A study of dermoscopic features of nail psoriasis

Abstract

IntroductionDermoscopy is a non-invasive imaging method that enables the evaluation of pigmented and non-pigmented skin lesions. More recently, dermoscopy has been recognized as an effective tool in the diagnosis of nail diseases.AimTo evaluate the dermoscopic features of nail psoriasis and to assess the relationship between these features and disease severity.Material and methodsA total of 67 patients with clinically evident nail psoriasis (14 women, 53 men) were prospectively enrolled. Following a thorough clinical examination, patients were graded according to the Nail Psoriasis Severity Index and physician’s global assessment score. A dermoscopic examination of all fingernails and toenails was performed using a videodermatoscope. Mann-Whitney U and χ2 tests were used for statistical analysis, with a significance threshold of p < 0.05.ResultsThe most frequently observed dermoscopic features were splinter haemorrhage (73.1%), pitting (58.2%), distal onycholysis (55.2%), dilated hyponychial capillaries (35.8%) and the pseudo-fiber sign (34.3%). The pseudo-fiber sign, dilated hyponychial capillaries, nail plate thickening and crumbling, subungual hyperkeratosis, transverse grooves, trachyonychia, pitting and salmon patches were positively associated with disease severity.ConclusionsThe pseudo-fiber sign described in this study appears to be a novel dermoscopic feature of nail psoriasis. We have demonstrated positive associations between a number of dermoscopic manifestations and disease severity. Further studies are required to support the present findings.

Dermoscopic features of psoriasis of the skin, scalp and nails – a systematic review

“…The frequency of onychoscopic features was analysed in two studies, including 68 and 67 patients, respectively. 41,42 In the study by Yadav et al 41 , subclinical onychoscopic changes were found in 46 of 68 patients with psoriasis vulgaris. Coarse pits/pitting constituted the most common onychoscopic feature indicating nail matrix involvement, while the most common onychoscopic feature indicating nail bed involvement was splinter haemorrhages.…”

“…Coarse pits/pitting constituted the most common onychoscopic feature indicating nail matrix involvement, while the most common onychoscopic feature indicating nail bed involvement was splinter haemorrhages. 41,42 Detailed data on onychoscopy in nail psoriasis are shown 43,44 Capillaries of the hyponychium described by Iorizzo et al 45 were visible in all digits and were described as dilated, tortuous, elongated and irregularly distributed. Capillary density correlated positively with disease severity.…”

A novel dermoscopic feature in traumatic onycholysis

“…In our opinion, red and black filamentous structures, that we detected on dermoscopy, correspond to subungual capillary remnants of this complex microvasculature. In a recent study, it has been demonstrated that identical dermoscopic features are found in nail bed psoriasis [11]. Nail psoriasis is characterized by increased hyponychial capillary density.…”

“…Nail psoriasis is characterized by increased hyponychial capillary density. Dilated, tortuous hyponychial capillaries are found in psoriatic patients [11,12]. Traumatic onycholysis is another nail disorder, in which damaged capillaries are exposed in the hyponychial area.…”

Dermoscopy in facilitating the recognition of acrodermatitis continua of Hallopeau

“…2 Of note, the usefulness of dermoscopy in recognizing ACH is further emphasized by the fact that similar conditions entering into the differential diagnosis typically show different dermoscopic features, including: (i) onychomycosis, commonly featuring chromonychia, onycholysis having a jagged proximal edge with spikes, opacity and longitudinal striae; 3 (ii) nail lichen planus, which is mainly characterized by chromonychia, trachyonychia, nail plate fragmentation and longitudinal streaks; 4 (iii) acral hand eczema, classically showing yellowish scales, brownish-orange dots/globules and yellowishorange crusts; 2 and (iv) psoriatic onychopathy, which frequently displays distal splinter hemorrhages, pits surrounded by a peripheral whitish halo and distal onycholysis encircled by an erythematous border. 5 In conclusion, dermoscopy may help highlight the typical pustules of ACH, even when they are scarcely visible on clinical grounds, thereby increasing the index of suspicion for such a condition. This may particularly come in handy for clinicians who are not very familiar with this rare disease, thus potentially reducing diagnostic mistakes/delays which may have a relevant impact on possible long-term destructive sequelae.…”