Which skin and nail findings are characteristic of reactive arthritis (ReA)?

Updated: Dec 24, 2020
  • Author: Carlos J Lozada, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Skin and mucocutaneous lesions are commonly observed in ReA. The dermal lesions are typified by keratoderma blennorrhagicum, [68] in which hyperkeratotic skin begins as clear vesicles on erythematous bases and progresses to macules, papules, and nodules—found on the soles of the feet (see the image below), palms, scrotum, trunk, or scalp—and eventually coalescing to form a hyperkeratotic erythematous dermatitis resembling pustular psoriasis. [56]

Plaques on soles of patient with reactive arthriti Plaques on soles of patient with reactive arthritis.

Distal involvement with painful and erosive lesions in the tips of the fingers (see the image below) and toes, with pustules and subungual pustular collections, also occurs.

Painful erosions on fingers in patient with reacti Painful erosions on fingers in patient with reactive arthritis.

In some patients, typical keratoderma blennorrhagicum develops 1-2 months after the onset of arthritis, with keratotic papules and plaques that are painful under pressure; sometimes, these can be disabling.

Erythematous macules and plaques, diffuse erythema, erosions, and bleeding can appear on the oral and pharyngeal mucosae in 30-60% of patients. [68] Circinate lesions on the tongue resemble geographic tongue (see the image below).

Plaques and erosions of tongue in patient with rea Plaques and erosions of tongue in patient with reactive arthritis.

Erythema nodosum may develop but is uncommon.

Nail dystrophy is present in 20-30% of patients. The nails can become thickened and ridged and may crumble, in a manner resembling mycotic infection or psoriatic onychodystrophy, but nail pitting is not observed. Nail shedding is common.


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