Derm Dx: Erythematous, Scaling Plaques and Pitting of the Nails - Dermatology Advisor

Derm Dx: Erythematous, Scaling Plaques and Pitting of the Nails

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  • Scaling Plaques

A 52-year-old man with psoriasis of longstanding duration presents with multiple erythematous, scaling plaques and pitting of all nails. His main complaint is that of progressive joint pain, most severe in his hands and lower back. Upon examination of his hands, his second digit is noted to be swollen.

Dactylitis, commonly referred to as "sausage-shaped" fingers and toes, is considered a hallmark of psoriatic arthritis. Psoriasis is a multifactorial inflammatory disease that may affect the spine, sacroiliac joints, and peripheral joints.1 Up to 20% of patients with psoriatic arthritis will...

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Dactylitis, commonly referred to as “sausage-shaped” fingers and toes, is considered a hallmark of psoriatic arthritis. Psoriasis is a multifactorial inflammatory disease that may affect the spine, sacroiliac joints, and peripheral joints.1 Up to 20% of patients with psoriatic arthritis will develop disabling arthritis. Joint damage may be seen both clinically and radiographically and can lead to a decreased quality of life. Other common clinical features of psoriatic arthritis include synovitis and enthesitis. Dactylitis results from peritendinous soft tissue edema.2

Dactylitis may affect multiple digits simultaneously and may be the initial sign of psoriatic arthritis.  It is frequently accompanied by nail changes, pain on palpation, tenderness, and soreness.2,3  Biologic therapies reduce the production of damaging cytokines and may limit progression of joint disease.4

Lauren Ax, MSPAC, PA-C, is a physician assistant on staff at the DermDox Center for Dermatology in Hazleton, PA, and Stephen Schleicher, MD, is director of the DermDox Center for Dermatology, as well as an associate professor of medicine at Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College.

References

  1. Kaley GS, Eder L, Aydin SZ, Gutierrez M, Bakewell C. Dactylitis: a hallmark of psoriatic arthritis. Semin Arthritis Rheum. 2018;48(2):263-273.
  2. Bagel J, Schwartzman S. Enthesitis and dactylitis in psoriatic disease: a guide for dermatologists. Am J Clin Dermatol. 2018;19(6):839-852.  
  3. Aiempanakit K. Psoriatic dactylitis [published online June 21, 2018]. J Clin Rheumatol.  doi: 10.1097/RHU.0000000000000841
  4. Yamamoto T. Optimal management of dactylitis in patients with psoriatic arthritis. Open Access Rhematol. 2015;7:55-62.
  5. Coates LC, Helliwell PS. Psoriatic arthritis: state of the art review. Clin Med (Lond). 2017;17(1):65-70
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