All the nail signs in Reithers syndrome may be present in severe psoriasis

involvement suggesting inflammation of the proximal nail fold. Onycholysis, ridging, splitting, greenish-yellow or sometimes brownish-red discoloration and subungual hyperkeratosis may be present. Small yellow pustules may develop and slowly enlarge beneath the nail, often near the lunula. Their contents become dry and brown. The nails may be shed. Nail pitting may be seen in Reiter's syndrome, individual pits being deep and punched out. This nail pitting may reflect a predisposition to the development of psoriasis or psoriasiform lesions dependent on the HLA-A2 and B27 antigens, as suggested by previously reported HLA typing studies. Both HLA-A2 and B27 were present in a 6-year-old boy who had only the nail changes which were compatible with Reiter's syndrome; the same antigens were also present in his father, who had uveitis, arthritis and amyloidosis.

Antibiotics, steroids and non-steroidal anti-inflammatory drugs are without benefit; PUVA may be helpful. Oral retinoid therapy may clear the nails in Reiter's syndrome. Combined chemotherapy with methotrexate, oral retinoid and prednisolone has been suggested.

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Treating Rheumatoid Arthritis With Herbs Spices Roots

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