الفهرس 
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Abstract
Ultrasound examination can contribute significantly to noninvasive examination of the nail apparatus, and may be used to visualize and quantify morphologic and functional aspects of nail biology. The use of sonography in lesions of the nail can be important because biopsies can be difficult to perform in the ungual tissue and may generate cosmetic sequelae. Noninvasive ultrasound imaging of nail lesions provides clinical information that is highly relevant and specific to each disease. Ultrasound also can improve diagnostic precision.
The study aims at assessment of ultrasound as a non invasive technique for diagnosing nail psoriasis and onychomycosis. One hundred subjects were included in our study, divided into 3 groups. The psoriatic patients group (n=25), the onychomycosis patients group (n=25) and the healthy control group (n=50). All subjects were interviewed and examined clinically, psoriasis patients were assessed by using NAPSI score, while OSI was used to assess onychomycosis patients, in addition to performing nail culture to them. Real-time ultrasonography was performed by radiologist, with a variable-frequency transducer of 15 MHz. Each nail has been scanned in the grey scale mode. The thickness of right fingernails plate and bed were measured in longitudinal ultrasonographic view. The following parameters have been also assessed: contour and echogenicity of the NP, NB focal lesions, distal phalanx periosteal surface, matrix thickness and length, DIJ space and contour, and distance between proximal NP and DIJ. Ultrasonographic measurements of thumb nail plate in psoriasis and onychomycosis patients were (0.80 ± 0.14, 0.77 ± 0.21), respectively, while in controls was 0.61 ± 0.09. The thumb nail bed thickness in psoriasis and
onychomycosis patients were (2.05 ± 0.32, 2.13 ± 0.32), respectively, while in controls 1.79 ± 0.23. These were the best indices that could be used in diagnosis of both thumb and index fingers. There were also, special ultrasonographic characters of each disease which can be used for its differentiation from each other and from control group, as in psoriasis group characterized by presence of DIJ changes, and onychomycosis group characterized by loss of interplate space proximally, presence of swollen PNF and decreased Plate/DIP distance.
Limitations of the study include that power Doppler for NB vasculature evaluation and nail histopathology were not performed. Moreover, the cross-sectional nature of the study could not discriminate the directionality of the association between nail thickening and skin manifestation of psoriasis. We haven’t done nail culture for patients with psoriasis to exclude onychomycosis as it is found to be associated with psoriatic nail changes in several studies (Sαnchez-Regaρa et al., 2008).
Recommendations for future studies:
The use of contrast medium can provide us with specific diagnoses, consideration of washout curves with relation to contrast, and detailed description of the vascular morphology of the lesions.
We recommend use of ultrasound in follow up of psoriasis and onychomycosis to figure out disease progression either improvement or regression.
We recommend use of ultrasound in other skin and nail diseases