Nail changes in various dermatoses: an observational study conducted at tertiary care center, Ujjain, Madhya Pradesh, India
Keywords:Nail, Epidemiological study, Ujjain
Background: Nail apparatus forms an integral part to be examined for all dermatological conditions. Nail changes are seen in various dermatosis like psoriasis, onychomycosis, lichen planus, collagen vascular disease, vesicobullous diseases and other papulosquamous diseases. Aims and objective of the study was to determine the prevalence of nail changes in various dermatological conditions.
Methods: After applying inclusion and exclusion criteria, 269 cases with various nail changes were enrolled in the study. Detailed history and thorough nail examination was carried out along with other necessary investigations like CBC, RFT, LFT, nail clipping for fungal hyphae culture and microscopy.
Results: Out of 269 cases with nail disorders, male to female ratio was 1.5:1 and most common age group was 31-40 years. The most common abnormality observed was onychomycosis (34.2%) followed by nail changes in psoriasis (30.4%), LP (18.5%), eczema (4%), trachonychia (3.3%), paronychia (2.9%), lichen striatus (2.2%) and darier’s disease (0.37%). Among onychomycosis most common pattern observed was DLSO (82.6%) followed by PSO (7.6%), SWO (5.4%) and TDO (4.34%). The pattern of nail changes in psoriasis patients was pitting (30.4%), subungual hyperkeratosis (21.9%) and onycholysis (10.9%). Cases with LP had longitudinal striations (52%), thinning of nail plate and trachonychia (10% each). V shaped notching and distal splitting was seen in one of the Dariers’ disease patient.
Conclusions: Nail changes form an indispensible part of various dermatological conditions. The pattern of involvement is unique in each and every disease. Hence examination of all the 20 nails should never be missed.
Chhatrapati DN, Purohit GL. Studies on the Shape of Human Nails in Normal Subjects. Ind J Dermatol, Venereol, Leprol. 1968;34(1):9-17.
Drake LA, Dinehart SM, Farmer ER, Goltz RW, Graham GF, Hordinsky MK, et al. Guidelines of care for nail disorders. J Am Acad Dermatol. 1996;34(3):529-33.
Puri N, Kaur T. A study of nail changes in various dermatosis in Punjab, India. Dermatol Online. 2012;3(3):164-70.
Grover S. Clinico-mycological evaluation of onychomycosis at Bangalore and Jorhat. Ind J Dermatol, Venereol, Leprol. 2003;69(4):284-6.
Garg A, Venkatesh V, Singh M, Pathak KP, Kaushal GP, Agrawal SK. Onychomycosis in central India: a clinicoetiologic correlation. Inter J Dermatol. 2004;43(7):498-502.
Sujatha V, Grover S, Singh G, Dash K. Aclino mycological evaluation of Onychomycosis. Indian J Dermatol Venerol Leprol. 200;66:238-90.
Sharma TP, Sepaha GC. Psoriasis-A clinical study. Ind J Dermatol, Venereol, Leprol. 1964; 30(5):191
Ghosal A, Gangopadhyay DM, Chanda M, Das NK. Study of nail changes in psoriasis. Indian J Dermatol. 2004;49:18-21.
Kanwar AJ, De D. Lichen planus in childhood: report of 100 cases. Clini Experiment Dermatol. 2010;35(3):257-62.
Tosti A, Peluso AM, Fanti PA, Piraccini BM. Nail lichen planus: clinical and pathologic study of twenty-four patients. J Am Acad Dermatol. 1993;28(5pt1):724-30
Taniguchi S, Kutsuna H, Tani Y, Kawahira K, Hamada T. Twenty-nail dystrophy (trachyonychia) caused by lichen planus in a patient with alopecia universalis and ichthyosis vulgaris. J Am Acad Dermatol. 1995;33(5):903-5.
Tosti A, Bardazzi F, Piraccini BM, Fanni T. Idiopathic trachyonychia: apathological study of 23 cases. Br J Dermatol. 1994;131:866-72.
Jerasutus S, Suvanprakorn P, Kitchawengkul O. Twenty-nail dystrophy: A clinical manifestation of spongiotic inflammation of the nail matrix. Arch Dermatol. 1990;126(8):1068-70.
Estever J. Chronic paronychia Dermatol. 1959;119:229-31.
Tosti A, Buwrra L, Mozelli R. Role of food in the pathogenesis paronychia. J Adm Dermatol. 1992;27:706-10.
Morten RH. Chronic paronychia: mycological & bacteriological study. Br J Dermatol. 1959;71:442-6.
Vozza A, Baroni A, Nacca L, Piccolo V, Falleti J, Vozza G. Lichen striatus with nail involvement in an 8‐year‐old child. J Dermatol. 2011;38(8):821-3.
Krishnegowda SY, Reddy SK, Vasudevan P. Lichen striatus with onychodystrophy in an infant. Ind Dermatol Online J. 2015;6(5):333.