Nail involvement is common at some point in the life of the patient with psoriasis. Simple
hand care, keeping nails cut short and avoiding nail trauma, will all help in management.
Medical interventions include topical therapies used for psoriasis at other body sites,
directed at the location of the disease within the nail unit. Individual digits may require
focused intensive treatment, such as steroid injections. Systemic therapy for psoriatic nail
disease can be justified when the disease presents in tandem with severe skin disease or
where function and quality of life are sufficiently diminished by nail involvement. Biological
therapy usually is indicated for widespread psoriasis, but studies show that therapy
directed at nail symptoms can be effective in the treatment of coincident nail disease.
Semin Cutan Med Surg 28:39-43 © 2009 Published by Elsevier Inc.
Tumors of the nail unit may be difficult to diagnose because of the screening effect of the
nail plate. In longitudinal melanonychia, several new promising techniques assist with early
diagnosis of melanoma (in vivo matrix dermoscopy and immunohistochemistry) as well as
sparing as much of the healthy tissues as is possible (shave biopsy technique). Diagnosing
nail disorders is in some instances difficult both for the clinician and the pathologist. New
tools such as polymerase chain reaction have been proposed for onychomycosis, which
accounts for more than half of nail conditions, will allow quick and accurate diagnosis.
However, polymerase chain reaction analysis remains expensive and is not routinely used
by clinicians. Scoring nail dystrophy by clinical observation remains very subjective;
therefore, severity indexes have been proposed. Another emerging noninvasive technique
is forensic analysis of nail clippings for detection of drug intake and abuse, as well as
exposure to environmental pollution
Semin Cutan Med Surg 28:44-48 © 2009 Elsevier Inc. All rights reserved.
Melanonychia describes a brown or black pigmentation of the nail plate caused by the
presence of melanin. In this article, we review possible causes of melanonychia and
discuss the main problems of management of patients with this condition. The goal in the
management of melanonychia is early diagnosis of melanoma of the nail matrix and bed.
Melanoma of the nail bed is also known as subungual melanoma. We discuss clinical,
dermoscopic features that may help the clinician in chossing lesions that should have
excisional biopsy and evaluate different options for the excision. Addressing melanonychia
is still a difficult task, and the correct management of pigmented bands in children is far
from established. Dermoscopy is possibly a useful tool but the real benefit of this technique,
screening lesions to determine which ones need to be removed, remains to be
Semin Cutan Med Surg 28:49-54 © 2009 Elsevier Inc. All rights reserved.
Nail surgery is part of the dermatologist’s armamentarium but it is often an afterthought in
teaching dermatologic surgery. We will offer some practical hints about instruments and
supplies, evaluation of pigmented lesions to determine whether a biopsy is needed, local
anesthesia, and surgical techniques that should make procedures of the nail unit more
efficient, less painful, and less likely to result in complications.
Semin Cutan Med Surg 28:55-60 © 2009 Published by Elsevier Inc.