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| Fig. 7.4 Nail pitting is one of the most common changes associated with psoriasis. As demonstrated here, even nail polish cannot hide these discrete pits. |
A careful examination of the nails should be part of the skin exam, especially when evaluating a rash that might be psoriasis. Characteristic nail changes are found in 25% to 50% of psoriatics. These changes include nail pitting, discoloration, onycholysis, subungual hyperkeratosis, and nail deformity. Nail pitting, the most common nail finding in psoriasis, consists of small, discrete, punched-out depressions on the nail surface (Fig. 7-4). Circular areas of nail bed discoloration that resemble oil drops are often seen under the nail plate (hyponychium). The nail can become thin and brittle at the distal edge with separation from the nail bed (onycholysis) or thickened with subungual debris. Ridges, grooves, or even frank deformity of the nail plate can also be seen.
