Onychoscopy and nailfold capillaroscopy in leprosy: A case–control study

Abstract

Objectives: Studies have reported significant number of individuals with leprosy develop nail changes of heterogeneous variety. Direct or indirect damage secondary to neural damage, repeated trauma, vascular injury, anemia or following drug therapy have been implicated. In this study, we compared nail changes in cases of leprosy with controls to determine leprosy specific nail changes through detailed onychoscopic evaluation along with nailfold capillaroscopy. Materials and Methods: We performed a case–control study in a tertiary care institute with 30 leprosy patients and 30 age- and sex-matched controls. The study was done over a period of three months from June 2023 to August 2023. Patients were classified as per Ridley-Jopling classification. A detailed clinical examination followed by onychoscopy and proximal nailfold (PNF) capillaroscopy using Dermlite DL4 was done in all the nails of cases and controls. Results: A total of 600 nails of 30 leprosy patients on treatment attending our outpatient department were studied over a span of three months. Nail changes were seen in 26 (86.6%) out of 30 patients of leprosy disease compared to 10 (33.3%) of the controls. The most common nail finding seen in leprosy patients was longitudinal melanonychia followed by leukonychia. Transverse lines, leukonychia, subungual hyperkeratosis, nail discoloration, nail pallor, onychochauxis, subungual hematoma, splinter hemorrhage, and brachyonychia were seen more in cases than in controls, and the difference was statistically significant. The PNF capillaroscopy showed microhemorrhages in eight patients of leprosy while none in controls. Conclusion: Nail changes seen in leprosy are multifactorial. The PNF capillaroscopy showed microhemorrhages, which could be an early feature of vascular changes in leprosy.