babli
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An 8-year-old boy has had a rash on his distal fingers for a few months, and the cuticles are becoming progressively worn. The boy constantly picks at the dried skin, causing frequent bleeding. At one point, the skin became infected, for which a course of an antibiotic was given. The boy is otherwise healthy and does not take any medications. Examination reveals erythematous and scaling plaques around the cuticles and on the distal fingers. Multiple small pits can be seen on the fingernails, and the distal nail is slightly separated from the nail bed. The remainder of the examination is unremarkable.
What is your diagnosis?
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| Jinx
Forum Elite
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Psoriasis
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| Banti
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The patient has psoriasis. Nail abnormalities associated with psoriasis are seen in up to 55% of adults and 13% of children. Such findings may be the only manifestation of psoriasis and may include pitting, onycholysis (detachment of the nail plate from the nail bed), discoloration of the nail bed, subungual hyperkeratosis, and splinter hemorrhage. Chronic paronychia may occur in conjunction with nail psoriasis.
The differential diagnosis for these findings includes contact dermatitis and onychomycosis. Appropriate cultures and testing can aid in the diagnosis. Psoriatic nails are the most difficult cutaneous feature of psoriasis to treat. Ultra-high potency steroid ointments may be beneficial. Steroid lotions-applied under the nail-may also be effective. On occasion, intralesional injections of steroid have been used with limited success.
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| frontal
Forum Guru
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Stable plaque psoriasis.
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| aml
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PSORIASIS
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| babli
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http://www.emedmag.com/html/pre/dia/04_01.asp
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