Finger (toe) nail point depression
Introduction
Introduction Point (toe) nail-like depression is a symptom of psoriasis involving nails. Psoriasis in the nail matrix will have point depressions, ridges and sulcus on the deck, and nail detachment, hyperkeratosis and rupture. Psoriasis, commonly known as psoriasis, is a chronic inflammatory skin disease with a long course of disease and a tendency to relapse. Some cases are almost unhealed for life. The disease is mainly caused by young adults, and has a great impact on the health and mental state of patients. The clinical manifestations are mainly erythema and scaly, and the whole body can be affected. The scalp and the extremities are more common, and more often in winter.
Cause
Cause
1 genetic factors
It is believed that the disease is controlled by multiple genes and is also affected by other factors.
2 infection factors
Some people think that it is caused by viral infection. Although eosinophilic inclusion bodies have been found in the nucleus of epithelial cells, viral culture has not been successful so far. Streptococcal infection may be an important predisposing factor for this disease, because acute tonsillary psoriasis often has acute tonsillitis or upper respiratory tract infection before rash.
3 metabolic disorders
There were reports of increased serum lipids, cholesterol, globulin, sugar, uric acid, potassium, etc., and decreased folic acid content, but failed to make a positive conclusion. It has also been reported that polyamines and arachidonic acid increase in lesions.
4 immune dysfunction
Some patients have low cellular immune function; some serum IgG, IgA, and IgE are increased; some patients have anti-IgG antibodies in their serum; some people have detected anti-keratin autoantibodies in the stratum corneum of the epidermis by immunofluorescence technique.
5 mental factors
Trauma and emotional stress and overwork can induce or exacerbate the disease.
6 other
Most patients relapse, aggravate in winter, remission or natural regression in summer, but the regularity of long-term patients disappears. There are also women who have aggravated before and after menstruation, rash during pregnancy and relapse after childbirth. Chloroquine, lithium carbonate and beta-adrenergic blockers can aggravate the disease.
Examine
an examination
Related inspection
Serum interleukin-6 rash
Psoriasis is generally divided into four types: vulgaris, pustular, arthritic and erythrodermic.
(a) psoriasis vulgaris
Psoriasis vulgaris is the most common type in the clinic. From the beginning, it is red papules or maculopapular rash. Later, it gradually enlarges or merges with each other to form a patch with clear boundaries. The surface is covered with silvery white scales. After smoothing off the scales, a smooth film is revealed. After scraping, multiple fine bleeding spots can appear. . The above scaly, film and punctiform hemorrhage are the three major clinical features of the disease. The disease can occur in any part of the body, distributed symmetrically, occurring in the knee, elbow joint and head, and a few patients have a point (needle-like) depression. Clinically, there are acute progression, quiescent phase and regression phase.
Progression: It is characterized by more rashes in the rash, bright red color and rapid development, more scaly, easy to fall off, and more itching. Normal skin, if stimulated by trauma, can be secondary to psoriasis lesions, which is called homomorphic reaction.
Resting period: The condition remains at rest, no new rash appears, and the old rash does not subside.
Degenerative period: The rash shrinks and gradually disappears. After the rash subsides, temporary hypopigmentation or plaque can be left behind.
(B) pustular psoriasis, divided into generalized, limited two types.
1. Generalized pustular psoriasis is rare in clinical practice. This type of disease is acute, with systemic discomfort and accompanied by systemic symptoms such as relaxation and hyperthermia and leukocytosis. The skin lesions begin with acute inflammatory erythema, with most dense needles on the surface to the size of the miliary yellow-white sterilized shallow small pustules. Pustules can be expanded to form a "pus paste" shape. Often involved in the majority of leather, and can even extend the whole body. The cause of the disease is often associated with psoriasis vulgaris. After long-term use of corticosteroids, the drug suddenly stops and is involved in infection or drug stimulation. The disease is severe, often with periodic recurrence and poor prognosis.
2. Localized pustular psoriasis, also known as palmoplantar pustular psoriasis, mostly limited to palmar palsy, often occurs in large numbers of small yellow needles to miliary size pustules in large and small fish or foot and ankle. Flushing red. After about 1 to 2 weeks, the pustules rupture, crusting, and desquamation. Later, small pustules appeared under the scales, which were light and heavy. Self-itching or pain. Can affect the nails, turbid and thick, with a braided bulge. Psoriasis lesions are often seen in other parts of the patient's body. It also occurred in the palm of the hand, and after several repeated episodes, it turned into a generalized person.
(three) arthritic psoriasis
Also known as psoriatic joints, often secondary to psoriasis vulgaris or psoriasis repeated repeatedly, may also have joint symptoms or complicated with pustular psoriasis and erythrodermic psoriasis . Joint symptoms and psoriatic lesions have a parallel relationship, the disease is more common in men.
The main clinical features are a history of psoriasis or asymmetrical peripheral polyarthritis complicated with psoriasis, involving the distal heart joint, accompanied by nail damage, and rheumatoid factor negative. In addition, you can refer to the X-ray inspection. It should be differentiated from rheumatoid arthritis, which infringes on the proximal parietal joint, but is not associated with psoriasis and rheumatoid factor. The disease can be prolonged for a long time, and treatment is more difficult.
(4) erythrodermic psoriasis
Many cases of psoriasis vulgaris in the acute stage of the application of more irritating drugs or long-term use of corticosteroids, improper withdrawal or reduction methods. In addition, pustular psoriasis can also occur in the process of pustular regression, erythroderma. The disease accounts for about 1% of psoriasis. At the beginning, the redness appeared in the original psoriatic lesions, and it quickly expanded into large pieces. Finally, the whole body showed diffuse flushing infiltration. In the diffuse flushing infiltration, there were often normal flaky "peel islands", which is the characteristic of this disease. one. Often accompanied by fever, chills, headache, general malaise and so on.
Diagnosis
Differential diagnosis
Clinical manifestations of psoriasis in various parts:
Damage can be seen throughout the body, and multiple symmetry occurs. However, the scalp and limbs are more common. Finger nails and mucous membranes can also be involved, and a few can be found in wrinkles such as the armpits and groin. The palmar palsy is less common. The characteristics of psoriasis in each part are as follows:
Head psoriasis: scaly erythema with clear boundaries, white or yellowish scales, and bundles of hair at the skin lesions. The rash can only be seen on the head or at the same time throughout the body.
Facial psoriasis: thin scales, scattered lesions, seborrheic dermatitis-like damage. But at the same time, the psoriasis changes in the trunk and limbs.
Pleated psoriasis: Skin lesions are more common in the underarms, breasts, groin, and perineum. The surface of the lesions is moist and eczema-like.
Mucosal psoriasis: often occurs in the glans and foreskin, a smooth and dry erythema with clear boundaries, white scales scraped, and psoriasis changes in other parts of the body.
Finger psoriasis: Most patients with psoriasis have nail damage. The performance indicates that the (toe) deck is dull, hypertrophic, and the free end is separated from the nail bed. The deck surface is somewhat sunken, and sometimes the deck is deformed or absent, and it changes like a nail.
Psoriasis of the palm of your hand: rare, can occur at the same time as other parts, or can be seen alone in the palm of your hand. Skin lesions are keratinized patches with obvious boundaries. The center is thicker and the edges are thinner. The spots may have a bit of white scales or dents.
Follicular psoriasis: rare, often occurring with typical psoriasis lesions, can be made by two different clinical types: adult and child.
 nail point depression)
