Absent Lunula Research Articles

The Spectrum of Nail Disorders in Patients With End-Stage Renal Disease Undergoing Conservative Treatment: A Case-Control Study

Objective: Various nail disorders have been reported in patients with chronic kidney disease. However, few studies have investigated nail disorders in patients with advanced chronic kidney disease. This study focused on nail disorders seen in patients with end-stage renal disease (ESRD) undergoing conservative treatment. Methods: A case-control study was conducted at Baraha Medical City in Khartoum State, Sudan. Data on patients with ESRD who were on conservative treatment and presented for follow-up between March and September 2021 were collected. Patients’ demographic features, nail findings on clinical examination, and laboratory results were recorded. The obtained data were compared with those on age- and sex-matched healthy individuals from the general population. The chi-square test and Student t test were performed to analyze categorical and numerical variables, respectively. Results: Data on 78 patients with ESRD were studied. Their mean age was 54.6 ± 17.6 years, and 45 (57.7%) were men. These patients were compared with 129 controls. Nail disorders were seen in 65 (83.3%) ESRD patients and 86 (66.6%) controls (P = 0.009). Patients with ESRD were found to be at increased relative risk of developing a wide spectrum of nail disorders. An absent lunula, half-and-half nails, nail dystrophy, Terry’s nails, onychomycosis, and koilonychia were the most common disorders and were seen in 44 (56.4%), 13 (16.7%), 10 (12.8%), 9 (11.5%), 6 (7.7%), and 5 (6.4%) patients, respectively. Patients with ESRD had a statistically significant risk of developing above diseases (all P < 0.05). Conclusion: The current study demonstrated a wide spectrum of nail disorders in patients with ESRD undergoing conservative treatment. Further studies are essential to understand their pathogenesis.

Frequency of Nail Deformities in Patients with Chronic Kidney Disease Undergoing Hemodialysis

Background: Nail disorders are common in patients with chronic kidney disease on maintenance hemodialysis. Even though there are some studies regarding nail disorders in peritoneal dialysis and renal transplant patients, to the best of our knowledge, sparse local data is present on nail disorders among maintenance hemodialysis patients. Aim: To determine the frequency of nail disorders in patients with chronic kidney disease on maintenance hemodialysis. Study design: Cross-sectional study Place and duration of study: Dept of Nephrology, Sir Ganga Ram Hospital, Lahore from 1st February 2019 to 1st August 2019. Methodology: Two hundred and ninety two cases were enrolled. The nails of the patients were inspected and shot by utilizing a 10-megapixelcamera. The photos were subsequently reviewed independently by two dermatologists and one nephrologist. Results: There were 198 (67.8%) males and 94 (32.2%) females. The mean age was 47.3±12.4 years. The overall frequency of nail disorder in patients with chronic kidney disease on maintenance hemodialysis was 197(67.5%). According to nail disorders distribution, 119(40.8%) had half and half nail, while 56(19.2%) had splinter hemorrhage, 47(16.1%) had absent lunula, 16 (5.5%) had chromonychia, 15(5.1%) had Beau’s line, 19(6.5%) had melanonychia and 52(17.8%) had onycholysis. Conclusion: The frequency of nail problems in CKD patients treated by hemodialysis is 67.5%. This finding highlights the need for nail evaluation as a component of periodic examination in hemodialysis patients. Key words: Chronic kidney disease, Haemodialysis, Nail disorders.

Prevalence of nail changes in patients infected with HIV - A cross sectional study

Introduction: The spectrum of nail changes is wider and their frequency is higher among HIV patients. These changes magnify the range and multiplicity of AIDS manifestations. Their systematic examination is a non-invasive method of possible diagnostic value . Objective: The present study was conducted to study the frequency and types of nail changes in   HIV infected individuals and to correlate the severity of nail changes   with CD4 count. Material and Method: This was a cross sectional study, conducted in Skin & STD Out-Patient department in a tertiary care hospital between March 2018 and April 2019. A total of 176 HIV patients were included in the study. Standardized examination was performed in which the changes in surface, color, thickness and curvature of nail plates were recorded.   Data were coded and analyzed. Results: The prevalence of nail changes in our study was 60.8%. Majority of the patients were in the age group of 34-41 years(38.1%) with a slight female preponderance Absent lunula (33.5%), diffuse pigmentation of nails (29.54%) and nail dystrophy (18.2%) occupied the top three changes followed by longitudinal melanonychia (13.06%), flat nails (4%), onychomycosis (3.4%) and pterygium (2.8%). Majority of the patients who had abnormal nails had CD4 count in the range of more than 500 cells/mm 3 (30.68%) because many patients in our study were having CD4 count more than 500 cells/mm 3 . The strength of association between abnormal nail changes and CD4 count was done by Chisquare test and the p value was 0.575 which was not   statistically significant. Conclusion: This study infers that systematic nail examination of HIV patients is necessary, but their relation to the severity of immunosuppression requires further large scale, multicentric studies. Key words: CD4 count, HIV/AIDS, Nail changes, Anolunula

Absent lunula: An overlooked finding in chronic kidney disease.

