The Exploration Of Dermoscopic Features Of Nail Psoriasis And Onychomycosis

Background With the improvement of people’s living standards,nail disorders has drawn increasing attention.In nail disorders, Onychomycosis and Nail psoriasis have a higher incidence. Onychomycosis and nail psoriasis have a great influence on the patient,s quality of life.However, the gold standard in the diagnosis of these two diseases are limited, so doctors need to seek new diagnostic methods. Psoriasis is a common,chronic,inflammatory dermatosis,and nail involvement affects approximately 10%~78% of psoriasis patient with about 5% of patients having isolated nail psoriasis. Merging other psoriasis damage of the nail psoriasis is easy to diagnose,but for the independence of nail psoriasis damage, it is difficult for clinical diagnosis and only depends on pathological biopsy. And because of the special anatomical structure, histopathologic examination has great trauma,and not easily accepted by patients. Therefore, seeking a new diagnostic method is the goal of a dermatologist continuous efforts. Onychomycosis is caused by ermatophytes, yeasts and non dermatophyte. Onychomycosis is common in the world, and the crowd of onychomycosis incidence is about 5%. Onychomycosis is infectious. Onychomycosis not only affects the patients’ daily interpersonal communication, but also affects the quality of life of patients with different degree.The gold standar(direct microscopy and culture) may be false negative in up to 35% of the cases,and Most of the general hospital is not set up a fungus microscopy examination,so Clinican only rely on experience in diagnosis and has great limitations. Dermoscopy as a noninvasive detection tool, can identify the structure that is not visible or difficult to identify to the naked eye,and widely used to diagnose or differentially diagnose pigment dermatopathya and some skin tumor. In recent years,Doctors have found that it can also be valual to diagnose no pigmentary lesions.Currently,the article of describing Onychomycosis and nail psoriasis,dermoscopic characteristics is lack.In the study, Through dermoscopic detection, we can observe and describe the dermoscopic features of onychomycosis and nailpsoriasis, and explore the role of dermoscopy in the diagnosis and differential diagnosis of onychomycosis and nail psoriasis. Aim Observation of he unique features of dermoscopy of nail psoriasis and onychomycosis, which might be helpful in the diagnosis of nail psoriasis and onychomycosis, especially especially isolated nail psoriasis and not typical of onychomycosis(microscopic examination negative) in the diagnosis and differential diagnosis.Materials and methods The clinical data,digital clinical and dermocopic images of 48 nail psoriasis with body psoriasis were recruited sequentially in Word of Dermatology and Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital from October 2014 to January 2015. The clinical data,digital clinical and dermocopic images of 59 onychomycosis were recruited sequentially in out-Patient Department of Dermatology and Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital from October 2014 to January 2015. Clinical images of each patient were taken with digital camera(DSC 一 HX50,Sony). Dermoseopic images of each patient were shotted with digital dermoscopic system(Dino-Lite AM4113ZT). Demoscopic patterns in nail disorsers were defined by experienced dermoscopist,and the frequency of each pattern was analyzed statistieally with SPSS10.0.Result 1. Basic information In 48 cases,male 20,female 28,the male to female ratio 1:1.4.The age of patients range from 18 to 68 years(median age 37 years). In 48 cases,Psoriasis vulgaris 38 cases, Psoriasis pustulosa 6 cases,Erythroderma Psoriasis 4 cases. In 59 cases,male 18,female 41,the male to female ratio 1:2.28.The age of patients range from 13 to 74 years(median age 54 years).The course of disease range from two month to for decades.The toenail lesion cases 35,fingernsil lesion cases 24.Full nail damage type 38 cases,distal subungual type 21 cases. 2. General dermoscopic features of Onychomycosis and nail psoriasis 2.1 General dermoscopic features of nail psoriasis General dermoscopic features of Psoriasis vulgaris of nail psoriasis:Pitting13/38(34.2%), Oil spot 9/38(23.7%)、Onycholysis 27/38(57.9%),Erythematous border of proximal onycholysis 16/38(42.1%), Nail destruction(Longitudinal crack/Horizontal streak/Rough/Thick) 21/38(55.3%),Subungual keratosis 11/38(28.9%), Splinter hemorrhages 14/38(36.8%),Pellets blood vessels 33/38(86.8%)。 The nails of Psoriasis pustulosa and Erythroderma Psoriasis are destructed seriously,and both have pellets blood vessels. 2.2 Dermoscopic features and the probability of dermoscopic features of onychomycosis. General dermoscopic features of full nail damaged onychomycosis: Ruin appearance/ Nail bed longitudinal ridges 38/38(100%) 、 Longitudinal striae 19/38(50%) 、 Colour change(white/yellow/yellow-brown/brown)38/38(100%) 、Splinter hemorrhages 20/38(52.6%) 、 Thick nail 38/38(100%) 、 Matte nail 38/38(100%) General dermoscopic features of diatal subungual onychomycosis: Ruin Appearance 21/21(100%), Longitudinal striae 18/21(85.7%), Jagged edge 17/21(81.0%), Colour change(white/yellow/yellow-brown/brown)21/21(100%), Splinter hemorrhages 13/21(61.9%), Thick nail 21/21(100%), Matte nail 21/21(100%).Conclusion Characteristic dermoscopy features of Nail psoriasis : Pitting 、 Oil spot 、Erythematous border of proximal onycholysis、Pellets blood vessels. Characteristic dermoscopy features of onychomycosis: Ruin appearance、 Nail bed longitudinal ridges、Longitudinal striae、Jagged edge. The dermoscopic features of Nail psoriasis and Onychomycosis contribute to the diagnosis of Nail psoriasis and Onychomycosis.The dermoscopic features can provide a certain amount of diagnosis,especially to the atypical lesions.