Psoriatic Nails; Severe Dystrophy and Hyperkeratosis.

Abstract

A 45-year-old gentleman presented with a 6-year history of progressive psoriasis. He reported having initially developed psoriasis 6 years previously. This had progressively worsened, and he developed significant nail involvement. He denied any joint symptoms. He previously had been treated with moderately potent topical steroids with limited response. On initial examination, he was noted to have extensive psoriatic plaques across his body. There was severe dystrophy of the finger and toenails with significant hyperkeratosis. Figure 1 illustrates significant subungal hyperkeratosis, dystrophy, and onycholysis of the right thumbnail. Following screening, the patient was commenced on fortnightly adalimumab 40 mg. At his review clinic visit, 3 months after starting treatment, his skin was clear with significant nail improvement noted (Fig. 2).