We highlight the importance of a thorough nail examination in every clinical encounter, especially in uremic patients. Absent lunula should prompt the clinician to rule out underlying kidney disease even in the absence of signs of uremia.

Mucocutaneous Manifestations in Patients with Chronic Kidney Disease: A Cross-sectional Study.

Background:Chronic kidney disease (CKD)-associated mucocutaneous manifestations significantly impair the quality of life but often remain understudied. They may also vary across regions, socioeconomic and nutritional status, and racial differences.Objectives:To study the patterns of mucocutaneous disorders and their prevalence in CKD patients irrespective of clinical stage or dialysis status.Materials and Methods:122 (M:F = 77:45) patients aged 21‒85 (Mean ± SD = 57.5 ± 14.0) years having CKD for 3 month to 5 years were studied for mucocutaneous manifestations. Fifty (41%) patients were on hemodialysis for 1‒42 months. Detailed medical history, clinical and mucocutaneous examination, and lab investigations were performed. KOH mounts, skin biopsy, Gram's and Giemsa staining, bacterial or fungal cultures were performed as required.Results:Xerosis in 93 (76.2%), skin pallor in 61 (50%), pruritus in 57 (46.7%), pigmentation in 47 (38.5%), and purpura in 18 (14.8%) patients were the major dermatoses. Bullous lesions and perforating folliculitis occurred in 3 (2.5%) patients each. Major nail abnormalities were pallor (in 35.2%), absent lunula (in 23.8%), nail discoloration (in 18%), and “half-and-half nails” in 16.4% patients, respectively. Hair abnormalities included sparse scalp and body hairs (in 35.2% and 13.1%, respectively) and lusterless hair in 12.3% patients. Coated tongue (in 14.8%), xerostomia (in 12.3%), and macroglossia with teeth indention (in 7.4%) patients were the mucosal manifestations.Conclusions:Xerosis, pruritus, skin pallor/pigmentary changes, nail pallor, absent lunula, nail discoloration, sparse hairs, coated tongue, xerostomia, macroglossia, and infections were the most common mucocutaneous manifestations in the studied patients irrespective of hemodialysis status. Cold and dry climates might be additional aggravators for xerosis/pruritus. Lifelong follow-up may be needed to reduce the morbidity associated with CKD/hemodialysis specific dermatoses appearing over a period.

Nail abnormalities in patients with vitiligo.

BackgroundVitiligo is an acquired pigmentary skin disorder affecting 0.1-4% of the general population. The nails may be affected in patients with an autoimmune disease such as psoriasis, and in those with alopecia areata. It has been suggested that nail abnormalities should be apparent in vitiligo patients.ObjectiveWe sought to document the frequency and clinical presentation of nail abnormalities in vitiligo patients compared to healthy volunteers. We also examined the correlations between nail abnormalities and various clinical parameters.MethodsThis study included 100 vitiligo patients and 100 healthy subjects. Full medical histories were collected from the subjects, who underwent thorough general and nail examinations. All nail changes were noted. In the event of clinical suspicion of a fungal infection, additional mycological investigations were performed.ResultsNail abnormalities were more prevalent in the patients (78%) than in the controls (55%) (p=0.001). Longitudinal ridging was the most common finding (42%), followed by (in descending order): leukonychia, an absent lunula, onycholysis, nail bed pallor, onychomycosis, splinter hemorrhage and nail plate thinning. The frequency of longitudinal ridging was significantly higher in patients than in controls (p<0.001).ConclusionsNail abnormalities were more prevalent in vitiligo patients than in controls. Systematic examination of the nails in such patients is useful because nail abnormalities are frequent. However, the causes of such abnormalities require further study. Longitudinal ridging and leukonychia were the most common abnormalities observed in this study.

