PMC6699325_01
Dystrophic nails of the hand with nail psoriasis (leukonychia, nail plate crumbling, and onycholysis) accompanied by onychomycosis at admission.
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Dermatologic consultation revealed that she had nail psoriasis accompanied by onychomycosis (Figure 1).
PMC6699325_02
Improved nail psoriasis with onychomycosis and severe paronychia that persisted although the patient received nine months of canakinumab therapy.
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Her arthritis features slightly recovered; however nail disease did not resolve but slightly improved (Figure 2).
MRI and X-ray of sacroiliac joints showing total ankylosis of the right sacroiliac joint and partial ankylosis with irregularity on the nonsclerotic segments of the left sacroiliac joint (grade 3-4 sacroiliitis).
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Both X-ray and new MRI showed chondrolysis in left hip joint as well as sacroiliitis (grade III-IV) and ankylosis in some areas (Figure 3).
Recovery of nail psoriasis and normal appearance of the nails with a very good response to 22 months of adalimumab therapy.
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The nail psoriasis on both hands also responded well to adalimumab therapy after few months (Figure 4).