Ultrasound Assessment of Psoriatic Onychopathy: A Cross-sectional Study Comparing Psoriatic Onychopathy with Onychomycosis
Mireia Moreno, Maria Pilar Lisbona, Fernando Gallardo, Gustavo Deza, Marta Ferran, Caridad Pontes, Jesús Luelmo, Joan Maymó, Jordi Gratacós
This cross-sectional study evaluated the usefulness of an ultrasound technique in assessment of nail changes in 35 patients with psoriatic onychopathy and 25 with nail dystrophy secondary to onychomycosis. All patients underwent 3 examinations: a complete clinical assessment; a nail ultrasound study; and fungal culture. Nails of patients with psoriatic onychopathy presented a thinner nail plate and nail bed, measured by ultrasound, than did those with onychomycosis. The percentage of patients with a power Doppler signal ?2 at nail bed was significantly higher in psoriatic onychopathy than in onychomycosis, and structural bone lesions were more frequent in psoriatic onychopathy than in onychomycosis. These results suggest that the presence of structural damage and high-power Doppler signal are the main ultrasound findings supporting a diagnosis of psoriatic onychopathy.
Ultrasound is an emerging, non-invasive, inexpensive, imaging technique with proven evidence for use in the assessment of different skin disorders. The aim of this study was to differentiate nail psoriasis from onychomycosis using an ultrasound technique, since clinical differentiation of these conditions is challenging, especially if psoriasis presents with nail disease alone. The long-term therapy and prognosis for these disorders are different, therefore early and adequate diagnosis is essential. Presence of structural bone damage and a high-power Doppler signal were the main observed ultrasonographic findings supporting a diagnosis of nail psoriasis and suggesting an association with psoriatic arthritis.