Clubbing/Pseudoclubbing only in Fingernails Previously Affected by Psoriasis

Abstract

We report a case of fingernails clubbing in a 55-year-old man suffered since the age of 40 from cutaneous psoriasis. The patient had no clubbing before and had no familial cases of clubbing. Cardiological and pneumological visits revealed no abnormalities. All laboratory tests were within normal limits and X-rays excluded the presence of pachyodermoperiostosis. We made the diagnosis of atypical clubbing exclusively in the fingernails previously affected by psoriasis. It may be that a common mechanism lies at the root of these two phenomena.The patient had no enlargement of the distal phalanx before (unfortunately we don't have photo) and had no familial cases of clubbing. Cardiological and pneumological visits revealed no abnormalities. All laboratory tests were within normal limits. The patient underwent X-rays that excluded the presence of pachyodermoperiostosis. Capillaroscopy of the fingers with the enlargement of the distal phalanx showed alterations in the capillarity pattern like splayed and arborized loops and plexus. We made the diagnosis of clubbing/pseudoclubbing exclusively in the fingernails previously affected by psoriasis. Till now the ACH has been treated with acitretina 25 mg daily with good results but the enlargement of the distal phalanx persists at the 6 months follow-up visit. DiscussionThe mechanism for the development of clubbing is not clear, and several hypotheses have been proposed. Brouwers et al. hypothesized