Differential Diagnosis for Nail Psoriasis

Nail involvement occurs in up to 50 % of patients with psoriasis. Although most patients experience concurrent skin involvement, 1–5 % of patients present with nail changes alone. In these patients, it can be diagnostically challenging, as psoriatic nail disease can resemble several other nail dystrophies. In this chapter, we describe the differential diagnoses for each classic signs of nail psoriasis including pitting, onycholysis, subungual hyperkeratosis, splinter hemorrhages, and oil spots

The Clinical Features of Nail Psoriasis

Nail involvement is present in over half of patients with psoriasis and consequently has a prominently negative impact on society. The clinical gamut of nail involvement is diverse and includes changes to the nail matrix, the nail bed, or both. The main nail matrix dystrophy is nail pitting while onycholysis, subungual hyperkeratosis, splinter hemorrhages, and oil-drop discoloration are the major nail bed findings. Lesions of the nail plate are due to the location of disease in the nail matrix as well as the duration of the disease. This chapter will describe the broad array of clinical features of nail psoriasis in order to help clinicians identify the condition, which will enable dermatologists to treat the symptoms and hopefully improve patients’ lives