Coexistence of onychomycosis in psoriatic nails: A descriptive study

Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Indian journal of dermatology, venereology and leprology (Impact Factor: 1.39). 11/2010; 76(6):723. DOI: 10.4103/0378-6323.72468
Source: PubMed


Psoriatic nail changes predispose to onychomycosis because it becomes easier for fungi to penetrate an already compromised nail plate. Moreover, some of the psoriatic nail changes closely resemble onychomycosis.
To investigate cases of nail psoriasis for any evidence of onychomycosis.
Seventy-two patients with psoriasis were included in the study. The patients were selected from the psoriasis clinic and dermatology in-patient ward. Direct microscopic examination with 20% KOH and culture were carried out in all patients showing psoriatic nail changes. Histopathological examination with Periodic Acid-Schiff (PAS) stain was done in cases negative by KOH examination and culture.
Nail changes were seen in 66.66% (48/72) of psoriasis patients. The most common fingernail changes observed were pitting, onycholysis and subungual hyperkeratosis, and the most common toenail changes were onycholysis and subungual hyperkeratosis. Nail changes were significantly more common in males. The duration of skin lesions of psoriasis and Psoriasis Area Severity Index scores were significantly higher in patients with nail changes. Out of 48 patients with psoriatic nail change, 23 (47.91%) had investigative evidence of onychomycosis. The fungal isolates on culture were non-dermatophytic molds in nine patients (18.75%) and yeast like fungi also in nine patients (18.75%).
Coexistent onychomycosis in psoriatic nails does occur.

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Available from: Rakesh Singh, Sep 12, 2015
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    • "The association between these two conditions is estimated to occur in 4.6-30% of patients with nail psoriasis, and the morphology of the lesions caused by these two diseases can be similar. 31 The presence of onychomycosis in patients with nail psoriasis may lead to more intense clinical manifestations through the Koebner phenomenon, which occurs as a result of continuous fungal infections.26 "
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    • "In contrast to psoriatic onycholysis that exhibits the classical salmon spot colour at its proximal margin, mycotic onycholysis has no reddish-brown margin (Fig 21 a&b). Nail psoriasis and onychomycosis may coexist (Natarajan et al, 2010). "

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