Table 2.

Characteristics of patients with nail psoriasis or trachyonychia developing pterygium

S. No.	Age/sex	Nail lesions	Skin lesions	Skin histopathology	Nail histopathology	Pterygium
1	15/F	Asymptomatic progressive thickening and discoloration of all 20 nails (2-year duration) Pachyonychia, prominent distal onycholysis and subungual hyperkeratosis (nail psoriasis) Additional surface irregularities in toenails (Fig. 1)	Nil	−	Prominent neutrophilic infiltrate with an absence of granular layer or any fungal elements, confirming the diagnosis of nail psoriasis	Two toenails (Fig. 1)
2	8/F	Asymptomatic nail changes (1 year) with slowly more nails getting involved (Fig. 2a–c) Roughening, longitudinal ridging, and thinning of nails (trachyonychia) Waxing and waning course Similar nail changes in younger brother over 2–3 months, seen as shiny trachyonychia	Nil	−	Not done in view of age and mild changes	Left ring fingernail Right thumb nail (Fig. 2b, c)
3	14/F	Asymptomatic nail changes (1.5 years) Roughening, thinning (trachyonychia) and splitting of fingernails (Fig. 3a, b) Fine pits with minimal longitudinal ridging involving few fingernails The patient was started on intramatricial triamcinolone injections at monthly intervals	Alopecia areata (Fig. 3c)	−	Biopsy from middle fingernail showed the presence of a prominent neutrophilic infiltrate involving the epithelium, suggestive of nail psoriasis	Left thumbnail Left index fingernail
4	62/M	Erythema, scaling, and loss of multiple nails (Fig. 6a, b) Significant erythema involving nail bed and the periungual skin (nail psoriasis) (Fig. 6a, b) Pustulation, scaling, and thinning with loss of multiple nails Onychoscopy showed prominent, dilated, and tortuous longitudinal nail fold capillaries and glomerular nail bed capillaries (Fig. 6c)	Psoriasis vulgaris on systemic therapy	−	Nail biopsy confirmed the diagnosis of nail psoriasis with marked neutrophilic infiltrate and hypergranulosis	Anonychia and pterygium involving multiple fingernails and toenails
5	17/F	Asymptomatic toenail changes (1.5 years) (Fig. 4b) Thinning and ridging of multiple toenails with partial nail destruction (nail psoriasis)	Psoriasis vulgaris − shins, elbows, and trunk (Fig. 4a) + Alopecia areata (ophiasis and patchy)	Changes compatible with psoriasis vulgaris	Not done	Pterygium involving multiple toenails (Fig. 4b)
6	45/F	Asymptomatic progressive thickening and discoloration of all 20 nails (2 years) Changes more marked in fingernails Distal onycholysis and subungual hyperkeratosis (nail psoriasis)	Plaque psoriasis − shins and elbows, lower back	Changes compatible with psoriasis vulgaris	Not done	Pterygium involving multiple toenails (Fig. 7)
7	17/M	Asymptomatic roughening of nails (1.5-year duration) Longitudinal ridging, with dry and lustreless nails Both finger and toenails (with more marked changes in fingers)	Nil	−	Nail plate and nail bed biopsy showed changes compatible with nail psoriasis with a prominent neutrophilic infiltrate	Pterygium involving multiple toenails (Fig. 7)