Ways to increase the effectiveness of treatment of psoriasis patients with dystrophic lesions of the nail plates

Objective — to increase the effectiveness of treatment of psoriasis patients with degenerative changes in the nails, by including in the complex therapy of the topical drug Onychocid® Emtrix, aimed at restoring the integrity of the nail plates. Materials and methods. 38 patients with psoriasis and various forms of onychodystrophy (OD) were examined and treated. The effectiveness of therapy was evaluated based on the results of treatment of patients who were divided into two clinical groups — the main and the comparison ones. Patients in both groups received basic therapy. In addition, patients of the main group were prescribed a combined drug Onychocid® Emtrix, which was applied on the nail plates and under the tips of damaged nails once a day for 3 – 6 months. Results and discussion. Patients with psoriasis are diagnosed with dystrophic changes of nail plates of varying severity. OD of the fingers only was detected in 14 (36.8 %) patients; toes — in 5 (13.2 %); fingers and toes at the same time — in 19 (50.0 %) patients. As a result of complex treatment, in patients of the main group there was an early (already on the 2—4th week of use of the drug Onychocid® Emtrix) improvement of the appearance of deformed nails. After the course of treatment, these patients showed a positive clinical effect, i. e. decrease in thickness, normalization of density, color and structure of nail plates. At the same time, «significant improvement» and «improvement» were noted in 34 (89.5 %), «slight improvement» — in 3 (7.9 %), «no improvement» — in 1 (2.6 %) patients. Conclusions. Treatment of psoriasis patients with dystrophic nail lesions should be complex and focused, including the restoration of the integrity of the nail plates. The inclusion in the complex therapy of patients with psoriatic OD of the combined drug Onychocid® Emtrix increases the effectiveness of treatment, in particular, helps to restore the structure, shape, integrity, thickness and color of the nail plates.

Familial median canaliform dystrophy of heller affecting multiple nails: a rare clinical entity

<p class="abstract">Median canaliform dystrophy (MCD); first described by Heller in 1928 is characterized by a midline or paramedian split in the nail plate. Mostly idiopathic, some identifiable causes include habitual picking of the nails, oral isotretinoin use and positive family history. The familial occurrence of MCD has rarely been described. Till date, no therapy has proven to be consistently successful in effectively managing the condition. Commonly utilized treatments have been intralesional triamcinolone acetonide injections into the dystrophic nail, topical 0.1% tacrolimus ointment and topical tazarotene 0.05% ointment. Despite available treatment options, the condition has a tendency to recur. Here; we report a case of a 14‑year‑old male presenting with familial MCD affecting multiple finger and toe nails.</p>

Mortality trends in a Cohort of Canadian Psoriatic Arthritis Patients

Methods: We reviewed retrospectively the charts of psoriatic arthritis patients who died from 1995-2010.We included 13 deceased patients with a psoriatic arthritis di-agnosis and compared them with 140 patients living with psoriatic arthritis that at-tend the same clinic. The population was derived from a single academic rheumatol-ogist’s practice in St. John’s, Newfoundland, Canada. Patients are seen at six-month intervals with a history and physical exam performed at each visit. Laboratory data was collected at each visit. Diagnosis of psoriatic arthritis is based on the CASPAR Classifcation and Diagnostic Criteria for Psoriatic Arthritis. Results: The mean age of the 13 deceased patients was 62.9 years. Of these, 38.5% were female and 85.7% had an erythrocyte sedimentation rate greater than 15 mm/hour vs. 36.4% of patients living with psoriatic arthritis. Of deceased patients, 16%had dystrophic nail changes of vs. 59.6% of living patients. Health Assessment Questionnaire was found to show a signifcantly greater loss in function in deceasedpatients. (1.39 vs. 0.70, p= 0.002). Almost half of the deceased patients had used Prednisone (46.2%) as opposed to 11.2% of living patients. Conclusions: We realize that this study employs a small sample size. Increased ESR and Health Assessment Questionnaire score were found to be associated with mor-tality in psoriatic arthritis patients. Dystrophic nail changes were found to be pro-tective for psoriatic arthritis patients.

Psoriatic onychodystrophy: clinical manifestations (part 1)

Psoriatic onychodystrophy is quite common in patients with psoriasis. Changes in psoriatic nails have a wide range of clinical manifestations, including symptoms of damage of the nail bed and/or nail matrix. The article presents information about clinical and pathological manifestations of psoriatic onychodystrophy, the mechanisms of formation of pathological changes. The existence of the relationship between the change of nail plates in patients with psoriasis and the development of psoriatic arthritis is explained, the prognostic value of individual symptoms is analyzed. The diagnostic criteria for the histological diagnosis of psoriatic onychodystrophy are described. The information about the occurrence of each symptom in patients with psoriasis with dystrophic nail changes is given.

NAIL DYSTROPHY IN PSORIATIC ARTHRITIS PRESENTING AS NAIL ONYCHOMYCOSIS: A CASE REPORT

Dystrophic nail changes without a skin lesion is a rare form of psoriasis. We describe a patient that presented with a chronic nail onychomycosis and a destructive thumb interphalangeal joint which was initially considered as onychomycotic joint infection, and was later diagnosed as having dystrophic nail changes in psoriatic arthritis and coexistent onychomycosis. The nail changes were completely normalized after methotrexate treatment.

Perinatal Manifestations of Maternal Yellow Nail Syndrome

A term female firstborn infant had unexplained nonimmune fetal hydrops and recurrent left chylothorax at 4 weeks of age. A few months before conception, her mother had had acute dystrophic nail changes and is being treated for recurrent sinusitis, bronchiectasis, and a deficiency of serum IgG2. We suggest that they both suffer from a dominantly inherited congenital lymphedema syndrome known as `yellow nail dystrophy.' Prenatal manifestation of this disorder has not been reported previously. The child's anthropometric and neurological development was normal at 1 year of age, whereas mild ankle edema and marbling of the skin of the limbs were salient clinical findings. Inherited lymphedema leading to nonimmune fetal hydrops also has been recognized in chromosomal disorders, Noonan's syndrome, multiple pterygium syndrome, pulmonary lymphangiectasis, and mixed-vessel lymphatic dysfunction. Indicators of parental lymphedema are not on record in those instances.