engleski

Therapeutic efficacy of soft x-ray therapy in a severe form of nail psoriasis : case report

The prevalence of psoriasis of the nails varies considerably among different authors, ranging from 10% to 55%. In psoriatic arthritis, the prevalence of as high as 85% is reported. The disorder may occur in isolation, without cutaneous lesions. Various local and systemic therapies have been tried, however, with rather low therapeutic efficacy. A case is presented of a 51-year-old male, railroad worker, with mild psoriasis of the skin and extremely severe form of psoriasis of all his fingernails and toenails, with nail plates up to 30 times thicker than normal. The psoriatic lesions of the nails caused great functional and psychic difficulties to the patient, along with considerable cosmetic defects. Upon obtaining an informed consent in writing from the patient, fractionated soft x-ray therapy was applied in nine doses of 150 cGy, first at one-week, then at two-week intervals, to a total dose of 1350 cGy (43 kV, 25 mA, 0.6 mm aluminum filter), upon nail plates of all fingernails and toenails, involving a periungual area of 5 mm in width in the region of nail matrix. Upon therapy completion, initial therapeutic results were observed in the proximal thirds of all nail plates as newly grown, "healthy" nail plates, whereas nearly normal appearance all along the nail length was recorded at one year of therapy completion. No side effects were observed and the patient did not complain of any unpleasant sensations either during therapy or at control clinical examinations at 6 and 12 months of therapy. High therapeutic efficacy improved the patient's work ability and substantially upgraded his quality of life. Soft x-ray therapy resulted in normalization of the appearance of nails heavily damaged by severe psoriasis of the nails. Soft x-ray therapy is a treatment option for some adult patients with nail psoriasis with massive subungual hyperkeratoses.

X-ray therapy; psoriasis; psoriatic arthritis

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