Nail Pitting Psoriatic Arthritis

Nail Pitting Psoriatic Arthritis, Psoriatic arthritis Onychodystrophy is statistically more common in patients with psoriatic arthritis than in patients with psoriasis vulgaris, presenting in 67%  to 83% 1841 to 86.5% 1851 to 88% 1861 of arthritic patients. In one study, psoriasis nail changes were able to predict thc onset of psoriatic arthritis with a risk ratio of 2.24 on multi variant analysis 1871. Zaias and Norton felt that the relationship between nail psoriasis and distal interphalangeal psoriatic joint involvement is unclear.

However, many other investigators disagree. Some reports show an association between the degree of arthritis and the presence of nail dystrophy, but not on the same digit. Baker et al. 1841 noted that clinical nail changes were unrelated to the distribution of the joint involvement. Lavaroni at reported that die more severe the arthritis, the greater the degree of nail involvement. However, there was no relationship found between arthritis of the distal joints and psoriatic nail change in the same digit.

 In a study of 69 patients with psoriatic arthritis. Williamson at  found that the more severe the nail psoriasis. the more unremitting and progressive was the arthritis (P <0.001). Other reports show an association between the arthritis and the nail dystrophy in the same finger. In a study by Jones et at [831 of 100 patients with psoriatic arthritis, there was a significant correlation between disease of the distal interphalangeal joint and disease in the adjacent nail.

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Wright at found nail changes in all patients with distal arthritis and in 88% of patients with deforming arthritis. Support for the association between arthritis and nail disease in the same finger can be found in the concept of psoriatic "nail matrix arthropathy." This concept unites the two conditions by the fact that the nail matrix and the terminal interphalangeal joint share the same blood supply 188, 891.

 Further evidence of a relationship between inflammation in the joint and nail dystrophy can be found in magnetic resonance imaging (MRI) and pathology studies that emphasize the anatomical relationship between the fingernail, the ligament enthesis and the distal interphalangeal joint.

The nail is actually a part of the "enthesis organ" which is composed of nail. ligament, tendon and bone. Other investigators support this theory. The joint collateral ligament enthesis has fibers that merge with the lateral borders of the nail anchoring the nail to the underlying periosteum 192]. Diffuse inflammation envelops the nail root and adjacent bone. These studies suggest that nail findings in psoriatic arthritis are an extension of entheseal inflammatory changes and are a part of arthritis.

Scarpa at  found that subchnical MRI nail involvement was present in almost all patients with psoriatic arthritis studied. including those without clinically evident nail dystrophy. Subclinical entheseal abnormalities were also documented via ultrasound in asymptomatic psoriasis patients 1951.

The tendon dorsal capsular enthesis appears to be the epicenter of the inflammatory reaction 1911 Tan et al 1911 commented that She nail is as much an integral part of the enthesis organ as it is of the skin.' Inflammation of the distal interphalangeal joint extends along enthuses] structures to involve the nail matrix and nail bed.

Proximal nail matrix involvement can lead to pitting; nail bed involvement can lead to onycholysis. If nail changes in psoriasis are an extension of the joint and are therefore a prediction of the development of psoriatic arthritis, this association may have a broader implication in the potential use of systemic medications. particularly systemic biological agents, in controlling psoriatic nail disease and preventing future psoriatic arthritis, a premise that merits further investigation.

Love at  commented that 'this growing body of knowledge suggests that nail changes deserve increased attention in the evaluation of patients with psoriasis and psoriatic arthritis.' Clinical nail changes in patients with psoriatic arthritis vary from mild pitting to gross destruction 1841. Lavaroni et at [85] found great toenail subungual hyperkeratosis to be the most common finding, followed by fingernail pitting.

Love at 1961 found that onycholysis was the nail change most strongly associated with small joint disease in psoriatic arthritis. This study found no association between small joint arthritis and pitting, oil spots or subungual hyperkeratosis. Juvenile psoriatic arthritis is defined through major and minor criteria.

The major criterion is arthritis associated with. but not necessarily coincident with, a typical psoriatic rash. Three of four minor criteria must be satisfied: dactylitis, nail pitting. psoriasis-like rash. and/or a family history of psoriasis. In childhood, there is a strong correlation between distal arthritis and nail dystrophy 1981.

