關節炎不是老人的專利，指甲病變竟暗藏警訊！一名妙齡女子手腳指甲長期泛黃、紅腫、增厚伴隨變形、斷甲問題。為了遮醜，她時常擦上厚厚的指甲油、穿包鞋、雙手插口袋才敢外出。原以為單純是指甲美觀，8年後卻陸續合併頭皮屑暴增、後腳跟疼痛等症狀，就醫確診竟罹患「乾癬性關節炎」。
指甲乾癬5種表現是徵兆
中山大學附設醫院皮膚科主任蕭玉屏說明，乾癬是一種自體免疫的皮膚發炎疾病，誘發原因多，且隨著病程進展，可能出現其他共病。根據2016年健保資料庫顯示，台灣約有5萬1千多名乾癬患者，約每500人中就有一位病友。乾癬主要病徵常見在頭皮、臉等外顯皮膚上，指甲也是觀察指標之一。
但乾癬指甲病變常被誤認是灰指甲而輕忽。laennec俗稱「臭甲」的灰指甲是由黴菌引起，夏天病況易加劇，甲面呈現厚、黃、黑甚至綠的顏色，接受治療有機會根治；看似單純「醜甲」的乾癬指甲病變，則是因自體免疫系統問題引發，病況易在冬天出現變化甚至惡化，指甲角化異常增厚、甲色泛黃成黃油樣、甲床有鮭魚色斑或剝離、甲面點狀凹洞，與灰指甲最明顯差異在指甲摺處有紅腫脫屑，需要接受適切治療以控制病情。以下為常見指甲乾癬表現：
1）匙狀指／
指甲板變薄，且中間像湯匙一樣凹下去的指甲。
2）指甲層狀剝離／
指甲末端像要脫落一樣，與甲床分開，有時會合併見到裂縫狀出血。
3）凹點／
指甲上有一個個小凹洞，常見於乾癬病人（發生機率約10至15％），出現凹洞後，接下來可能出現黃、增厚的指甲變形，症狀與灰指甲很難分辨。治療上會將指甲化驗，確定是否黴菌感染。如果出現很深、不規則幾何分布的凹點，可能代表其他種皮膚疾病，如異位性皮膚炎或圓禿等。
4）指甲縱裂症／
在指甲表面呈線狀隆起的縱痕，進一步有縱裂發生。
5）指甲下角質增生／
在遠端的指甲床發生不正常角化，造成遠端的指甲板下方堆積角質，增厚。
乾癬病患10年內都要定期追蹤
蕭玉屏主任提醒，根據英國研究指出，經回溯性分析4千多名乾癬患者，如有「乾癬指甲病變」者，後續發生「乾癬性關節炎」的風險是其他病友的3倍。如指甲有異狀都會輕忽，如果始終治療不好，就要懷疑是否罹患乾癬，可進一步化驗指甲來確認。對已經確診的乾癬患者來說，如果發現指甲有異狀，則要警覺是否罹患乾癬性關節炎，建議就醫檢查。
乾癬是一種自體免疫疾病，除了皮膚症狀外，還可能有關節炎、心血管問題等共病發生，患者要有長期抗戰的決心，接受正規治療且至少10年內都要定期追蹤，切勿誤信偏方或民俗療法，讓病況加劇。如有「乾癬指甲病變」症狀出現，恐為乾癬性關節炎高風險族群，務必諮詢專科醫師接受適切治療，並追蹤關節發炎狀況，以免關節發生不可逆的損傷。
Arthritis is not a patent for the elderly, and nail lesions are hidden warnings! A long-term woman's hand and nails have long-term yellowing, redness, thickening and deformation, and broken nails. In order to cover the ugly, she often wears thick nail polish, wears shoes, and puts her hands in her pockets to dare to go out. Originally thought that it was pure nails, after 8 years, it gradually merged with symptoms such as scalp spurt and heel pain. He was diagnosed with "dry arthritis".
5 kinds of nail dryness are signs
Xiao Yuping, director of the dermatology department of the attached hospital of Sun Yat-sen University, said that cognac is an autoimmune skin inflammatory disease with many causes, and other comorbidities may occur as the disease progresses. According to the 2016 Health Insurance Database, there are more than 51,000 cognac patients in Taiwan, and about one in every 500 people. The main symptoms of cognac are commonly found on the skin of the scalp, face, etc. The nail is also one of the observation indicators.
However, dry nail lesions are often misidentified as gray nails and neglected. The onychomycosis, commonly known as "Smelly A", is caused by mold. In summer, the condition is prone to increase. The surface of the nail is thick, yellow, black and even green. It has a chance to cure after treatment. It seems to be a simple "ugly nail" dry nail lesion. It is caused by the autoimmune system problem, the condition is easy to change or even worse in winter, the nail keratinization is abnormally thickened, the yellow color is yellowed into a buttery, the nail bed is squid stained or peeled, and the nail surface is pitted, and The most obvious difference in onychomycosis is redness and scaling at the nail fold, which requires appropriate treatment to control the condition. The following are common nail dryness performances:
1) Key finger /
The nail plate is thinned and the nails are recessed like a spoon.
2) Layered peeling of nails /
The ends of the nails appear to fall off, separate from the nail bed, and sometimes merge to see crack-like bleeding.
3) Pit /
There are small pits on the nails, which are common in dry patients (the incidence is about 10 to 15%). After the pits appear, yellow and thickened nails may appear. The symptoms are difficult to distinguish between the nails and the nails. The nail will be tested to determine if the mold is infected. If there are deep, irregular geometrically distributed pits, it may represent other skin diseases such as atopic dermatitis or round baldness.
4) Nail fracture /
Longitudinal cracks appear in the shape of a linear bulge on the surface of the nail, and further longitudinal cracking occurs.
5) Under the nail horny hyperplasia /
Abnormal keratinization occurs at the distal nail bed, causing horniness and thickening under the nail plate at the distal end.
Cognac patients are regularly tracked within 10 years
Director Xiao Yuping reminded that according to British research, after retrospective analysis of more than 4,000 patients with cognac, if there is "dry nail lesions", the risk of subsequent "dry arthritis" is three times that of other patients. If the nail is abnormal, it will be neglected. If it is not treated well, it is necessary to suspect whether it is dry or not. You can further test the nail to confirm. For patients who have been diagnosed with cognac, if they are found to have abnormalities in their nails, they should be alert to whether they have dry arthritis.
Cognac is an autoimmune disease. In addition to skin symptoms, there may be comorbidities such as arthritis and cardiovascular problems. Patients must have a long-term determination to fight the war. They should receive regular treatment and should be regularly tracked for at least 10 years. Mistaken remedies or folklore treatments make the condition worse. If symptoms of "dry nail lesions" appear, it is a high risk group of dry arthritis. Be sure to consult a specialist for appropriate treatment and track joint inflammation to avoid irreversible damage to the joints.
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