Psoríase com envolvimento ungueal

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Involvement of the nail apparatus in psoriasis remains the best indicator of concomitant arthropatic pasoriasis
  • Apresentação clínica
    • Manchas de óleo
    • Pitting
    • Splint hemorragias (fragilidade capilar)
    • Fingernails>toenails
    • Small parakeratotic foci in the proximal portion of the nail matrix → pits in the nails
    • Leukonychia
    • Psoriatic changes in the nail bed → exocytosis of leukocytes beneath the nail plate → oil drop or salmon patch
    • Increased capillary fragility → Splinter hemorrhages
    • Parakeratosis of distal nail bed → subungueal hyperkeratosis and distal onycholysis
  • Tratamento
    • When it affects the nail matrix, topical treatments are disappointing → intralesional injection of corticosteroids through the subungueal fold, using a 30G needle once per month for 6 months → then if is is working continue every 6 or 8 weeks for 1 year, then one injection every three months. Avoid dermo-jet (may lead to amputation of distal phalanx)
    • If corticosteroids fail, inject 2,5mg of MTX on each side of the nail at the level of the subungueal fold, after anesthesia. Once a week for 6 months
    • Distal non-matrix tissues: 40% urea, strong dermocorticoids
      • May also use intralesional injection (with troncular anesthesia)
      • BalneoPUVA (not many followers)