Interestingly, juvenile psoriatic arthritis may have more in common with juvenile rheumatoid arthritis than other seronegative spondylarthropathies with which it is traditionally associated. In 50 children in whom juvenile arthritis was the presenting complaint, 67% had nail pitting as the most common associated feature of psoriasis and IX% went on to develop the cutaneous psoriasis 1241.

 A separate subgroup of juvenile psoriatic arthritis is represented by young females with widespread plaque-type or suberythrodermic psoriasis with a strong family history of psoriasis. a strong family history of autoimmune disease, nail changes and large joint arthropathy.

Source:

Baran and Dawber's Diseases of the Nails and their Management

editat de Robert Baran,David A. R. de Berker,Mark Holzberg,Luc Thomas

In the nearest future will post more about Nail Pitting Psoriatic Arthritis.

Nail Pitting Psoriasis Pictures

Nail Pitting Psoriasis Pictures

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Nail Pitting Eczema

Nail Pitting Eczema, Eczema of the nail folds or nail bed may be associated with eczema elsewhere on the hand or foot and can cause nail unit disturbance in a manner similar to psoriasis. Special patterns of eczema can be relevant for allergic contact sensitivity.

Clinical Features and Diagnosis

The most common pattern of nail changes in eczema is where the nail fold is inflamed as part of an irritant hand eczema or as part of atopic eczema. This acts as a focus of inflammation that in turn disturbs matrix function owing to their adjacency.

 The nail then suffers transverse ridges and alterations of color, which reflect the fluctuating inflammation. Where the eczema is more directed at the digit tip, the nail bed is more likely to be involved, which in turn results in onycholysis. 

Both patterns often manifest most in the dominant hand because trauma, or simply use, increases the likelihood of pathology.

Occupational factors can be important bath for analysis of the cause and for helping patients manage the global situation because they can suffer degrees of incapacitation. 

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Where the occupation plays a part in the pathology, such as irritants in a health care or food-preparation worker, it may be necessary to review career choices. Hairdressers, beauticians, and engineers in certain fields come into contact with a wide range of contact sensitizers. The use of nail cosmetics alone can be relevant. Consider patch testing.

Treatment is as for eczema elsewhere and shares many of the

points made for managing psoriasis of the nail unit: 

Avoidance of irritants, trauma, nail manipulation, and frequent wetting

Use of copious thick emollient

Topical steroid tailored to severity

Hand protection 

Ineffective and chronic paronychia can be a complicating factor in nail unit eczema and requires additional systemic antibiotics in some instances.

Source:

Conn's Current Therapy 2016

De Edward T. Bope,Rick D. Kellerman

Soon more about Nail Pitting Eczema.

Nail pitting vitamin deficiency

Nail pitting vitamin deficiency, various nutritional deficiencies can cause nail abnormalities. Deficiencies of folic acid, protein and vitamin C can cause nails that split and fray. 

Lack of iron can cause pale, spoon-shaped nails. Mineral deficiencies can cause soft nails.

The best treatment for nails is to avoid contact with harsh cleaners and other chemicals (wear rube gloves), keep nails trimmed (soak them first to avoid chipping), and make sure nutrition is adequate. 

Vitamin B12 supplements are important for maintaining healthy nails, as are trace minerals. 

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Calcium also can be a very big problem for nail an nail pitting disease. If you have nail problems please consider that is the most important to consume food that includes enough vitamins and minerals.

Source:

Chronic Fatigue Syndrome Treatment Guide, 2nd Edition

De Erica Verrillo

Will post here in the near future more info about Nail pitting vitamin deficiency.

Nail Pitting on one finger

Nail Pitting on one finger, is a rare benign self-limited linear dennatosis of unknown origin that follows lines of Blaschko. The condition is most common in children 3-10 years of age [340] but can occur from 6 months to 12 years of age.

 It is more common in males. The etiology of lichen striatus is unknown. It presents as the sudden onset of a continuous or interrupted linearly distributed array of small 1-3 mm pink, tan or flesh-colored lichenoid papules.

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The papules may be lichenoid, smooth, scaly or flat topped. It usually involves the entire length of an extremity and may extend far enough along a finger or toe to involve the proximal nail fold and nail plate. It usually involves just one finger, usually the thumb, but more than one f mger involved has been reported. Unilateral lichen striatus has been reported with bilateral onychodystrophy.

Nail changes have been reported to occur before, and concurrently with the cutaneous eruption. Nail involvement has been reported as the only finding; the diagnosis was made based on the clinical appearance, spontaneous clearing of the nail abnormalities and the histopathological findings. Nail involvement in lichen striatus usually

indicates a prolonged course and the nail plate deformity may persist for several years, but cases may be transient and may resolve in less than I year. 

