Abstract
Psoriasis is a common disease in dermatologic practice that affects approximately 2 % of the population, with a rising incidence over the years. Nail involvement has long been recognized as a common manifestation of psoriasis, occurring in up to 50 % of patients with an estimated lifetime incidence of 80–90 %. Nail psoriasis occurs more frequently in patients with severe disease such as those with psoriatic arthritis, with a prevalence of 70–80 % in this latter group.
However, nail psoriasis also occurs in 40 % of patients with mild psoriasis (PASI ≤10). In patients with moderate to severe psoriasis, approximately 82 % have nail psoriasis symptoms. Importantly, between 1 and 5 % of patients have affected nails without skin lesions. Biopsies are difficult to perform in nails since they may leave permanent cosmetic sequels; therefore, to have at our disposal a noninvasive window to unveil the anatomic details of the nail unit and their pathologies would be of great benefit.
Ultrasound has been increasingly used for studying skin and nails lesions and has become a daily imaging technique in our practice. Furthermore, the addition of variable frequency ultrasound to the clinical dermatologic practice has been reported to increase the correctness of the diagnosis from 73 to 97 %. This method of imaging provides exquisite detail of the nail anatomy, covering from the surface of the ungual plate to the bony margin of the distal phalanx. It can recognize submillimeter lesions and can show the ungual blood flow in real time.
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Wortsman, X., Soto, R. (2014). Ultrasound Imaging of Psoriatic Nails. In: Rigopoulos, D., Tosti, A. (eds) Nail Psoriasis. Springer, Cham. https://doi.org/10.1007/978-3-319-08810-5_7
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DOI: https://doi.org/10.1007/978-3-319-08810-5_7
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