背景:银屑病患者可能经历甲癣(OM)的共存。然而,与非银屑病患者OM的潜在临床差异阻碍了银屑病患者OM的评估.
目的:评估和比较银屑病患者和非银屑病患者脚趾甲OM的皮肤镜特征。
方法:在2020年9月至2023年9月之间,在两个中心对银屑病患者的183个受OM影响的脚趾甲和非银屑病患者的232个受OM影响的脚趾甲进行了皮肤镜检查。使用卡方检验比较皮肤观察特征。
结果:在银屑病患者的脚趾甲OM病例中,最普遍的皮肤镜特征包括点蚀(147/183,80.33%)和甲下角化过度(118/183,64.48%).相反,非银屑病患者的脚趾甲OM的特征是甲下角化过度(175/232,75.43%)和指甲钉(139/232,59.91%)。比较分析显示,点蚀的发生率明显较高(80.33%与15.96%,p<.001),甲周毛细血管扩张(22.40%vs.4.74%,p<.001),油贴(12.57%与0.43%,p<.001)和横向凹槽(43.72%vs.28.45%,p<.01)在牛皮癣中的脚趾甲OM中。此外,牛皮癣患者的脚趾甲OM显示出黄色无结构区域的频率显着降低(13.11%与42.67%,p<.001),钉钉(43.17%vs.59.91%,p<.01),硫金块的废墟外观(8.20%vs.31.03%,p<.001),点状/块状出血(6.01%vs.20.69%,p<.001)和部分甲状腺溶解(32.79%与46.98%,p<.01)。
结论:牛皮癣患者和非牛皮癣患者脚趾甲OM的皮肤镜特征表现出显著差异。银屑病患者的OM显示点蚀和甲周毛细血管扩张的频率较高,而皮肤镜下黄色无结构区域和指甲钉的频率较低。
BACKGROUND: Psoriatic patients may experience the coexistence of onychomycosis (OM). However, the evaluation of OM in psoriatics has been hindered by potential clinical differences from OM in non-psoriatics.
OBJECTIVE: To assess and compare dermoscopic features between toenail OM in psoriatic and in non-psoriatic patients.
METHODS: Between September 2020 and September 2023, dermoscopy was conducted on 183 affected toenails by OM in psoriatics and 232 affected toenails by OM in non-psoriatics in two centres. The dermoscopic characteristics were compared using the Chi-squared test.
RESULTS: Among toenail OM cases in psoriatic subjects, the most prevalent dermoscopic features included pitting (147/183, 80.33%) and subungual hyperkeratosis (118/183, 64.48%). Conversely, toenail OM in non-psoriatics was characterized by subungual hyperkeratosis (175/232, 75.43%) and nail spikes (139/232, 59.91%). Comparative analysis revealed a significantly higher occurrence of pitting (80.33% vs. 15.96%, p < .001), periungual telangiectasis (22.40% vs. 4.74%, p < .001), oil patches (12.57% vs. 0.43%,p < .001) and transverse grooves (43.72% vs. 28.45%,p < .01) in toenail OM in psoriatics. Furthermore, toenail OM in psoriatics exhibited a significantly lower frequency of yellow structureless area (13.11% vs. 42.67%, p < .001), nail spikes (43.17% vs. 59.91%, p < .01), ruin appearance of sulphur nugget (8.20% vs. 31.03%, p < .001), dotted/blocky haemorrhage (6.01% vs. 20.69%,p < .001) and partial onycholysis (32.79% vs. 46.98%, p < .01).
CONCLUSIONS: Dermoscopic features of toenail OM in psoriatic and non-psoriatic patients exhibit notable differences. OM in psoriatics shows a higher frequency of pitting and periungual telangiectasis, while a lower frequency of yellow structureless areas and nail spikes under dermoscopy.