Source:

Baran and Dawber's Diseases of the Nails and their Management

editat de Robert Baran,David A. R. de Berker,Mark Holzberg,Luc Thomas

In the short future will post more about Nail Pitting on one finger.

Nail pitting psoriasis

Nail pitting psoriasis, common causes of nail pitting include psoriasis, alopecia areata, and eczema. A few pits can also be seen in normal nails. Uncommon causes include parakeratosis pustulosa, pemphigus vulgaris, sarcoidosis, dermatomyositis, drug-induced erythrodenna, secondary syphilis, Reiter’s disease, chronic renal failure / hemodialysis, and chronic paronyehia 

Certain characteristics of nail pitting can help to identify its etiology. Psoriatic pits are typically deep, indicating involvement of the intermediate and ventral nail plate. Moreover, presence of more than 20 pits is suggestive of psoriatic nail disease. 

Over 60 pits has been said to be diagnostic of psoriasis. In contrast, pits in alopecia areata are small, superficial and usually arranged in a regularly distributed geometric pattern. 

They may demonstrate a “rippled” effect and run along longitudinal or transverse lines. Other nail signs of alopecia areata include mottled erythema of the lunula, onychomadesis, and trachyonychia. 

Pits in eczema are coarse, very irregular and associated with cross ridging. The term elkonyxis describes a very large irregular depression, which can be seen in syphilis, Reiter’s disease, following a traumatic event, or after isonetinoin therapy. 

Small pitted craters on the middle and ring fingers, known as Rosenaus depressions, are characteristically seen in patients with diabetes mellitus. It is important to remember that an isolated pit is not diagnostic and may be idiopathic in nature. 

Very soon more about Nail pitting psoriasis.

Florida Nail Pitting

 Florida Nail Pitting, the number of pits and the type of pitting may occasionally be suggestive of the associated disease. It has been proposed that having less than 20 nail pits is nonspecific and can be present in non psoriatic conditions, whereas 20 to 60 pits is suggestive of psoriasis and greater than 60 pits is unlikely to be found in the absence of psoriasis.

 Irregular pits and deeper pits are often seen with psoriasis. In contrast, fine geometric pitting (longitudinal or transverse lines) is more characteristic of alopeciaareata, and coarse pitting may indicate eczematous dermatitis. Rarely, uniform pitting over the entire nail plate can be a developmental anomaly.

The evaluation of nail pitting should include a thorough history and physical exam ination. assessing for concomitant psoriatic skin lesions, joint symptoms, atrophy, hair loss, and additional nail changes suggestive of an inflammatory dermatitis.

Sources:

Nail Psoriasis: From A to Z

edited by Dimitris Rigopoulos, Antonella Tosti

Soon this list with dermatology clinics in Florida that handle Nail Pitting

Texas Nail Pitting

Texas Nail Pitting, It is important to understand that nail pitting is not specific for any one disease J Perhaps the most common associated condition is psoriasis. Few studies have assessed the prevalence of nail psoriasis in the pediatric population.

It is estimated that between 7% and 39.4% of children with psoriasis have nail disease,()6 which can consist of nail pitting, as well as onycholysis, subungual hyperkeratosis, longitudinal ridging, oil spots, splinter hemorrhages, discoloration, and/or trachyonychia.

In one study, 61.8% of children with nail psoriasis had evidence of pitting, Psoriasis nail pitting has been described in infancy as well.

 Although data in adults have correlated psoriasis severity and psoriasis arthritis with nail disease, the same relation ships so far have not been established in the pediatric literature.

Source:

Pediatric Dermatology, An Issue of Pediatric Clinics,

By Kara N. Shah

In a few days will post here a list of dermatologist from Texas who treat Nail Pitting

Nail Pitting California

Nail Pitting California, nail pits are superficial punctuate depressions of the dorsal nail plate . Multiple nails may have pitting, with fingernails more commonly affected.

The proximal nail matrix gives rise to the dorsal nail plate and is therefore primarily affected by a cause active dermatitis. The ventral aspect of the proximal nail fold closely approximates the nail plate and may also play a role in parthenogenesis.

It is believed that clusters of cells with retained nuclei develop in the superficial layers of the developing nail plate, and as the nail grows outward, these cells are sloughed off leaving pits in the nail plate.

