Nail involvement is present in over half of patients with psoriasis and consequently has a prominently negative impact on society. The clinical gamut of nail involvement is diverse and includes changes to the nail matrix, the nail bed, or both. The main nail matrix dystrophy is nail pitting while onycholysis, subungual hyperkeratosis, splinter hemorrhages, and oil-drop discoloration are the major nail bed findings. Lesions of the nail plate are due to the location of disease in the nail matrix as well as the duration of the disease. This chapter will describe the broad array of clinical features of nail psoriasis in order to help clinicians identify the condition, which will enable dermatologists to treat the symptoms and hopefully improve patients’ lives.
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