The n e w e ng l a n d j o u r na l of m e dic i n e

Images in Clinical Medicine

Chana A. Sacks, M.D., Editor

Nail Pitting in Psoriasis

A
28-year-old man presented to the dermatology clinic with Juan A. Moreno-Romero, M.D.
fingernail changes that had developed over a period of 3 years. Examina- Hospital Universitari General de Catalunya
tion revealed multiple small depressions (pits) in the surface of the nails Barcelona, Spain
on both hands, with yellow discoloration of the distal nail. Scaly, erythematous 35844jmr@gmail.com
plaques were also present on the extensor surfaces of both elbows and both knees. Ramon Grimalt, M.D.
The patient had no joint tenderness, swelling, or stiffness. A clinical diagnosis of
Universitat Internacional de Catalunya
psoriasis was made. Nail changes are common in patients with psoriasis. Signs Barcelona, Spain
of psoriasis in the nails include discoloration (e.g., areas of yellow or pink discolor-
ation known as oil-drop discoloration or salmon patches), onycholysis, subungual
hyperkeratosis, nail plate crumbling, and splinter hemorrhages. Other conditions
in which nail pitting can be seen include alopecia areata, eczematous dermatitis,
and traumatic occupational injury. Isolated pits can develop in normal nails. In this
patient, a high-potency glucocorticoid in nail lacquer was initiated, and cutaneous
psoriasis was treated with a combination topical vitamin D analogue and a gluco-
corticoid. At follow-up 6 months after the initiation of treatment, the patient’s nail
pitting and skin plaques had abated and joint involvement had not developed.
DOI: 10.1056/NEJMicm1803217
Copyright © 2018 Massachusetts Medical Society.

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