Piraccini Bianca Maria, Starace Michela
Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
Psoriasis (Auckl). 2015 Jan 9;5:25-33. doi: 10.2147/PTT.S55338. eCollection 2015.
Psoriasis is a common skin disease, with nail involvement in approximately 80% of patients. Nail psoriasis is often associated with psoriatic arthropathy. Involvement of the nails does not always have relationship with the type, gravity, extension, or duration of skin psoriasis. Nail psoriasis can occur at any age and all parts of the nails and the surrounding structures can be affected. Two clinical patterns of nail manifestations have been seen due to psoriasis: nail matrix involvement or nail bed involvement. In the first case, irregular and deep pitting, red spots of the lunula, crumbling, and leukonychia are seen; in the second case, salmon patches, onycholysis with erythematous border, subungual hyperkeratosis, and splinter hemorrhages are observed. These clinical features are more visible in fingernails than in toenails, where nail abnormalities are not diagnostic and are usually clinically indistinguishable from other conditions, especially onychomycosis. Nail psoriasis causes, above all, psychosocial and aesthetic problems, but many patients often complain about functional damage. Diagnosis of nail psoriasis is clinical and histopathology is necessary only in selected cases. Nail psoriasis has an unpredictable course but, in most cases, the disease is chronic and complete remissions are uncommon. Sun exposure does not usually improve and may even worsen nail psoriasis. There are no curative treatments. Treatment of nail psoriasis includes different types of medications, from topical therapy to systemic therapy, according to the severity and extension of the disease. Moreover, we should not underestimate the use of biological agents and new therapy with lasers or iontophoresis. This review offers an investigation of the different treatment options for nail psoriasis and the optimal management of nail disease in patients with psoriasis.
银屑病是一种常见的皮肤病，约80%的患者会累及指甲。甲银屑病常与银屑病关节炎相关。指甲受累情况并不总是与皮肤银屑病的类型、严重程度、范围或病程相关。甲银屑病可发生于任何年龄，指甲的所有部位及周围结构均可受累。银屑病导致的指甲表现有两种临床模式：甲母质受累或甲床受累。在第一种情况下，可见不规则且深陷的凹点、半月痕红斑、甲脆裂和白甲；在第二种情况下，可观察到鲑鱼色斑、边缘有红斑的甲分离、甲下角化过度和裂片形出血。这些临床特征在手指甲上比在脚趾甲上更明显，脚趾甲的异常表现不具有诊断性，通常在临床上与其他疾病难以区分，尤其是甲癣。甲银屑病首先会引发心理社会和美观问题，但许多患者常抱怨有功能损害。甲银屑病的诊断依靠临床判断，仅在特定情况下才需要组织病理学检查。甲银屑病的病程不可预测，但在大多数情况下，该病为慢性，完全缓解并不常见。日晒通常不会改善甲银屑病，甚至可能使其恶化。目前尚无治愈方法。根据疾病的严重程度和范围，甲银屑病的治疗包括从局部治疗到全身治疗的不同类型药物。此外，我们不应低估生物制剂以及激光或离子导入等新疗法的作用。本文综述了甲银屑病的不同治疗选择以及银屑病患者甲病的最佳管理方法。
