Differential Diagnosis for Periungual Erythema and Loss of Lunulas
- Single most likely diagnosis:
- Psoriasis: This condition is characterized by periungual erythema, nail pitting, and loss of lunulas due to inflammation and keratinocyte proliferation.
- Other Likely diagnoses:
- Eczema (Dyshidrotic or Atopic): Can cause periungual erythema and inflammation leading to loss of lunulas.
- Lichen Planus: May involve the nails, leading to periungual erythema, nail thinning, and loss of lunulas.
- Alopecia Areata: Although primarily an autoimmune condition affecting hair, it can also cause nail changes including periungual erythema and loss of lunulas.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Systemic Lupus Erythematosus (SLE): A systemic autoimmune disease that can cause periungual erythema and nail changes, among other symptoms. Early diagnosis is crucial due to the potential for severe organ involvement.
- Dermatomyositis: An inflammatory disease characterized by skin and muscle involvement. Periungual erythema and nail changes can be part of the presentation, and missing this diagnosis could lead to delayed treatment of a potentially severe condition.
- Rare diagnoses:
- Sjögren's Syndrome: An autoimmune disorder that can cause dryness in the eyes and mouth but may also involve the skin and nails, leading to periungual erythema and loss of lunulas.
- Sarcoidosis: A condition characterized by the formation of granulomas in various parts of the body, which can rarely cause nail and periungual changes.