Inflammatory Nail Disorders

Inflammatory disorders that involve the nail matrix, such as psoriasis, can result in distinctive deformities of the nails. For example, nail pitting, “oil spots,” and onycholysis are commonly seen in patients with psoriasis. Other conditions, such as eczema of the proximal nail fold, result in nonspecific deformities.

Psoriasis

The typical nail changes are pitting, onycholysis, thickening (subungual hyperkeratosis), and “oil spots” (Fig. 22.7; see also Figs. 14.25-14.27).

Management (see Discussion in Chapter 14: Psoriasis)

Eczematous Dermatitis with Secondary Nail Dystrophy

Nail deformity secondary to eczematous dermatitis is a problem that is often overlooked in patients with severe atopic dermatitis (Fig. 22.8).
It results when eczematous dermatitis involves the distal extensor surface of the fingers, and the associated inflammation also involves the matrix, or “root,” of the nail. The inflamed matrix, which underlies the proximal nail fold, consequently gives rise to a dystrophic nail plate.
The nails generally have a ripple-like deformity that corresponds to the time of activity of the underlying inflammatory process.

Management

Improvement of the appearance of the nail plate follows control of inflammation of the proximal nailfold skin with the use of topical steroids.