ULTRASONIDO DE ALTA RESOLUCION (15 MHz) EN EL ESTUDIO DE LA UÑA PSORIATICA

Abstract

Background. Psoriasis is a common disease in dermatology practice. In USA, 7 million of people (2-3%) have psoriasis. Approximately 5% of the patients with nail psoriasis don't show cutaneous psoriasis and 10-20% of them have psoriatic arthritis. In patients with psoriatic arthritis, 53-86% have nail involvement. Objective. To study the nail changes with high-resolution ultrasound (15MHz). Methods and material. We utilized Philips ATL 5000 ultrasound equipment with SonoCT, XRES, extended field of vision and a linear probe of 15-7 MHZ. We studied 15 patients, 9 healthy control individuals and 6 psoriatic patients with nail involvement, (Women n=9; Men n= 6, Mean age= 47.7 years). All the nails of both hands were observed in both groups (150 nails). We measured in every patient the distance between ventral and dorsal nail plates and also between the ventral plate and the bone margin of the distal phalanx at the right index finger. Results. The normal ultrasound anatomy of the nail in high resolution was described and also the morphological changes in the psoriatic nails that included 4 types of alterations: focal hyperechoic compromise of the ventral plate without involvement of the dorsal plate, loosening of the borders of the ventral plate, wavy plates, and absence of definition of both plates. There was a significant difference (p= 0.02) between the mean distance ventral plate- osseous margin of the distal phalanx in psoriatic patients (3,0 mms) and healthy control individuals (1,5 mm). Conclusion. High resolution ultrasound permits non invasive study of the nail, to describe and measure the morphological characteristics and changes of the nail in healthy control individuals and psoriatic patients, which can be useful for monitoring treatment effects of psoriasis in its different manifestations. Imperceptibles nail changes for the clinician in magnitude and location, can be detected without waiting the whole total replacement of the nail. To our concern the differences of distance between the nail plates including the distance with the bone margin in high resolution ultrasound has not been previously reported.