Sequential nail changes in psoriasis

Panel A: Mild nail involvement characterized by discrete pits in the nail plate and early onycholytic separation of the lateral edges of the nail plate from the nail bed. These nail changes are the earliest and the most common in psoriasis. Panel B: Moderate nail involvement manifested by the combination of nail plate pitting and more advanced distal onycholysis; the distal third of the nail plate is now separated from the nail bed. Panel C: The most severe and the least common type of psoriatic nail involvement, in which the normal nail plates have been replaced by thickened hyperkeratotic masses.