Alexander KC Leung1*, Amy AM Leung2 and Benjamin Barankin3
1Clinical Professor of Pediatrics, The University of Calgary, Pediatric Consultant, The Alberta Children's Hospital, Calgary, Alberta, Canada
2Medical Student, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
3Dermatologist & Medical Director, Toronto Dermatology Centre, Toronto, Ontario, Canada
Received : 30 July, 2015; Accepted: 29 August, 2015;Published: 01 September, 2015
Dr. Alexander KC Leung, #200, 233 – 16th Avenue NW, Calgary, Alberta, Canada T2M 0H5, Tel: (403) 230-3322; Fax: (403) 230-3322; E-mail:
Leung AKC, Leung AAM, Barankin B (2015) Psoriasis with Onychodystrophy in a 7-Year-Old Boy. Int J Dermatol Clin Res 1(2): 016-017. DOI: 10.17352/2455-8605.000007
© 2015 Leung AKC, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Subungual hyperkeratosis; Nail-plate crumbling; Nail-plate discoloration; Onycholysis; Onychomycosis
Up to 90% of patients with psoriasis develop onychodystrophy at some point during their lives. Nail involvement precedes the skin lesions in approximately 4% of patients. We herewith report a case of a 7-year-old boy with psoriatic onychodystrophy at the age of 6 years followed by the appearance of plaque psoriasis 6 months later. The psoriatic onychodystrophy was initially misdiagnosed as onychomycosis by his family physician and was treated as such. Psoriatic onychodystrophy can clinically mimic onychomycosis and differentiation of the two conditions can be difficult. We emphasize the need for potassium hydroxide examination and culture of nail scrapings/clippings to demonstrate fungal elements, should there be doubt in the diagnosis.
Psoriasis, a chronic inflammatory immune-mediated disease involving the skin, nails, and the musculoskeletal structures, affects 1 to 3% of the world population . Approximately 25% of patients develop the disease before 20 years of age . It is reported that up to 90% of patients with psoriasis develop onychodystrophy at some point during their lives [3-5]. Nail involvement precedes the skin lesions in approximately 4% of patients . We herewith report a 7-year-old boy who presented with psoriatic onychodystrophy at the age of 6 years followed by the development of plaque psoriasis 6 months later.
A 7-year-old Chinese boy sought medical attention from his family physician a year ago because of nail abnormalities on the hands and feet. He was diagnosed with onychomycosis and was treated with several courses of oral terbinafine without much success and with no adverse reaction. Six months later, he developed a pruritic skin eruption on the scalp and trunk. The skin lesions were erythematous and increased in size and number with time. There was no associated joint pain. His past health was otherwise unremarkable. There was no family history of psoriasis.
The patient was referred to us for consultation at this stage. Physical examination revealed a solitary, discrete, well-demarcated, thick, erythematous plaque with overlying scales on the left frontal scalp and sharply demarcated erythematous plaques with adherent silvery micaceous scales on the trunk. The distal aspects of all digits were erythematous with subungual hyperkeratosis, nail-plate crumbling, yellow nail-plate discoloration, and distal onycholysis (Figure 1). The rest of the physical examination was normal. In particular, there were no signs of psoriatic arthritis.
- Al-Mutairi N, Manchanda Y, Nour-Eldin O (2007) Nail changes in childhood psoriasis: a study from Kuwait. Pediatr Dermatol 24: 7-10.
- Leung AK, Robson WL (2009) Psoriasis. In: Lang F, ed. The Encyclopedia of Molecular Mechanisms of Disease. Berlin: Springer-Verlag 1750-1751.
- Schons KR, Beber AA, Beck Mde O, Monticielo OA (2015) Nail involvement in adult patients with plaque-type psoriasis: prevalence and clinical features. An Bras Dermatol 90: 314-319.
- Tan ES, Chong WS, Tey HL (2012) Nail psoriasis: a review. Am J Clin Dermatol 13: 375-388.
- van der Velden HM, Klaasen KM, van de Kerkhof PC, Pasch MC (2013) Finfernail psoriasis reconsidered: a case-control study. J Am Acad Dermatol 69: 245-252.
- Augustin M, Reich K, Blome C, Schäfer I, Laass A, et al. (2010) Nail psoriasis in Germany: epidemiology and burden of disease. Br J Dermatol 163: 580-585.
- de Berker D (2009) Management of psoriatic nail disease. Semin Cutan Med Surg 28: 39-43.
- Klaassen KM, Dulak MG, van de Kerkhof PC, Pasch MC (2014) The prevalence of onychomycosis in psoriatic patients: a systematic review. J Eur Acad Dermatol Venereol 28: 533-541.
- Hoy NY, Leung AK, Metelitsa AI, Adams S (2012) New concepts in median nail dystrophy, onychomycosis, and hand, foot, and mouth disease nail pathology. ISRN Dermatology 680163.
- Natarajan V, Nath AK, Thappa DM, Singh R, Verma SK (2010) Coexistence of onychomycosis in psoriatic nails: a descriptive study. Indian J Dermatol Venereol Leprol 76: 723.
- Klaassen KM, van de Kerkhof PC, Pasch MC (2014) Nail psoriasis, the unknown burden of disease. J Eur Acad Dermatol Venereol 28: 1690-1695.
- Langenbruch A, Radtke MA, Krensel M, Jacobi A, Reich K, et al. (2014) Nail involvement as a predictor of concomitant psoriatic arthritis in patients with psoriasis. Br J Dermatol 171: 1123-1128 .
- Raposo I, Torres T (2015) Nail psoriasis as a predictor of the development of psoriatic arthritis. Actas Dermosifiliogr 106: 452-457.