Roentgen Therapy for Psoriasis of the Nails and Psoriatic Arthritis

Abstract

Psoriasis of the nails is usually charracterized by pitting, brownish discoloration of the nail bed, leukonychia, cracking of the free edges, and subungual hyperkeratosis. Among the remedies suggested for treatment of this lesion, the use of roentgen rays is one of the most prominent. Most writers suggest treating the nails after carefully protecting the nail base from the roentgen rays. Because of the fact that arthritis of the distal joints of the hands or feet (or both) occurs not infrequently in cases of psoriasis, we have tried, during the past five years, a different method of treatment with roentgen rays, applying them to the dorsum of the hands in a field extending from the nail tips to the wrists, and to the dorsum of the feet in a field from the tips of the nails to the ankles. We have used this method of treatment whether the individual patient did or did not have arthritis as a complication of his psoriasis. We have given treatment in 24 cases in which the diagnosis of psoriasis of the nails was unquestionable. Of these, six showed involvement of the fingernails only, and 18 showed involvement of the nails of both hands and feet. Of these 24 patients, nine had arthritis of the distal joints. The history of the patients with arthritis complicating psoriasis is interesting because, with development of psoriatic changes in the nails, there was usually a definite exacerbation of arthritis with pain and periarticular swelling. Roentgenologic studies of the joints showed no definite changes, but only some periarticular swelling. In this series of cases, the average duration of symptoms was approximately seven years. The shortest duration was three months and the longest twenty years. The method of roentgen therapy in this series of cases has been to expose the hands or feet in the manner mentioned previously. The treatments are given with roentgen rays generated at approximately 130 kv., constant potential, filtered through 4 mm. of aluminum for the hands, and through 6 mm. of aluminum for the feet. The dose for each treatment is about 300 r (measured in air). The treatments are usually repeated twice, at monthly intervals. After the third, no further treatments are given. We feel that at least three months must be allowed to elapse before the results can be definitely evaluated. In the cases in which arthritis was a complication, symptomatic improvement has been manifest after the first treatment, but at times an exacerbation of the pain and stiffness in the joints may be noted in the first few days after a treatment has been given. This exacerbation can be disregarded, as it lasts only a few days and quickly subsides. The results of treatment have been gratifying to us because in six cases complete remission of all changes in the nails occurred and no exacerbation has occurred to date.