LONGITUDINAL NAIL BIOPSY IN THE DIAGNOSIS OF NAIL PSORIASIS

Abstract

ABSTRACT

Nail psoriasis can clinically mimic onychomycosis and nail lichen planus, particularly in patients with extensive onychodystrophy, making definitive diagnosis challenging when clinical manifestations overlap. Nail biopsy may provide histopathological evidence to distinguish nail psoriasis from other causes of nail dystrophy when clinical, dermoscopic, and mycological findings are inconclusive. This case report aimed to describe the diagnostic role of longitudinal nail biopsy in establishing the diagnosis of nail psoriasis in a patient with overlapping clinical manifestations. A descriptive case report was conducted in a 76-year-old male presenting with brittle, rough, and discolored fingernails and toenails for two months. Clinical examination, nail dermoscopy, potassium hydroxide (KOH) examination, fungal culture, and longitudinal nail biopsy with histopathological evaluation were performed. Clinical examination revealed onychodystrophy, onycholysis, onychodyschromia, and onychorrhexis involving all fingernails and toenails. Dermoscopy of the second fingernail of the right hand showed onycholysis, salmon patches, and a leukonychic appearance. KOH examination and fungal culture were negative. Histopathological examination of the longitudinal nail biopsy demonstrated elongated rete ridges in the nail matrix and nail bed with focal stratum granulosum and no Munro microabscesses, supporting the diagnosis of nail psoriasis. The diagnosis was established through correlation of clinical, dermoscopic, mycological, and histopathological findings. This case demonstrates that longitudinal nail biopsy provides important diagnostic support in patients with onychodystrophy and overlapping clinical manifestations, with good wound healing and a dubia ad bonam prognosis.

ABSTRAK

Psoriasis kuku dapat secara klinis menyerupai onikomikosis dan nail lichen planus, terutama pada pasien dengan onikodistrofi luas, sehingga diagnosis definitif menjadi sulit ketika terdapat tumpang tindih manifestasi klinis. Biopsi kuku dapat memberikan bukti histopatologis untuk membedakan psoriasis kuku dari penyebab distrofi kuku lainnya ketika temuan klinis, dermoskopi, dan mikologi belum memadai. Laporan kasus ini bertujuan menggambarkan peran biopsi kuku longitudinal dalam menegakkan diagnosis psoriasis kuku pada pasien dengan manifestasi klinis yang tumpang tindih. Laporan kasus deskriptif dilakukan pada laki-laki berusia 76 tahun dengan keluhan kuku tangan dan kaki rapuh, kasar, serta berubah warna selama dua bulan. Pemeriksaan meliputi evaluasi klinis, dermoskopi kuku, pemeriksaan kalium hidroksida (KOH), kultur jamur, serta biopsi kuku longitudinal dengan pemeriksaan histopatologi. Pemeriksaan klinis menunjukkan onikodistrofi, onikolisis, onikodiskromia, dan onikoreksis pada seluruh kuku tangan dan kaki. Dermoskopi kuku jari kedua tangan kanan menunjukkan onikolisis, salmon patches, dan leukonychic appearance. Pemeriksaan KOH dan kultur jamur negatif. Histopatologi biopsi longitudinal menunjukkan rete ridges memanjang pada matriks dan dasar kuku serta fokus stratum granulosum tanpa abses Munro, yang mendukung diagnosis psoriasis kuku. Diagnosis ditegakkan melalui korelasi temuan klinis, dermoskopi, mikologi, dan histopatologi. Kasus ini menunjukkan bahwa biopsi kuku longitudinal memiliki nilai diagnostik penting pada onikodistrofi dengan manifestasi klinis yang tumpang tindih, dengan penyembuhan luka yang baik dan prognosis dubia ad bonam.