ABSTRACT
Nail involvement in psoriasis is common. It is seen in up to 80% of patients with psoriatic lesions and may be the only manifestation in 6% of cases. Nail psoriasis is correlated with more severe disease, characterized by earlier onset and a higher risk of psoriatic arthritis. Accordingly, it can also result in significant functional impairment and reduced quality of life. Psoriasis involving the nail matrix causes pitting, leukonychia, red lunula and nail dystrophy, while nail bed involvement causes splinter hemorrhages, onycholysis, oil spots (salmon patches), and subungual hyperkeratosis. Common evaluation tools are the Nail Psoriasis Severity Index (NAPSI), the modified NAPSI, and the f-PGA (Physician's Global Assessment of Fingernail Psoriasis). Treatment options include topical therapy, intralesional injections, and systemic and biologic agents. Treatment should therefore be assessed on an individualized basis according to the number of nails involved, the part of the nail or nails affected, and the presence of concomitant nail and/or joint involvement.
Subject(s)
Arthritis, Psoriatic , Nail Diseases , Psoriasis , Arthritis, Psoriatic/complications , Humans , Nail Diseases/diagnosis , Nail Diseases/etiology , Nail Diseases/therapy , Nails , Psoriasis/complications , Psoriasis/drug therapy , Psoriasis/pathology , Quality of Life , Severity of Illness IndexABSTRACT
La psoriasis ungueal puede afectar al 80% de los pacientes con psoriasis cutánea y puede ser la única manifestación en el 6% del total. Además, se correlaciona con una enfermedad psoriásica más grave, con un inicio más precoz y con una mayor probabilidad de desarrollar artritis psoriásica. Todo ello hace que se asocie a un importante deterioro funcional y a una disminución de la calidad de vida. La psoriasis ungueal que afecta la matriz puede causar piqueteado/pitting, leuconiquia, manchas rojas en la lúnula o distrofia de la lámina, mientras que la afectación del lecho causa hemorragias en astilla, onicólisis, manchas de aceite o salmón e hiperqueratosis subungueal. Los métodos de evaluación comunes son las escalas NAPSI, NAPSI modificada o f-PGA. Actualmente, disponemos de tratamientos tópicos, intralesionales, sistémicos y biológicos, por lo que deberá individualizarse según el número de uñas implicadas, la zona ungueal afectada y la presencia de afectación cutánea y/o articular (AU)
Nail involvement in psoriasis is common. It is seen in up to 80% of patients with psoriatic lesions and may be the only manifestation in 6% of cases. Nail psoriasis is correlated with more severe disease, characterized by earlier onset and a higher risk of psoriatic arthritis. Accordingly, it can also result in significant functional impairment and reduced quality of life. Psoriasis involving the nail matrix causes pitting, leukonychia, red lunula and nail dystrophy, while nail bed involvement causes splinter hemorrhages, onycholysis, oil spots (salmon patches), and subungual hyperkeratosis. Common evaluation tools are the Nail Psoriasis Severity Index (NAPSI), the modified NAPSI, and the f-PGA (Physician's Global Assessment of Fingernail Psoriasis). Treatment options include topical therapy, intralesional injections, and systemic and biologic agents. Treatment should therefore be assessed on an individualized basis according to the number of nails involved, the part of the nail or nails affected, and the presence of concomitant nail and/or joint involvement (AU)
Subject(s)
Humans , Nail Diseases , Psoriasis , Nail Diseases/epidemiology , Nail Diseases/etiology , Nail Diseases/therapy , Psoriasis/epidemiology , Psoriasis/etiology , Psoriasis/therapy , Risk FactorsABSTRACT
Nail involvement in psoriasis is common. It is seen in up to 80% of patients with psoriatic lesions and may be the only manifestation in 6% of cases. Nail psoriasis is correlated with more severe disease, characterized by earlier onset and a higher risk of psoriatic arthritis. Accordingly, it can also result in significant functional impairment and reduced quality of life. Psoriasis involving the nail matrix causes pitting, leukonychia, red lunula and nail dystrophy, while nail bed involvement causes splinter hemorrhages, onycholysis, oil spots (salmon patches), and subungual hyperkeratosis. Common evaluation tools are the Nail Psoriasis Severity Index (NAPSI), the modified NAPSI, and the f-PGA (Physician's Global Assessment of Fingernail Psoriasis). Treatment options include topical therapy, intralesional injections, and systemic and biologic agents. Treatment should therefore be assessed on an individualized basis according to the number of nails involved, the part of the nail or nails affected, and the presence of concomitant nail and/or joint involvement (AU)
