Chauhan Ankita, Singal Archana, Grover Chander, Sharma Sonal
Department of Dermatology & STD, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, India.
Department of Pathology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, India.
Skin Appendage Disord. 2020 Jul;6(4):207-215. doi: 10.1159/000508165. Epub 2020 Jun 11.
Nail involvement in psoriasis occurs in up to 30-50% of patients, and 5-10% may have isolated nail disease. Onychoscopy, a noninvasive tool, might obviate the need for nail biopsy, which is a diagnostic gold standard.
The aim of this study was to evaluate onychoscopic features of nail unit in patients with nail psoriasis.
Fifty-five patients with clinically diagnosed and histologically documented nail psoriasis were recruited. Onychoscopy was performed for each nail (excluding the 5th toenail). Clinically, 443/550 fingernails and 101/440 toenails were involved. The frequency distributions of various onychoscopic features was assessed and compared using the χ test ( value <0.05 was considered significant).
With onychoscopy, additional 52 fingernails and 64 toenails showed psoriatic involvement. Pitting was the commonest finding in fingernails (60.5%) followed by subungual hyperkeratosis (SUH) (52.8%), onycholysis (40.8%), and dotted capillaries in hyponychium, proximal, and lateral nail folds (38.6 vs. 35.8 vs. 35.8%). In toenails, we observed SUH (85.1%), nail plate thickening (82.1%), onycholysis (77.2%), and dotted capillaries in hyponychium and nail folds (59.4 vs. 53.4 vs. 45.5%). Fuzzy lunula was a novel onychoscopic finding noted in 33.6% fingernails and 4.95% toenails ( < 0.00001).
Small sample size.
Onychoscopy may aid in diagnosing nail lesions even before the clinical signs are apparent.
银屑病累及指甲的情况在高达30%-50%的患者中出现，5%-10%的患者可能仅有指甲病变。甲下镜检查作为一种非侵入性工具，可能无需进行作为诊断金标准的指甲活检。
本研究旨在评估指甲银屑病患者指甲单位的甲下镜特征。
招募了55例临床诊断且经组织学证实的指甲银屑病患者。对每只指甲（不包括第五趾甲）进行甲下镜检查。临床上，550只手指甲中有443只、440只脚趾甲中有101只受累。使用χ检验评估和比较各种甲下镜特征的频率分布（P值<0.05被认为具有统计学意义）。
通过甲下镜检查，另外52只手指甲和64只脚趾甲显示有银屑病累及。点状凹陷是手指甲中最常见的表现（60.5%），其次是甲下过度角化（SUH）（52.8%）、甲剥离（40.8%）以及甲下、近端和外侧甲襞处的点状毛细血管（38.6%对35.8%对35.8%）。在脚趾甲中，我们观察到甲下过度角化（85.1%）、甲板增厚（82.1%）、甲剥离（77.2%）以及甲下和甲襞处的点状毛细血管（59.4%对53.4%对45.5%）。模糊甲半月是一种新的甲下镜表现，在33.6%的手指甲和4.95%的脚趾甲中出现（P<0.00001）。
样本量小。
甲下镜检查甚至在临床体征出现之前可能有助于诊断指甲病变。
