Nail psoriasis by Dr : Ahmad Nofal

A 45 years female patient presented with these lesions on the hands only, without any skin lesions elsewhere

the DD was psoriasis and dermatophytosis of the nails due to presence of common findings in both diseases that include subungual hyperkeratosis, onycholysis, yelowish discoloration and thickening, The absence of skin lesions adds to the difficulty in diagnosis. Culture was done and revealed positive findings for dermatophytes and the patient received terbinafine and then itraconazole without any response in spite of adequate dose and duration. so the diagnosis is : secondary dermatophytosis on top of psoriasis .

acitretin 25 mg twice daily