Psoriatic Nail Disease — SCE Dermatology MCQ

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HardNail DisordersPsoriatic Nail DiseaseSCE Dermatology

A 62-year-old woman has nail changes affecting multiple fingernails. Examination shows pitting, onycholysis, subungual hyperkeratosis, and 'oil drop' discolouration. She also has scaly plaques on her elbows and scalp. What is the most likely cause of her nail changes?

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Correct answer: E — Psoriatic nail disease

The best answer is “Psoriatic nail disease”. Nail findings localise disease to matrix, bed or periungual tissue; a new changing longitudinal pigmented or erythronychic band requires specialist assessment because benign and malignant causes overlap. The alternatives “Nail trauma”, “Lichen planus nail involvement”, “Onychomycosis”, “Alopecia areata” are clinically adjacent possibilities, but they do not fit the defining morphology, distribution, histopathology, risk signal or management sequence in this stem.

Reference: DermNet specialist nail terminology reference: https://dermnetnz.org/topics/nail-terminology