U4 Deeper depressions suggest involvement of the intermediate and distal portions of the nail matrix, in addition to the proximal portion.

The amount of time in which the matrix is free of disease correlates directly with the length of normal nail plate growth observed?"

Nail Pitting California

Source:

Pediatric Dermatology, An Issue of Pediatric Clinics,

By Kara N. Shah
Here we will post in a very short time the list of all dermatologist form California who treat nail pitting 

New York Nail Pitting

New York Nail Pitting of the nails, typically the fingernails, is characterized by depressions in the surface of the nail. Nail pitting is caused by defective development of the layers of the superficial nail plate.

 It is common in patients with psoriasis and can affect up to 50% of people suffering from this condition. Nail pitting can also be associated with other conditions, including connective tissue disorders, alopecia areata, and sarcoidosis. 

Any condition that can cause a superficial and localized inflammation of the skin (dermatitis) can also affect the nails and result in nail pitting. Nail pitting can be associated with other abnormalities of the nails, including nail separation, flaking or crumbling, or other damage to or changes in the nail. 

Nail pitting that is associated with disease processes generally shows involvement of multiple or all nails, while trauma to an individual nail bed can cause localized pitting or disruptions in a single nail.

Source: http://www.medicinenet.com/nail_pitting/symptoms.htm

You can find in a short time all the dermatologist list from New York who can make treatment for Nail Pitiing

Nail pitting treatment

Nail pitting treatment

First let's start with nail pitting home treatment:

- consume food that includes enough vitamins and minerals.
- tea tree oil is a natural phenomenon used in the nails to resolve problem of nail pitting
- do not clip your cuticles at all
- water therapies
- hydrotherapy
- consumption of adequate water
- diet: no fast food, eat all the food that is 100% natural!
It is very important to understand that the nail diseases are usually caused by the kind of life that we have,factors such as stress, lack of rest and bad food can affect our bodies in ways increasingly worse.

Medical treatment of nail pitting is quite complex and it must be done by a dermatologist.
We explain here like you to know about what it is and do not consider is a painful treatment.
They use topical steroids in form of creams or ointments, once or twice per day for 4-6 months.
If this is not god for the patient the the doctors can use intralesional.
Triamcinolone acetonide solution is the most popular steroid. and it is used at different

solution concentrations ranging from 2.5 to 5 mg/ml and quantity per site injected between

0.05 and 0| ml at up to four injection areas. Usually injections are performed with a 30 g

needle locked to the syringe, monthly or bimonthly for 5-6 months at the proximal nail fold, as

it is useful mainly in nail matrix psoriasis (pitting. nail plate crumbling). ln cases of nail signs

due to the affection of the nail bed, injections must be perfonned at the lateral nail folds in

the nail bed .
As shown these treatments may differ from doctor to doctor and from patient to patient.
Anyway please do not try any medical treatment of nail pitting at home even if it seems simple.
See the video

Nail pitting causes

Nail pitting can be caused by psoriasis, alopecia areata and atopic eczema. A few pits can be present due to trauma. Onycholysis is caused by psoriasis, thyrotoxicosis, following trauma.

Uncommon causesinclude parakeratosis pustulosa, pemphigus vulgaris, sarcoidosis, dermatomyositis.

NAIL PITTING Inflammatory conditions affecting the matrix cause abnormal keratin to be formed, which becomes detached from the nail plate leaving pits or ridges. Pits are more easily seen in the finger nails than in toe nails.

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To be sure that you have this nail disease please see an dermatologist first because can be a very serious thing! 

Let's see some pictures with nail pitting:

Nail pitting

Pits are superficial depressions within the nail plate that vary in morphology and distribution. A pit indicates a defect in the uppermost layer of the nail plate, which arises from the proximal nail matrix.
Or for more simple, Nail pitting Superficial depressions in the nail plate.

 When a series of transverse grooves parallels the proximal nail fold the cause is likely to be repeated trauma from overzealous manicuring. ‘Rhythmic’ parallel transverse grooves may be an isolated sign of psoriasis, equivalent to patterned pitting.

Nail pitting may also be present in alopecia areata and lichen planus.5 However, the most characteristic features in lichen planus are longitudinal grooves and fissures, and dorsal pterygium, and nail pitting may not be present.3 In alopecia areata, nail pitting is usually fine and stippled, and other features such as areas without body hair should be present.

