Evaluation of Subclinical Nail changes in Patients with Chronic Plaque Psoriasis using Dermoscopy

Abstract Background Dermoscopy is a non-invasive technique that allows the visualization of subtle clinical features of the skin surface and appendages details not visible to the naked eye, allowing magnifications of up to 200x. It is widely used for evaluating and diagnosing all nail diseases, as it provides important information. As any other examination, nail dermoscopy (onychoscopy) requires a good knowledge of nail anatomy & physiology and the pathogenesis of the nail diseases, and it is helpful for the diagnosis of numerous nail diseases and tumors. Nail disorders are defined according to their appearance and the part of the nail affected (from distal to proximal): hyponychium, onychodermal band (ODB), nail bed, nail plate, lateral nail folds (perionychium), lunula (distal part of the matrix), cuticle, nail matrix and proximal nail fold. Objective To study the dermoscopic findings of subtle nail changes in patients with chronic plaque psoriasis and compare it with that nail changes in healthy controls by both polarized and non polarized mode of dermoscope, aiming to assist clinicians in correctly evaluating and diagnosing nail changes with the help of dermoscopy. Methods We conducted a comparative descriptive study on 50 patients having chronic plaque psoriasis, 26 were males (52.0%) and 24 were females (48.0%), as well as 50 normal healthy control subjects, 31 were males (62.0%) and 19 were females (38.0%). Patients and controls were randomly recruited from the outpatient clinic of dermatology department at Ain Shams University Hospitals, during the period from February 2018 till September 2018. And the age of both groups ranged from 14 to 70 years. Results Our study revealed that the most common fingernail changes found in psoriatic patients were nail plate thickening and crumbling followed by Dilated nailbed capillaries at the onychodermal band, Oncholysis, Subungual hyperkeratosis, Pitting, Longitudinal ridges, Scales, Salmon patch, Leukonychia, Splinter hemorrhage, Lunula red spot and Trachyonychia. And the most common toenail changes found in psoriatic patients were Subungual hyperkeratosis followed by Nail Plate Thickening &Crumbling, Oncholysis, Pitting, Longitudinal ridges, Scales, Salmon patch, Trachyonychia, Dilated nailbed capillaries at the onychodermal band, Splinter hemorrhage, Leukonychia and Lunula red spot. We found there was no difference between polarized and non polarized mode of dermoscope in examination of fingernails and toenails except that the non polarized mode showed the changes of the Dilated capillaries at the onychodermal band more obviously. And also, there was no difference between wet and dry method of polarized mode of dermoscope. Conclusion This study confirms that a handheld dermoscope is a very efficient and simple tool for detection of any nail abnormality.

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Oral PUVA Versus Bath PUVA in Chronic Plaque Psoriasis: A Comparative Study of Efficacy

Revista da Sociedade Portuguesa de Dermatologia e Venereologia ◽

10.29021/spdv.76.2.889 ◽

2018 ◽

Vol 76 (2) ◽

pp. 165-168

Author(s):

Katarina Kieselova ◽

Felicidade Santiago ◽

Martinha Henrique

Keyword(s):

Side Effects ◽

Plaque Psoriasis ◽

Systemic Treatment ◽

P Value ◽

Chronic Plaque Psoriasis ◽

Dermatology Department ◽

Uva Irradiation ◽

Specialized Equipment ◽

The Mean

Introduction: Phototherapy has long been recognized as beneficial for psoriasis treatment, with a favorable risk- -benefit relation. Photochemotherapy comprises the use of psoralen, either orally (oral PUVA) or topically (bath PUVA), prior to UVA irradiation. Oral administration of psoralen may lead to short or long-term side effects. Bath PUVA is particularly useful to minimize systemic toxicity and psoralen side effects. The aim of this study was to compare the effectiveness of these two PUVA modalities.Material and Methods: A retrospective review of patients with chronic plaque psoriasis treated with PUVA therapy (oral and bath) in our dermatology department, between January 2001 and December 2016.Results: We performed 81 treatments with oral PUVA and 38 treatments with bath PUVA, in 68 and 26 patients, respectively. The mean age of the patients was 50,6 years. Oral PUVA group achieved PASI 75 in 68 cases (89.5%), and bath PUVA group in 26 (74.3%), with p-value=0 .05. The mean total dose needed to achieve PASI 75 in the oral PUVA group was 113.1 J/cm2 and in the bath PUVA group was 69.8 J/cm2. The mean number of sessions performed to achieve remission in the oral PUVA group was 23.31, and in the bath PUVA group was 17.58.Conclusion: Despite requiring specialized equipment and being more time consuming, bath PUVA represents one of the most effective therapies available for psoriasis and it should be considered as a treatment option for patients who are not candidates for systemic treatment.

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NAIL VARIATIONS IN PAPULO-SQUAMOUS DISORDERS: A CLINICAL INVESTIGATION

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i9.2225 ◽

2021 ◽

Vol 5 (9) ◽

Author(s):

Rajeev Kumar Singh ◽

Sanjeev Kumar Varshney

Keyword(s):

Lichen Planus ◽

Clinical Investigation ◽

Systemic Disease ◽

Central India ◽

Malignant Tumours ◽

Dermatology Department ◽

Nail Diseases ◽

Nail Changes ◽

Environmental Agents ◽

Tertiary Healthcare

Background: Nail diseases account for about 10% of all dermatological conditions. Any abnormality that affects any part of the nail unit is classified as a nail condition. The plate, matrix, bed, proximal and lateral folds, hyponychium, and underlying distal phalanx are all part of the nail unit. Heredity, skin problems, infections, systemic disease, and the ageing process, as well as internal and external drugs, physical and environmental agents, trauma, and benign and malignant tumours, can all affect these tissues. Papulo-squamous disorder is one of the main causes. Nail changes in Papulo-squamous disease have received insufficient attention, with only a few research available. Aims & Objectives: This study attempts to shed some information on the frequency and patterns of nail involvement in Papulo-squamous illnesses. Methodology: This is a descriptive research project. Over the course of two years, it was conducted at the dermatology department of a tertiary healthcare centre in central India. Examinations of the general, systemic, and dermatological systems were performed. The nails were meticulously examined. In pertinent cases, special examinations such as skin biopsy and potassium hydroxide (KOH) mount were performed. Results: Papulo-squamous disorder affected 100 people. Psoriasis was the most frequent Papulo-squamous condition, followed by lichen-planus and PRP. Pitting was the most prevalent nail alteration (81%) while dorsal pterygium was the least common. Conclusion: The nail is an important appendage that affects a variety of dermatoses and serves as a diagnostic window. Knowing the normal and abnormal variations, as well as their relationship to various Papulo-squamous illnesses, aids not only in diagnosis but also in treatment. Key words: Papulo-squamous disorder, nail changes, psoriasis, lichen-planus.

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