[Psoriatic acropachydermy].

Abstract

We report the case of a 55-year old man complaining of painful distal changes in the fingers. At physical examination the distal part of the fingers was enlarged as a result of thickening of the soft parts of the ungueal phalanges, and ungueal dystrophies were present. The patient also had inflammatory arthralgia of the distal interphalangeal (DIP) joints, with limited flexion movements. Interrogation revealed a history of cutaneous psoriasis, and radiography of the hands showed DIP arthritis as well as osteitis and periostitis of the ungueal phalanges. The condition was diagnosed as classical psoriatic arthritis of the DIP type, and psoriatic onycho-pachydermo-periostitis, a new form of psoriatic arthritis recently described by Fournié et al. These authors have put forward a physiopathological hypothesis indicating a direct link between psoriatic inflammatory ungueal lesions and lesions of the ungueal phalanx and its soft parts. We had great difficulty in ascertaining the psoriatic nature of this acropachyderma, and we made successive tentative diagnoses of DIP osteoarthritis, pachydermo-periostitis and acromegaly. In this study, we describe the appearance of the ungueal lesions suggestive of psoriasis, and the other clinical forms of psoriatic arthritis.