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The family physician (FP) diagnosed plaque psoriasis on the elbows along with nail psoriasis, characterized by onycholysis.
In this case, the FP clipped off a portion of the fingernail and sent it for a fungal culture. He prescribed clobetasol ointment for the elbows and told the patient to apply it twice daily for 2 weeks and then on weekends only, as needed. He also counseled her to quit smoking, even though she claimed that she hardly smoked.
The patient returned in 2 weeks and was delighted that her elbows were 90% clear. The fungal culture was negative and the FP and patient discussed options for the treatment of the nail psoriasis.
Application of a high-potency topical corticosteroid under the free edge of the distal nail plate can slow the progression of distal onycholysis. Other topical therapies that have shown some effectiveness include 1% 5-fluorouracil solution or 5% cream applied twice daily to the matrix area for 6 months, as well as topical calcipotriol, anthralin, tazarotene, or cyclosporine. Systemic therapies for psoriasis may improve nail manifestations, but would have been overkill for this patient. She decided to use clobetasol cream for her nails.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux EJ. Psoriatic nails. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:838-841.
To learn more about The Color Atlas of Family Medicine, see:
• http://www.amazon.com/Color-Atlas-Family-Medicine/dp/0071474641
You can now get The Color Atlas of Family Medicine as an app for mobile devices including the iPhone and iPad by clicking this link:
The family physician (FP) diagnosed plaque psoriasis on the elbows along with nail psoriasis, characterized by onycholysis.
In this case, the FP clipped off a portion of the fingernail and sent it for a fungal culture. He prescribed clobetasol ointment for the elbows and told the patient to apply it twice daily for 2 weeks and then on weekends only, as needed. He also counseled her to quit smoking, even though she claimed that she hardly smoked.
The patient returned in 2 weeks and was delighted that her elbows were 90% clear. The fungal culture was negative and the FP and patient discussed options for the treatment of the nail psoriasis.
Application of a high-potency topical corticosteroid under the free edge of the distal nail plate can slow the progression of distal onycholysis. Other topical therapies that have shown some effectiveness include 1% 5-fluorouracil solution or 5% cream applied twice daily to the matrix area for 6 months, as well as topical calcipotriol, anthralin, tazarotene, or cyclosporine. Systemic therapies for psoriasis may improve nail manifestations, but would have been overkill for this patient. She decided to use clobetasol cream for her nails.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux EJ. Psoriatic nails. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:838-841.
To learn more about The Color Atlas of Family Medicine, see:
• http://www.amazon.com/Color-Atlas-Family-Medicine/dp/0071474641
You can now get The Color Atlas of Family Medicine as an app for mobile devices including the iPhone and iPad by clicking this link:
The family physician (FP) diagnosed plaque psoriasis on the elbows along with nail psoriasis, characterized by onycholysis.
In this case, the FP clipped off a portion of the fingernail and sent it for a fungal culture. He prescribed clobetasol ointment for the elbows and told the patient to apply it twice daily for 2 weeks and then on weekends only, as needed. He also counseled her to quit smoking, even though she claimed that she hardly smoked.
The patient returned in 2 weeks and was delighted that her elbows were 90% clear. The fungal culture was negative and the FP and patient discussed options for the treatment of the nail psoriasis.
Application of a high-potency topical corticosteroid under the free edge of the distal nail plate can slow the progression of distal onycholysis. Other topical therapies that have shown some effectiveness include 1% 5-fluorouracil solution or 5% cream applied twice daily to the matrix area for 6 months, as well as topical calcipotriol, anthralin, tazarotene, or cyclosporine. Systemic therapies for psoriasis may improve nail manifestations, but would have been overkill for this patient. She decided to use clobetasol cream for her nails.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux EJ. Psoriatic nails. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:838-841.
To learn more about The Color Atlas of Family Medicine, see:
• http://www.amazon.com/Color-Atlas-Family-Medicine/dp/0071474641
You can now get The Color Atlas of Family Medicine as an app for mobile devices including the iPhone and iPad by clicking this link: