Psoriasis may also solely involve the nails, without any other skin findings, in which the treatment can be more challenging. The lifetime incidence of nail involvement in psoriatic patients is estimated to be 80–90%, and the nails can be affected in 10% to 55% of psoriatic patients. Nail psoriasis may lead to considerable impairment in quality of life due to aesthetic concerns and more importantly limitations in daily activities resulting from the associated pain, which may be overlooked by the physicians.
Nail psoriasis may show different clinical presentations according to the structure that is involved within the nail unit. Nail matrix involvement leads to irregular nail pitting (the most common finding of nail psoriasis), dystrophy, and leukonychia; nail bed involvement causes onycholysis, subungual hyperkeratosis, splinter hemorrhages, oil drop patches, and nail thickening,…
