The use of videodermoscopy for monitoring subungual hyperkeratosis in a psoriasis patient treated with infliximab

Introduction . Nail psoriasis is observed in nearly 50% of patients with common psoriasis and in more than 80% of patients with psoriatic arthritis. Severe nail involvement is painful and impairs everyday functioning. Data indicate a correlation between nail changes and psoriatic arthritis. Effective and safe treatment improves the aesthetic aspect of nails and hand/foot function. The search for effective but non-invasive methods to monitor nail involvement is ongoing.

Objective . Presentation of clearing of nail changes in a patient with common psoriasis and psoriatic arthritis during infliximab therapy with corresponding results of dermoscopic observations of nail apparatus.

Case report . Severe nail lesions presenting as subungual hyperkeratosis with tendency to onycholysis and salmon patches in a 58-year-old female with psoriasis and psoriatic arthritis have been a therapeutic challenge. Eleven-month treatment with infliximab resulted in complete regrowth of healthy nails, clearance of skin lesions and reduction of joint pain. With videodermoscopy, we observed improvement of nail plates, especially lack of subungual hyperkeratosis and normalization of vascular structures of the proximal nail fold. All lesions reappeared a few months after discontinuation of infliximab therapy.

Conclusions . Eleven-month treatment with infliximab led to clearance of nail changes in the patient with psoriasis and psoriatic arthritis. On videodermoscopy gradual disappearance of pathological dermoscopic findings was observed, giving hope to use this method as a tool for monitoring of nail psoriasis therapy.