The Differential Diagnosis For Psoriasis Assignment

The Differential Diagnosis For Psoriasis Assignment

Psoriasis refers to a long-term autoimmune skin disease that entails inflammation occurring on the skin’s surface and nails. It may also present with features similar to a condition known as tinea unguium, which results in thickening, staining, pitting, roughness, ridging, crumbling, and proximal subungual hyperkeratosis. While fungal infections have an impact on nail look, often in the form of longitudinal ridges, psoriasis may also cause pitting, or onycholysis (nail separation from the nail bed). A focal diagnostic criterion is the existence of psoriatic skin lesions in other parts of the body like, pinkish or red, scalp, elbow, or knee pálms covered by tiny silvery sheens (Jiaravuthisan et al., 2017)The Differential Diagnosis For Psoriasis Assignment. Also, nail psoriasis can cause pain and can pose a significant threat to the health of the joints, which leads to psoriatic arthritis. The diagnosis of this skin condition is usually done clinically by assessing the patient’s history and performing a physical examination; however, in ambiguous situations, a biopsy may be performed or dermoscopy used.

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Lichen Planus

Lichen planus is an inflammatory disorder that initially developed in the skin, but can also involve the oral and genital mucosa, hair, and nails. One or more nails can be affected in approximately 10% of patients and has a similar clinical manifestation to tinea unguium where there may be thickening, ridging, and discoloration of nails (Hwang et al., 2024). However, lichen planus does ulceration but can lead to longitudinal grooving, also splitting and pterygium which is a wing-like growth on the skin. Some characteristic oral and cutaneous manifestations include purpuric papules, flat-topped, itchy nodules or lacy white lesions in the mouth, always accompanying alterations in nails. However, diagnosis of PC is a clinical diagnosis where skin biopsy can complement the diagnosis by presenting histological features of PC. The Differential Diagnosis For Psoriasis Assignment

Traumatic Onychodystrophy

Traumatic onychodystrophy is defined as nail disorder incurred through physical injuries or repeated microinjuries of the nail matrix and nail folds. This can very much resemble tinea unguium , due to signs such as, thickening, discoloration, and onycholysis of the nails. In most cases, traumatic changes are observed as isolated alterations in one or several nails and have a specific history of injury or repetitive athletic loads or improper shoes  (Shemer, 2013)The Differential Diagnosis For Psoriasis Assignment. Distinguishable from fungal infections there is no scaling or identification of any fungal part under the microbiological analysis. It depends on clinical findings, and nail scraping and clipping examination by KOH mount and fungal culture are negative.

References

Hwang, J. K., Grover, C., Iorizzo, M., Lebwohl, M. G., Piraccini, B. M., Rigopoulos, D. G., & Lipner, S. R. (2024). Nail psoriasis and nail lichen planus: Updates on diagnosis and management. Journal of the American Academy of Dermatology, 90(3), 585-596. https://doi.org/10.1016/j.jaad.2023.11.024

Jiaravuthisan, M. M., Sasseville, D., Vender, R. B., Murphy, F., & Muhn, C. Y. (2017). Psoriasis of the nail: Anatomy, pathology, clinical presentation, and a review of the literature on therapy. Journal of the American Academy of Dermatology, 57(1), 1-27. https://doi.org/10.1016/j.jaad.2005.07.073

Shemer, A., & Daniel, C. R. (2013). Common nail disorders. Clinics in Dermatology, 31(5), 578-586. https://doi.org/10.1016/j.clindermatol.2013.06.015 The Differential Diagnosis For Psoriasis Assignment