Ahu Yorulmaz

Background: Nail psoriasis (NP) presents with various morphological patterns. Identifying these patterns enhances the recognition and diagnosis of NP. Dermoscopy is the only modality capable of providing accurate information regarding these patterns. Objective: This study aimed to identify and classify NP into distinct dermoscopic patterns and evaluate their relationships with disease severity and the risk of psoriatic arthritis. A secondary objective was to propose a pattern-based dermoscopic algorithm for NP diagnosis. Methods: This prospective study included 208 patients diagnosed with NP and 418 individuals without any nail disorders as controls. Over 1 yr, all participants underwent a dermoscopic examination of each nail. Results: Two primary dermoscopic patterns were observed in NP patients: the bed and matrix (BM) pattern and trachyonychia. The BM pattern, the prototypical presentation of NP, involved findings related to both the nail bed and nail matrix. Trachyonychia was characterized by rough nail surfaces and pitting. The BM pattern was more prevalent than trachyonychia. However, patients with trachyonychia exhibited more severe psoriasis and NP and were more likely to develop psoriatic arthritis. Leukonychia was more common in the control group. Conclusion: Although dermoscopy is a highly reliable diagnostic tool, it remains underutilized in NP diagnosis. This study demonstrates that NP exhibits specific morphological patterns that distinguish it from other nail disorders. A pattern-based dermoscopic algorithm was proposed, potentially eliminating the need for histopathological examination when these characteristic patterns are detected.

Aim: This study aimed to investigate the relationship between early‐onset androgenetic alopecia (AGA) and the prevalence of insulin resistance (IR) and metabolic syndrome (MetS) in young adult males. Methods: A total of 200 males aged 18 to 35 years were enrolled in this case–control study, including 100 patients with early‐onset AGA and 100 age‐ and body mass index‐matched controls. Clinical staging was performed using the Hamilton–Norwood classification, and all participants underwent standardized physical and biochemical evaluation. Results: The prevalence of insulin resistance (HOMA‐IR ≥ 2.7) was significantly higher in the AGA group compared to the control group (18% vs. 4%, p = 0.003). Similarly, MetS was more common among AGA patients (21% vs. 9%, p = 0.011). Fasting insulin levels, triglyceride concentrations, and HOMA‐IR scores were all significantly elevated in the AGA group, while HDL‐C levels were comparable between groups. Waist circumference was also significantly greater in the AGA group ( p = 0.026). When stratified by AGA severity, the frequency of IR progressively increased with increasing Hamilton–Norwood stages. No significant differences were observed in fasting glucose or blood pressure categories. Although individual MetS components were similar, cumulative clustering of risk factors appeared to be associated with a significantly higher MetS frequency among patients with AGA. Conclusion: Early‐onset AGA in men may serve as a visible clinical indicator of underlying metabolic disturbances, particularly IR. Routine metabolic screening may be advisable in young men presenting with advanced AGA stage.

Palmoplantar pustulosis (PPP) is a chronic, recurrent inflammatory dermatosis affecting the palms and soles, classified as a form of acral pustular psoriasis. Nail involvement occurs in over half of PPP patients. This report presents a patient with PPP and idiopathic thrombocytopenic purpura who exhibited purpuric plantar and nail lesions. Dermoscopic examination revealed the hypopyon sign in both plantar and nail lesions, as well as centrally located eccrine duct openings within the plantar pustules. The hypopyon sign has been rarely documented, with previous reports limited to lymphangioma circumscriptum and angiosarcoma. This case supports the role of microvascular abnormalities in psoriasis pathogenesis and warrants further investigation into the underlying mechanisms.

Psoriasis is a common, chronic inflammatory dermatosis, and patients with psoriasis often develop nail involvement. It is estimated that up to 90% of patients experience nail lesions at least once in their lifetime. Nail psoriasis (NP) occurs when psoriatic inflammation affects the nail matrix, nail bed, or both. The clinical manifestations of NP vary depending on the location and severity of the inflammation. Common signs include pitting, splinter hemorrhages, salmon patches, and distal onycholysis. Although cutaneous psoriasis is considered more severe in individuals with nail involvement, there is no clear relationship between the duration, severity, and clinical presentations of cutaneous psoriasis and NP patterns. NP is notable for an increased prevalence of arthritis among patients and is considered a significant clinical burden due to its association with arthritis and its slow or poor response to many therapeutic agents. Effective reassurance and patient education are essential components of NP management. This review summarizes clinical manifestations and diagnostic and therapeutic strategies for NP.

Introduction: Palmoplantar psoriasis (PP) is classified as nonpustular psoriasis (NPPP) or palmoplantar pustulosis (PPP). Objective: We sought to shed light on the phenotypic diversity of nail psoriasis (NP) and conducted a thorough study of the dermoscopic features of nail lesions from patients with NPPP and PPP. Methods: A prospective study included 35 patients with NPPP and 20 patients with PPP who had macroscopic NP changes in at least three of their nails. Demographic and clinical data, such as general characteristics, history, a thorough dermatological examination, and musculoskeletal assessment, were recorded. Each patient had their nails evaluated with video dermoscopy. The statistical analysis was carried out using SPSS software, including descriptive and analytical statistics. Results: Dermoscopic patterns of nail lesions in both groups differed from those seen in psoriasis vulgaris (PV). Trachyonychia was the most common dermoscopic pattern among NPPP patients. Nail bed pustules were found in 75% of the PPP patients, and they were the most common dermoscopic finding identifying PPP nail lesions. In comparison to the NPPP group, patients with PPP had a higher frequency of psoriatic arthritis (PsA) and higher PP and NP severity scores. In the PPP group, all patients with PsA had pustules. Conclusions: NP has a heterogeneous presentation and various clinical manifestations in NPPP, PPP, and PV. The differences in dermoscopic patterns of nail lesions among NPPP, PPP, and PV reflect the diseases' distinct characteristics. A thorough dermoscopic examination of the nails may reveal information about both the underlying pathophysiological pathways and the overall course of psoriasis.