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Nail pitting due to psoriasis. Pits are large, deep and irregularly scattered, in contrast with alopecia areata, where they are small, superficial and geometrically distributed.
Diseases that produce nail pitting include psoriasis, alopecia areata and eczema.

Nail matrix damage produces irregular pitting and Beau’s lines; onychomadesis can occur in severe cases. Chronic eczema frequently localizes to the hyponychium, resulting in subungual hyperkeratosis, onycholysis and fissuring of the hyponychium. Chronic eczema of the proximal nail fold can lead to chronic paronychia. In atopic dermatitis, the nail plate frequently shows mild superficial abnormalities such as irregular pits and Beau’s lines. Controlling the skin disease results in gradual improvement of the nails.

For example, pitting must be treated at the level of the nail matrix. It is useless to treat the nail plate for pitting because the pathology that causes pitting is in the matrix. The nail plate is the end-product of the nail matrix and, in its normal state, is a smooth translucent hard structure that is tightly adherent to the nail bed. Nail plate abnormalities can be traced to the nail matrix, as in pitting, or to the nail bed or nail fold, as in a space-occupying lesion.


The configuration of nail pitting depends on the area of the matrix involved, and the duration of the pathological process in the nail matrix. The longitudinal dimension of the pits is determined by the length of time that the psoriasis is active in that portion of the nail matrix.

Treatment of pitting due to any of the dermatological disorders must be directed to the matrix of the nail. Topical corticosteroids under occlusion and intralesional triamcinolone acetonide 2–3 mg/ml into the proximal nail fold are the most effective treatment for nail pitting.

The combination of the nail pitting and onycholysis with the silvery-white, scaly patches in the external ear canal and scalp (classical signs of skin psoriasis) makes nail psoriasis the most likely diagnosis in this case.

Nail pitting

 In alopecia areata, nail pitting is usually fine and stippled, and other features such as areas without body hair should be present.

Pitting was the most common finding in psoriasis, accounting for 70% cases. Next most common nail changes were onycholysis in 52% and subungual hyperkeratosis in 40%cases. Discoloration was found in 25% cases followed by paronychia in10% cases. Splinter hemorrhages were seen in 12% and Beau’s lines were observed in 14% cases.

Pitting is most common nail abnormality seen in psoriasis and affects finger nail more commonly than toe nails. Pitting is due to focal parakeratosis of abnormally keratinizing cells of the proximal nail matrix. As the nail plate grows out, parakeratotic cells are lost and leave behind a punctate surface depression.

Pitting in psoriasis is deep, irregularly and randomly placed. In psoriasis, onycholysis commonly starts at the free distal edge of the nail plate but may commence in the centre of the nail plate also. When onychodermal band is disrupted, the condition is progressive.

It has been shown that regular pitting may convert to rippling or ridging, and these two conditions appear, at times, to be variants of uniform pitting . Nails showing diffuse pitting grow faster than the apparently normal nails in psoriasis. Occasional pits occur on normal nails. Deep pits can be attributed to psoriasis, and profuse pitting is most often due to this condition. In alopecia areata shallow pits are usually seen and they are often numerous, leading to trachyonychia  and twenty-nail dystrophy; however, curiously, one nail often remains unaffected for a long time, Pits may also occur in eczema or occupational trauma. In some cases a genetic basis is thought likely. In secondary syphilis and pityriasis rosea pitting occurs rarely. One case of the latter has been observed with the pits distributed on all the finger nails at corresponding levels, analogous to Beau’s lines.

Since treatment of nail psoriasis is always disappointing, before treatment is started the individual problems of every patient should be carefully considered, and in particular the degree of discomfort that results from the nail lesions. Reassuring the patient is probably the best approach for isolated nail pitting, oily patches, mild onycholysis and splinter haemorrhages. However, diffuse onycholysis, subungual hyperkeratosis and severe nail plate surface abnormalities may require a positive therapeutic approach.

See the video with nail pitting


Resources of study:

Journal of Pakistan Association of Dermatologists 2011
Nail changes in psoriasis – A profile Neerja Puri, B B Mahajan

The Royal Australian College of General Practitioners 2016 Nail pitting and onycholysis Joana Tendais-Almeida, Fátima Aguiar, Tiago Torres

An Atlas of DISEASES OF THE NAIL
Rich Phoebe, Richard K.Scher

Nail Disorders
Antonella Tosti and Bianca Maria Piraccini