Psoriatic onycho-pachydermo-periostitis successfully treated with low-dose methotrexate

Abstract

Background: Psoriatic onycho-pachydermo-periostitis (POPP) is a rare manifestation of psoriatic arthritis that is often misdiagnosed as a nail infection. The treatment for POPP has not yet been established.

Case report: We present a case of a 67-year-old man who had no psoriatic skin lesions with POPP, characterized by psoriatic nail changes, painful swelling of the distal soft tissues on the great toes and fingers, and enthesopathies of the involved terminal phalanges. The clinical nail and arthritic changes were improved with methotrexate treatment 4 mg weekly for 6 months.

Conclusions: Methotrexate can be recommended as the first-choice therapeutic agent for patients with POPP.