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. 2011 Jul;56(4):415-7.
doi: 10.4103/0019-5154.84743.

Painful 20 fingers' onychodistrophy

Michele Bertero  1 , Zelda Seia, C Del Grande, L Musso, S Palazzini
Affiliations

Painful 20 fingers' onychodistrophy

Michele Bertero et al. Indian J Dermatol. 2011 Jul.

Abstract

Psoriatic onycho-pachydermo-periostitis (POPP) is a rare subset of psoriatic arthritis. It is usually localized to the hands and it is characterized by onychodistrophy, soft tissue thickening above the distal phalanx and periosteal reaction. The resolution is very slow due to the involvement of nails and bone. Low dose methotrexate and anti-tumor necrosis factor-α (anti-TNF-α) agents are the suggested therapies. We report a case of a 53-year-old man affected by palmo-plantar slight psoriatic dermatitis, who presented a rapid onset of POPP. Rx imaging showed enthesitis and a moderate phalanx erosion with articular spaces narrowing and swollen periosteal reaction. A magnetic resonance imaging test of the hands showed an initial stage of synovitis and extensive periostitis of the distal phalangeal tufts. The patient has been treated with oral methotrexate for a month with a rapid clinical improvement and pain reduction. As POPP at first manifests as a painful onycodistrophy, it can easily be confused with bacterial perionyxis. The delay in making the correct diagnosis, and therefore, the delay in giving a proper treatment would mean the progressive articular erosion and the permanent invalidation of the patient's ability to use his hands.

Keywords: Psoriatic arthritis; psoriatic dactilitis; psoriatic onycho-pachydermo-periostitis.

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Conflict of interest statement

Conflict of Interest: Nil.

Figures

Figure 1
Figure 1
Hyperkeratosis and onycholysis of hands, fingers with soft tissue swelling of the terminal phalanx. Severe onychodistrophy with ostraceous nails are seen
Figure 2
Figure 2
Erythematous scaly lesions with rhagades and erosions. Dystrophy of nails is similar to that of the hands
Figure 3
Figure 3
Methotrexate treatment improved the patient's onycholysis and painful erythematous swelling of the terminal phalanx. Nails still present with scales but appear thinner
See this image and copyright information in PMC

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