Journal List > J Rheum Dis > v.22(1) > 1064238

Park, Kim, Park, Kwon, Shin, Kim, Kim, and Han: Psoriatic Onycho-pachydermo-periostitis of the Fingertips: A Report of Two Cases

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-epi-physeal 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.

REFERENCES

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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.
jrd-22-45f1.tif
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).
jrd-22-45f2.tif
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.
jrd-22-45f3.tif
Table 1.
Summary of clinical characteristics of the 21 psoriatic onycho-pachydermo-periostitis patients
Study Age (yr) Sex Disease duration Skin psoriasis Onycholysis Distal phalanx swelling HLA-B27 Treatment
Fournié et al. [1] (1989)* 57 NA 2 yr None Both 1st toes None Positive NA
45 NA 2 yr None Both 1st toes, left 3rd finger None NA NA
  46 NA 20 yr None Both 1st toes None NA NA
  39 NA 3 yr None Right 1st toe None NA NA
Marguery et al. [2](1991)* 55 M 2∼3 yr NA All fingers except left 5th finger Right 3rd, 4th and left 2∼4th fingers NA NA
De Pontville et al. [3] (1993)* 40 NA 1 yr NA All fingers and toes Right 1st finger, right 1st, 3rd, 4th toe, left 1st, 4th toe Positive NA
  62 NA 1 yr NA Right 1st toe None Positive NA
Grosshans and Bosser [4] (1993)* 35 NA Several years NA Left 1st toe None NA NA
37 NA 2 yr NA Left 3rd finger, both 1st toes Left 3rd finger Positive NA
  49 NA 5 yr NA Right 1st finger None NA NA
Boisseau-Garsaud et al. [5] (1996) 37 M 2 yr None Left 1st∼5th fingers, both 1st toes Left 2nd and 3rd fingers, both 1st toes Positive MTX 20 mg/wk (response)
  49 M 5 yr Both elbow, scalp Right 1st finger Right 1st finger NA NA
Bauzá et al. [6] (2000) 50 F 2 yr None Left 3rd∼5th fingers, right 3rd finger Both 3rd fingers NA Cyclosporin A 200 mg→ MTX 15 mg/wk
Anders et al. [7] (2002) 49 M NA None All fingers and toes Right 3rd, 4th and left 2nd and 3rd fingers, left 1st toe NA SSZ→ radiotherapy
Fietta and Manganelli [8] (2003) 33 M 6 yr Both elbows, leg All fingers None Negative Topical steroid
Bongartz et al. [9] (2005) 42 M 1.5 yr Both feet All toes All toes Positive MTX 15 mg/wk→ adalimumab
Kapusta and Dumont [10] (2008) 53 M 0.5 yr Right ear, both feet All fingers and toes Left 1st, 2nd, and 4th toes; both 2nd, 3rd, and 5th fingers Negative MTX→ etanercept→ infliximab
Watanabe et al. [11] (2012) 59 M 3 mo Whole body All fingers and toes All fingers and toes Negative Etretinate→ MTX 8 mg/wk
Bethapudi et al. [12] (2014) 55 F 1 yr Palm, foot All toes Right 1st, 4th toe, left 1st toe NA NA
This study (2014) 60 F 4 yr Both hands, foot All fingers and toes Left 4th finger Negative MTX, cyclosporin A
  39 F 1 yr Both knees, right foot Left 2nd and 5th fingers Left 2nd and 4th fingers Negative Cyclosporin A

F: female, HLA: human leukocyte antigen, M: male, MTX: methotrexate, NA: not available, SSZ: sulfasalazine.

* These first 4 case reports were published in French and the data presented in this table was adapted from the report by Boisseau-Garsaud et al. [5].

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