BH01 Experiences of nail pathology seen within a specialist clinic over 1 year

Abstract

Abstract Nail disorders comprise an important subset of dermatological conditions that can pose diagnostic and therapeutic challenges for clinicians. The pathology can be limited to the nail or reflect wider systemic processes. We present a single-centre cross-sectional study on nail conditions seen within a specialist nail clinic over a 12-month period. Demographic and clinical data were collected retrospectively using electronic patient records and analysed using a coding framework. In total, 62 new patients, including 12 paediatric patients, were seen between August 2021 and July 2022. The average patient age was 41 years. Only four patients were seen twice. In terms of ethnicity, 28 patients were White, six were Asian, two were Black and one patient was of mixed race. Ethnicity data were unavailable for 25 patients. Although most patients presented with a single pathology (76%), 24% presented with two or more pathologies. In total, 79 nail diagnoses were given for 62 patients; aetiological categories included infection (onychomycosis, infection other), inflammatory, tumour, trauma, melanonychia, congenital, structural, systemic and idiopathic. Patients had fingernail involvement alone, toenail involvement alone or involvement of both sites. The most common pathologies seen were infection (other) and infection (onychomycosis), accounting for 33% of the conditions seen; melanonychia was next most frequently observed at 18%. Onychomycosis accounts for up to 40% of all nail diseases in the UK. In our nail clinic, onychomycosis consisted of 17.7% of diagnoses. Across Europe, the overall prevalence has been reported to be 23%. In France, the prevalence of onychomycosis is reported to be 20–30% within general practice and dermatology. The true incidence is difficult to assess due to the lack of large-scale studies. We may see fewer cases in secondary care due to the podiatry service available in the UK. The availability of podiatry professionals varies across the world and we believe this plays a role in the presentation of nail diseases to physician-led clinics. Our review here did not encompass UK 2-week-wait cancer referrals, which were accommodated with our consultant as soon as possible. Patients often present to our clinic due to diagnostic uncertainty, especially regarding linear melanonychia, which generates anxiety in primary care. Secondary complications such as nail dystrophy and toenail displacement are also frequent causes for referral. This review, although single centre and retrospective, is a comprehensive snapshot of nail pathology at a UK specialist centre and demonstrates the pathologies encountered in secondary care, helping to plan future services and direct both primary care and trainee teaching.