Anonychia multiplex: methotrexate induced?

Psoriasis is a chronic systemic inflammatory disease primarily involving skin, nails, and articular system with associated disease-related comorbidities including type 2 diabetes mellitus and metabolic syndrome. In the past, studies had hypothesized that rapid nail growth of psoriatic nail plate with associated parakeratosis does not allow the fungus to lodge in the nail keratin, thereby the incidence of onychomycosis should have been low in nail psoriasis. However, current studies mention that psoriatic nails are predisposed to secondary onychomycosis, but the end result of manifesting as anonychia multiplex of these two coexistent nail diseases, further complicated by methotrexate, has not been reported in the literature till date. We hereby, report a case of anonychia multiplex of psoriatic nails with coexisting onychomycosis, probably induced by methotrexate-related immunosuppression, for its rarity.