Introduction::Nail psoriasis has a profound negative influence on quality of life and has a more closely relationship with psoriatic arthritis. However, patients with nail changes only were often overlooked with the diagnosis of psoriasis. It is necessary to pay more attention to nail psoriatic changes.Case presentation::The nails presented with white streaks, deformations, and had been missed for 8 months. Physical examination further revealed one erythematous scaly plaque on the buttock, anusand scalp respectively with positive Auspitz sign. Combined with the negative fungal microscopic, dermoscopic results and pathological results, the diagnosis of nail psoriasis was made. Oralacitretin (30 mg/day) and topical calcipotriene liniment was prescribed for 3 months followed with etanercept (50 mg once per week), and the nail symptoms were well controlled.Discussion::Nail psoriasis is usually noticed after the occurrence of skin lesions, but may occur simultaneously with or before skin psoriasis. Occasionally, nail involvement is the only manifestation of psoriasis. Nail lesions maybe one of the strongest clinical predictors of psoriatic and it has a profound negative influence on quality of life, so that timely recognition and proper treatment are improtant.Conclusion::Nail psoriasis can cause substantial physical and psychological impairment. However, nail involvement is an often overlooked feature of psoriasis. More attention should be paid to nail psoriatic changes and the administration of appropriate treatment.

nail psoriasis;initial presentation;biologic agents;case report

Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China

[1]Zhang Jing;Chen Xue-Yan;Man Xiao-Yong;Zheng Min-.Nail Changes as the Initial Sign of Psoriasis: A Case Report)[J].国际皮肤性病学杂志（英文）,2022(01):50-52

erythematous,scaly,buttock,anusand,dermoscopic,Oralacitretin,calcipotriene,liniment,etanercept,Occasionally,improtant

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