J Rheum Dis.  2015 Feb;22(1):45-50. 10.4078/jrd.2015.22.1.45.

Psoriatic Onycho-pachydermo-periostitis of the Fingertips: A Report of Two Cases

• Park MI
• Kim BY
• Park I
• Kwon KT
• Shin DJ
• Kim GW
• Kim SH
• Han SW

• KMID: 2222927
• DOI: http://doi.org/10.4078/jrd.2015.22.1.45

Abstract

Psoriatic onycho-pachydermo-periostitis (POPP) causes severe nail dystrophy, painful soft tissue swelling, and marked periosteal reaction of the involved distal phalanx. There are few reports of POPP involving the great toe. We report on 2 cases of POPP involving the fingertips. A 60-year-old woman presented with fusiform swelling of her right 4th fingertip with severe tenderness, and her fingernails and toenails had varying degrees of onycholysis. She had mixed multiple erosions and meta-epiphyseal periostitis at the distal phalanx of the right 4th finger but was treated successfully with methotrexate and cyclosporine. A 39-year-old woman presented with painful swelling of the left 2nd and 5th fingertip, psoriatic lesions on the knees and soles of the feet, and onycholysis without reactive periostitis of the left 2nd and 5th fingers. She was treated successfully with cyclosporine. Despite its rarity, POPP should be considered when diagnosing arthritic or infectious conditions affecting the distal interphalangeal joint.

Keyword

Arthritis; Psoriasis; Periostitis; Onycholysis

MeSH Terms

Adult
Arthritis
Cyclosporine
Female
Fingers
Foot
Humans
Joints
Knee
Methotrexate
Middle Aged
Nails
Onycholysis
Periostitis
Psoriasis
Toes
Cyclosporine
Methotrexate

Figure

• 

  Figure 1. The first patient's skin lesion and three-phase bone scintigraph. (A∼ C) The right 4th fingertip shows fusiform swelling with erythema, and the nails of the fingers and toes demonstrate dystrophic onycholysis. (B, C) Pustular psoriatic lesions are noted in the left palm and right great toe. (D) Three-phase bone scintigraphy shows a focal radio-nuclide accumulation in the right 4th and left 3rd distal phalanx fingers on a delayed static scan.

• 

  Figure 2. A serial change of the hand is shown on anteroposterior radiographs. (A) The radiograph taken 6 months prior to presentation demonstrates meta-epi-physeal periostitis and multiple erosions of the distal phalanx of the left 4th finger. (B) After 4 months, a reactive bone formation is observed at the shaft of the distal phalanx (arrow). (C) The radiograph at presentation reveals progression of erosion and marked soft tissue swelling (arrow).

• 

  Figure 3. The second patient's hand and skin lesions before treatment. (A) The left 2nd and 5th fingers exhibit drumstick-like swelling and inflammation, and the fingernails show severe onycholysis. (B, C) Erythematous, hyperkeratotic plaque is seen on both knee and the sole of the right foot.

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