Nail involvement occurs in up to 50 % of patients with psoriasis. Although most patients experience concurrent skin involvement, 1–5 % of patients present with nail changes alone. In these patients, it can be diagnostically challenging, as psoriatic nail disease can resemble several other nail dystrophies. In this chapter, we describe the differential diagnoses for each classic signs of nail psoriasis including pitting, onycholysis, subungual hyperkeratosis, splinter hemorrhages, and oil spots.
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