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Psoriatic onycho-pachydermo-periostitis. A variant of psoriatic distal interphalangeal arthritis?
A M Boisseau-Garsaud1, M Beylot-Barry, M S Doutre
1Service de Dermatologie, Hôpital Haut-Lévèque, Bordeaux-Pessac, France.
Background:
Joint and nail involvement in psoriasis is relatively common. In contrast, bony involvement of the terminal phalanx under a psoriatic nail is rare. We report on this psoriatic onycho-pachydermo-periostitis and suggest pathophysiologic mechanisms.
Observations:
Two new cases are reported and the data are compared with the data from eight similar cases reported in the literature. All subjects presented with similar changes--onychopathy, soft-tissue thickening, and radiologic features consisting of bone erosions and a periosteal reaction of the terminal phalanx. Of the 10 patients, two had no history of psoriasis before a diagnosis of psoriatic onycho-pachydermoperiostitis was made. The inflammation is likely transmitted from the psoriatic nail to the adjacent underlying bone by the same mechanism as in enthesopathies.
Conclusion:
Psoriatic onycho-pachydermo-periostitis should be recognized as a specific entity in the spectrum of psoriatic disease.