Onycholysis is a common nail disorder with multiple causes.Transverse onycholysis bordered by a proximal erythematous rim is a typical manifestation of nail psoriasis.Its isolated onset after bacterial tonsillitis is uncommon and may pose a diagnostic challenge.We describe a previously healthy 20-year-old female who developed transverse onycholysis 2 weeks after treatment with amoxicillin/clavulanic acid for acute bacterial tonsillitis.Clinical examination revealed characteristic psoriatic nail changes, including a proximal erythematous-orange border and mild subungual hyperkeratosis.A diagnosis of post-streptococcal nail psoriasis was considered.She was treated with topical betamethasone/calcipotriol and advised on protective nail care, achieving marked improvement after 3 months.This case reinforces the association between streptococcal infections and psoriatic manifestations and highlights the diagnostic value of recognizing specific patterns of onycholysis.Early identification of psoriatic nail disease can prevent unnecessary investigations and enable timely, appropriate management.
Pacheco-Silva et al. (Wed,) studied this question.