La psoriasis ungueal puede afectar al 80% de los pacientes con psoriasis cutánea y puede ser la única manifestación en el 6% del total. Además, se correlaciona con una enfermedad psoriásica más grave, con un inicio más precoz y con una mayor probabilidad de desarrollar artritis psoriásica. Todo ello hace que se asocie a un importante deterioro funcional y a una disminución de la calidad de vida. La psoriasis ungueal que afecta la matriz puede causar piqueteado/pitting, leuconiquia, manchas rojas en la lúnula o distrofia de la lámina, mientras que la afectación del lecho causa hemorragias en astilla, onicólisis, manchas de aceite o salmón e hiperqueratosis subungueal. Los métodos de evaluación comunes son las escalas NAPSI, NAPSI modificada o f-PGA. Actualmente, disponemos de tratamientos tópicos, intralesionales, sistémicos y biológicos, por lo que deberá individualizarse según el número de uñas implicadas, la zona ungueal afectada y la presencia de afectación cutánea y/o articular (AU)
Subject(s)
Humans , Nail Diseases , Psoriasis , Nail Diseases/epidemiology , Nail Diseases/etiology , Nail Diseases/therapy , Psoriasis/epidemiology , Psoriasis/etiology , Psoriasis/therapy , Risk FactorsSubject(s)
Carcinoma , Lichen Sclerosus et Atrophicus , Vulvar Diseases , Vulvar Lichen Sclerosus , Vulvar Neoplasms , Administration, Topical , Adrenal Cortex Hormones/therapeutic use , Female , Glucocorticoids/therapeutic use , Humans , Lichen Sclerosus et Atrophicus/complications , Lichen Sclerosus et Atrophicus/drug therapy , Lichen Sclerosus et Atrophicus/pathology , Recurrence , Vulvar Lichen Sclerosus/drug therapy , Vulvar Lichen Sclerosus/pathology , Vulvar Neoplasms/drug therapy , Vulvar Neoplasms/pathologySubject(s)
Humans , Keratoacanthoma/drug therapy , Injections, Intralesional , Administration, Topical , Methotrexate/administration & dosage , Imiquimod/administration & dosage , Fluorouracil/administration & dosage , Bleomycin/administration & dosage , Adrenal Cortex Hormones/administration & dosage , Interferon-alpha/administration & dosageSubject(s)
Humans , Keratoacanthoma/drug therapy , Injections, Intralesional , Administration, Topical , Methotrexate/administration & dosage , Imiquimod/administration & dosage , Fluorouracil/administration & dosage , Bleomycin/administration & dosage , Adrenal Cortex Hormones/administration & dosage , Interferon-alpha/administration & dosageABSTRACT
BACKGROUND: Monitoring of disease activity in sclerosing dermatoses (SD) can be challenging and tools to support clinical decision-making are lacking. AIM: To analyse the impact of high-frequency ultrasonography (HFUS) on the clinical management of SD and to describe the US characteristics of disease activity. METHODS: This was a cohort study of patients with various SD [morphoea, systemic sclerosis (SS) and chronic graft-versus-host disease (cGvHD)] who underwent HFUS between January 2017 and August 2019. HFUS criteria for diagnosing active SD were increased Doppler vascularity and/or meeting all B-mode greyscale US signs of activity. Discordance in SD activity between HFUS and clinical examination was evaluated at the time of the first US assessment. Changes in patient management were instituted after HFUS were recorded. RESULTS: In total, 72 patients (31 with morphoea, 19 with SS and 22 with cGvHD), who underwent 163 HFUS sessions in total, were included. All HFUS-active morphoea lesions exhibited increased vascularity, and all HFUS-active SS exhibited dermal thickening and dermal hypoechogenicity. HFUS-active cGvHD displayed increased dermal thickness and loss of definition of the dermal-hypodermal junction, and there were signs of panniculitis in 80% of cases and of increased vascularity in 70%. Discordance in disease activity between clinical and HFUS evaluation was found in 17 (23.6%) patients. Changes in clinical management after HFUS were made for 14 (19.4%) patients: treatment discontinuation for 6 patients (42.9%), treatment initiation for 5 (35.7%), medication change for 2 (14.3%) and skin biopsy taken for 1 (7.1%). CONCLUSION: HFUS seems an efficacious support tool in the monitoring of SD activity with a notable impact on clinical management. Further studies are warranted to evaluate the impact of HFUS-supported management changes on SD outcomes.
Subject(s)
Graft vs Host Disease/diagnostic imaging , Scleroderma, Localized/diagnostic imaging , Scleroderma, Systemic/diagnostic imaging , Skin/diagnostic imaging , Ultrasonography/methods , Adult , Aged , Cohort Studies , Female , Humans , Male , Middle Aged , Skin/pathologyABSTRACT
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