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Psoriatic Nail Disease — SCE Dermatology MCQ

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ModerateNail DisordersPsoriatic Nail DiseaseSCE Dermatology

A 45-year-old woman with psoriasis has developed nail changes. She has isolated oil drop discolouration and onycholysis of the nail bed without pitting. What is the most appropriate initial topical treatment for nail bed psoriasis?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Topical Calcipotriol applied under the nail

Nail bed psoriasis (onycholysis, oil drop sign, subungual hyperkeratosis, splinter haemorrhages) is treated differently from nail matrix disease (pitting, ridging, crumbling). Topical Calcipotriol (or Calcipotriol/Betamethasone) applied to the hyponychium (under the free edge of the nail) can reach the nail bed and is first-line for nail bed psoriasis. For matrix disease, application of potent topical corticosteroid to the proximal nail fold targets the matrix. Both require prolonged treatment (6 months for fingernails, 12+ months for toenails) due to slow nail growth. Fungal infection should be excluded before assuming nail psoriasis.

Reference: BAD 2020 Psoriasis Guidelines