Digit
See also in: Overview,Anogenital,Hair and ScalpAlerts and Notices
Synopsis
The most common nail findings in psoriasis are pitting, nail plate yellowing, onycholysis, subungual hyperkeratosis, splinter hemorrhages, and "oil spots." Psoriasis may also involve the nail folds in the form of swelling and chronic paronychia. Toenail findings are less frequent than psoriatic changes in the fingernails. When they do occur, subungual hyperkeratosis and yellow discoloration of the nail plate are the predominant findings.
Pediatric Patient Considerations:
Nail psoriasis in children is associated with more severe disease in most studies. It may be more common in boys than girls. The prevalence of nail psoriasis in children is 15%-19%. Furthermore, psoriasis is believed to be the cause of 7%-40% of all nail dystrophies seen in children.
Codes
ICD10CM:L40.0 – Psoriasis vulgaris
SNOMEDCT:
9014002 – Psoriasis
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Onychomycosis
- Reactive arthritis (Reiter syndrome)
- Lichen planus
- Alopecia areata – Pits are generally more superficial and regular.
- Pachyonychia congenita
- Pityriasis rubra pilaris
- Idiopathic trachyonychia
- Other causes of onycholysis (eg, autoimmune diseases, medications, trauma)
- Atopic dermatitis – If there is eczema that involves the proximal nail folds, abnormalities in the nails may be seen, including coarse pits and nail dystrophy.
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:08/07/2022
Last Updated:07/08/2020
Last Updated:07/08/2020
Psoriasis - Nail and Distal Digit
See also in: Overview,Anogenital,Hair and Scalp