2.4 Pitty has Nail Pitting

by | Nov 28, 2017

Carol is a 45 year old woman with a history of psoriasis who presents with nail pitting.

What are the causes of pitting of the nail plate?

  1. Psoriasis
  2. Alopecia Areata
  3. Atopic dermatitis

What are the pharmacological treatment options for nail psoriasis?

  1. Calcipotriol solution twice daily
  2. Topical high-potency corticosteroid solution or ointment as weekend pulses under cellophane occlusion at night
  3. Clobetasol propionate 8% in a lacquer vehicle twice daily for 3 weeks then twice weekly
  4. 5-fluorouracil cream twice daily.

What are some second line option for treatment of nail psoriasis?

  1. Intralesional triamcinolone acetonide injections into proximal nail folds.
  2. Localised phototherapy with UVB
  3. photochemotherapy (PUVA)
  4. methotrexate
  5. acitretin
  6. ciclosporin

Reading

  1. Murtaghs General Practice Chapter 129 – http://murtagh.mhmedical.com/content.aspx?bookid=1522&sectionid=116046129
  2. Murtaghs Practice Tips – Chapter 8 – Nail Problems – http://murtagh.mhmedical.com/content.aspx?bookid=1920&sectionid=143276631

Podcast

  1. GP Core Content Podcast Episode 150 – Dermatology | Nails