Nail Psoriasis: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body weight, height; furthermore:
    • Inspection (viewing).
      • Nails
        • Dimple or spotted nails (pinhead-sized retractions, filled with scales).
        • Oil stains (yellowish discolorations).
        • Longitudinal, brownish streaks (splinter hemorrhages).
        • Transverse or longitudinal grooves
        • Nail dystrophy (psoriatic crumbling nails – completely destroyed nail plate).
        • Onycholysis (detachment of the nail, white spots may form under the nail).
      • Skin [the skin around the nail may be red].
      • Range of motion of the joints [movement restrictions due to joint pain (possible secondary disease)]
    • Auscultation (listening) of the heart [due todifferential diagnosis: valvular heart disease].
    • Examination of the lungs [due todifferential diagnoses: asbestosis (one of the pneumoconioses (dust lung disease) lung disease, which is caused by inhaled asbestos dust); bronchiectasis (synonym: bronchiectasis; permanent outpouchings of the bronchi, which can occur congenitally or acquired as a result of inflammation); chronic obstructive pulmonary disease (COPD)]
  • Dermatological examination [due todifferential diagnoses:
    • Acrodermatitis continua Hallopeau (focal redness and pustules on the end phalanges of the fingers and toes).
    • Alopecia areata (circular hair loss).
    • Atopic eczema (neurodermatitis)
    • Dystrophia unguium mediana canaliformis (hereditary nail growth disorder).
    • Eczema (skin inflammation associated with pruritus (itching) and erythema (areal redness of the skin).
    • Lichen ruber planus (nodular lichen)
    • Nail mycosis (nail fungus)
    • Paronychia congenita (genetic disease of the nails associated with other hair abnormalities such as hyperhidrosis (increased sweating) and changes in mucous membranes).
    • Pityriasis rosea (scale florets)
    • Psoriasis (psoriasis)
    • Pustulosis palmoplantaris (disease with the appearance of pustules on the palms of the hands and feet).
    • Vitiligo (white spot disease)]
  • If necessary, neurological examination [due topossible secondary diseases: Alcohol dependence, drug dependence, resignation, social isolation]
  • Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings.