Differential Diagnosis for Onycholysis, Splinter Haemorrhage, and Nail Dystrophy

• Single Most Likely Diagnosis
  • Psoriasis: This condition is a strong candidate due to the presence of onycholysis (separation of the nail from the nail bed), splinter hemorrhages (small bleeding spots under the nails), and nail dystrophy (nail deformation), all of which are common manifestations of psoriatic nail disease.
• Other Likely Diagnoses
  • Lichen Planus: Although less common than psoriasis in causing these specific nail symptoms, lichen planus can lead to nail changes including onycholysis, thinning, and scarring, making it a plausible diagnosis.
  • Onychomycosis: Fungal infection of the nails can cause dystrophy and onycholysis, but splinter hemorrhages are less commonly associated with this condition.
• Do Not Miss Diagnoses
  • Systemic Lupus Erythematosus (SLE): Although rare, SLE can cause nail changes including splinter hemorrhages and nail dystrophy due to its autoimmune nature affecting multiple body systems.
  • Antiphospholipid Syndrome: This condition can lead to vascular complications, including splinter hemorrhages, and should be considered, especially if there are other systemic symptoms.
• Rare Diagnoses
  • Sarcoidosis: A systemic disease that can rarely affect the nails, causing dystrophy and other changes.
  • Darier's Disease: A genetic disorder that affects the skin and can lead to nail abnormalities, including red and white streaks and nail dystrophy.