Fast Five Quiz: Plaque Psoriasis Management

William James, MD


July 09, 2021

Figure 1. Plaque psoriasis.

Nail pitting is the most common symptom in psoriatic arthritis as well as the most common nail sign in psoriasis. Approximately 68% of patients with psoriasis and nail changes have pitting or superficial depressions within the nail plate.

Nail lesions are found in up to 80% of patients with PsA, and the presence of nail changes is a strong predictor of the development of arthritis. Nail pitting also correlates with disease activity in that the length of pits indicates time of the disease, whereas the length of the healthy nail between pits correlates with time free from psoriasis.

Nail psoriasis can involve the nail matrix (eg, pitting, trachyonychia, dystrophy, leukonychia) or the nail bed (eg, onycholysis, subungual hyperkeratosis, oil drop, splinter hemorrhages). The oil drop sign is produced by nail bed parakeratosis and psoriasiform hyperplasia, and it is the only nail symptom that is considered to be pathognomonic of nail psoriasis.

Onychomycosis can coexist with nail psoriasis but is not pathognomonic of psoriatic nail disease.

Learn more about the management of plaque psoriasis.


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