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Painful 20 fingers' onychodistrophy
Michele Bertero1, Zelda Seia, C Del Grande
1MD Ospedale S. Croce e Carle di Cuneo, Diparimnto Specialistico, Italy .
Indian Journal of Dermatology
|October 4, 2011
Summary
Psoriatic onycho-pachydermo-periostitis (POPP) is a rare psoriatic arthritis subset. Early methotrexate treatment rapidly improved symptoms in a patient with this painful, potentially debilitating condition.
Area of Science:
- Rheumatology
- Dermatology
- Orthopedics
Background:
- Psoriatic onycho-pachydermo-periostitis (POPP) is a rare manifestation of psoriatic arthritis.
- It typically affects the hands, presenting with nail changes, soft tissue swelling, and periosteal reactions.
- POPP's slow resolution and potential for permanent disability necessitate prompt diagnosis and treatment.
Purpose of the Study:
- To report a case of rapid-onset Psoriatic onycho-pachydermo-periostitis (POPP).
- To highlight diagnostic challenges and the efficacy of early methotrexate treatment.
Main Methods:
- Case report of a 53-year-old male with palmo-plantar psoriasis.
- Radiographic (Rx) and magnetic resonance imaging (MRI) of the hands were utilized for diagnosis.
- Treatment involved oral methotrexate.
Main Results:
- The patient presented with rapid-onset POPP, confirmed by imaging showing enthesitis, phalanx erosion, synovitis, and extensive periostitis.
- Treatment with oral methotrexate resulted in rapid clinical improvement and pain reduction within one month.
- The condition mimicked bacterial perionyxis, underscoring diagnostic difficulties.
Conclusions:
- POPP requires early recognition to prevent irreversible joint damage and functional impairment.
- Methotrexate demonstrates efficacy in managing POPP, leading to rapid symptom relief.
- Distinguishing POPP from infectious causes like bacterial perionyxis is crucial for timely and appropriate management.
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