Nail dystrophy in hand eczema and correlation with severity index: A cross-sectional study

Abstract

Objectives: Hand eczema (HE) causes frequent periungual inflammation, affecting the functioning of the nail matrix unit leading to varied clinical reaction patterns. The objective of the study was to study nail dystrophic changes among patients of HE and to investigate the association between the prevalence of nail dystrophy and HE severity. Material and Methods: In the present study, 100 consecutive patients of HE presenting to our hospital were evaluated. Morphological features of nail dystrophy, involvement of HE in the fingertip area, and presence of paronychia were assessed. Where indicated, samples of nail unit were sent for bacterial and fungal cultures. Results: Nail involvement was seen in 76% of the patients; loss of cuticle was the commonest (37%) finding. A positive correlation (P = 0.012) was found between paronychia and nail dystrophic changes. Hand eczema severity index >12 was seen in 28.9% of patients with nail dystrophy as compared to 12.5% without nail dystrophy (P = 0.259). Severity index of 3+ was documented more in the presence of nail dystrophy as compared to 0 in patients without nail dystrophy (P = 0.001). Out of 20 samples sent for bacterial nail culture, 8 (40%) grew Staphylococcus aureus and two Pseudomonas aeruginosa, Acinetobacter baumannii, Serratia species, and Klebsiella pneumoniae. Yeast grew in nail KOH in 7 (30.4%) of 23 samples but cultures were negative. Conclusion: Nail involvement adds up to the clinical severity of the disease and may be affected by chronicity, duration of disease, and impacts the disease prognosis.