Characterized by monomorphic rash in the form of flat papules (nodules), slightly raised above the surface of healthy skin. The papules tend to merge and formation of pinkish-red plaques large size with white spots.
Many cases involved joints and even internal organs. 80% of the diseases psoriasis affects the nails. Nail involvement in psoriasis can be isolated or be accompanied by manifestations of disease in the skin (50% of people with this disease). It represents a considerable complexity in terms of treatment and the differential diagnosis with other diseases of nails, especially onychomycosis(fungal infection).
Nail changes also indicates the high probability of development of articular psoriasis and usually for 7-10 years preceded him. This is due to the anatomical unity of the matrix of the nails joints and tendon apparatus of the fingers as inflammatory processes occur in the fixation of the joint capsule and tendons. Local treatment of psoriasis of the nails on the hands and feet is complicated by the difficulty of penetration of drugs in the affected area.
Clinical manifestations of the disease
The symptoms of nail psoriasis depend on the affected area of the nail unit matrix or the bed. The matrix (root) is the most important section of the epithelial tissue under the root division of the nail plate, which is behind the rear roller. The matrix affects the shape, length, and partly on the thickness of the nail plate, that is, it is an area of growth. Box — connective tissue layer, covered by the epidermis, which is the nail plate. From it also partially depends on the thickness of the nail.
Symptoms the nail bed:
- Under the nails, hyperkeratosis, representing the accelerated proliferation and keratinization Under the nails of the epithelium, accumulate under the nail.
- Under the nails splinter hemorrhages (in the form of dew) or hemorrhages (in the form of strips) brown or black color.
- The phenomenon of oil stains — a spot of yellowish-brown color under the nail plate.
- The symptom of "stearin spot" — with a light scratching of the nail or the skin papules around the nail is increased flaking silvery scales whitish colour, resembling particles formed during the grinding of stearin.
- Onycholysis — a complete or partial detachment of the nail plate from the bed.
- In onychogryphosis — thickening and curvature separated from the bed of the nail, with the result that he becomes like a bird's beak or claw.
Any lesions of the nails can be accompanied by inflammatory phenomena and thickening surrounding the plate of the nail and soft tissues . Such character of changes in the nails and around nail folds leads to an itch, burning sensation and pain and impaired tactile sensitivity of the fingers, difficulties in the execution of works with small objects, as well as to fatigue and psychological "oppression."
Differential diagnosis and treatment of psoriasis on the feet and hands represent significant difficulties in connection with the presence of these symptoms in other diseases. They meet and defeat nail fungus, and when taking certain medications, when seborrhea eczema, lichen pink and neurodermatitis. Such lesions often accompanied by hypertension, cardiac and pulmonary insufficiency, atherosclerosis of vessels of lower extremities, diabetes mellitus, chronic bacterial infection etc.
Often the psoriasis is combined with one or more of these diseases. Sometimes in a more accurate diagnosis, additional research methods are culture and histological examination, direct microscopy.
How to treat nail psoriasis
Diagnosis and duration of disease cause patient fear and anxiety, in which exacerbations become more frequent and more severe. Therefore, the responsibility of the dermatologist to inform patients about the resistant course of the disease, need long-term treatment with the correct implementation of all recommendations. Treatment of nail psoriasis is to combination of the General recommendations from medical drugs. Common activities include:
- Protection of the hands and feet gloves or medical gloves when in contact with water and household chemicals, especially in the presence of paronychia and onycholysis de.
- Preventing mechanical damage to the nails.
- Drawing on cushions around nail and skin moisturizing creams.
- Short haircut nails to avoid damage and de onycholysis.
- The rejection of the use of artificial nails and frequent use of manicure tools for machining plates of nails.
- The use of therapeutic coatings that have cosmetic value, and preventing penetration of infectious pathogens.
- Normalization of sleep and adherence to active physical regime.
- Prevention of hypothermia and prevention respiratorii viral diseases.
Treatment medical drugs
For local treatment at all stages of the disease are recommended for creams and ointments with vitamin D3 , steroid drugs.
It is applied topically the combination of corticosteroids with emollients (aloe) or preparations of tar. Courses local corticosteroid therapy are held 1-2 times per day for 3 to 9 months. The formulations are applied to areas of the nail bed, paronychia and hiponia. In addition, in severe inside the lesion, the introduction of a needle Triamcinolone acetate in a concentration of 10 mg in 1 ml, 2 times in 1 month.
Of secondary importance are the drugs of omega-3 polyunsaturated fatty acids, vitamins of different groups with a content of trace elements zinc, selenium and calcium, sedatives, and antihistamines for unstable psyche, the sensation of itching in the affected areas, the tendency to allergic reactions.
Tactics therapeutic effects of drugs depends on the clinical form, severity, duration, course and stage of the disease, and the presence of as related lesions of psoriasis and chronic somatic diseases in a specific patient. She has a goal to not only arrest deterioration but also a reduction in the frequency and duration of relapses, the increase in terms of remission, prevention of complications and rehabilitation in social terms.