Prevalence of cutaneous manifestations in chronic renal failure patients on regular hemodialysis: a hospital-based study

Background Chronic renal failure (CRF) presents with an array of cutaneous manifestations. Newer changes are being described since the advent of hemodialysis (HD), which prolongs life expectancy, providing time for these changes to manifest. Objective The aim of this study was to estimate the prevalence and pattern of cutaneous manifestations among patients with CRF on regular HD. Patients and methods This case-series study included 100 patients with CRF on regular HD. They were subjected to a full assessment of history, and general and dermatological examinations of the skin, hair, nails, and oral mucosa. Results All patients included in this study had at least one cutaneous manifestation attributed to CRF. The most prevalent finding was xerosis (72%), followed by pruritus (52%) and hyperpigmentation (44%), whereas purpura (2%) and bullous dermatosis (1%) were the least detected. Oral changes included xerostomia (46%), macroglossia with teeth markings (43%), fissured tongue (17%), ulcerative stomatitis (11%), and angular cheilitis (6%). The most common nail changes were absent lunula (61%), half and half nail (41%), and koilonychia (29%). Hair changes included sparse scalp hair (48%), sparse body hair (41%), and brittle and lusterless hair (39%). Hypertension and diabetes mellitus were the most common causes of CRF (53 and 18%, respectively). Conclusion Every CRF patient on HD had at least one cutaneous manifestation, which may appear before or after HD. The most common cutaneous manifestations were xerosis, pruritus, hyperpigmentation, xerostomia, macroglossia, absent lunula, half and half nail, sparse scalp hair, and sparse body hair.

Nail Disorders in Patients With Chronic Renal Failure Undergoing Peritoneal Dialysis

Background: Nail disorders are common in patients with end-stage renal diseases. Even though there are some studies regarding the nail disorders in hemodialysis and renal transplant patients, to the best of our knowledge, no studies are present in the area of the nail disorders in the peritoneal dialysis patients. The purpose of this study was to investigate the frequencies of nail disorders in chronic renal failure (CRF) patients treated by peritoneal dialysis (PD). Material and Methods: The study group consisted of 61 CRF patients treated by PD and 61 healthy individuals were used as controls. The findings of nail examinations of patient and control groups were assessed. Results: Both the study and the control groups consisted of 37 (61%) males and 24 (39%) females each. T he most frequently observed nail disorders in patients were absent lunula (61%), vertical stripes (48.8%) and onychomycosis (26.8%). Significantly increased frequencies of absent lunula, vertical stripes, onychomycosis, color changes and pitting were determined in patients (P &lt; 0.05). Conclusion: The frequency of nail disorders in CRF patients treated by PD is increased. This finding emphasizes the significance of nail assessment as part of physical examination in PD patients. World J Nephrol Urol. 2014;3(1):30-34 doi: http://dx.doi.org/10.14740/wjnu156e

Clinical study of nail changes in vitiligo

Both vitiligo and alopecia areata (AA) are associated together, associated with other autoimmune diseases, and autoimmunity is one of the important theories in their etiology. Nail changes are a known association with AA, thus we hypothesized that nail changes can be found in vitiligo patients. On revising the literature, only two types of nail changes were described in association with vitiligo. Our aim was to study the frequency and types of nail changes among vitiligo patients in comparison with normal healthy volunteers. This multi-centric study was carried on 91 patients with vitiligo, as well as 91 normal healthy control subjects who were age- and sex-matched. Nails were examined for changes in nail plates as regards striations, texture, curvature, dystrophy, and pigmentation. The presence or absence of the thumb lunula was also reported. Nail changes were observed in 62 patients (68.1%) and 46 (50.5%) control subjects with a statistically significant difference (P=0.016). Longitudinal ridging and absent lunula were significantly higher in patients than in the controls (P=0.001 and 0.037, respectively). Other reported nail abnormalities in the current study included punctate leukonychia, pitting, flag sign, and Terry's nails. Awareness of this association will widen the clinician's perspective to carefully examine the nail changes in vitiligo patients and conversely examine patients with nail changes for vitiligo.

Nail disorder among patients on maintenance hemodialysis

Abstract Background/Objective Chronic renal failure can lead to nail disorders. The aim of this study was to investigate nail disorders and laboratory data in patients on constant hemodialysis (HD) in a hospital in Qazvin, Iran. Methods A case-controlled study was performed. End stage renal disease patients ( n = 149) undergoing regular HD and 147 randomly selected individuals were examined for nail disorder. All participants were examined by two trained students and a single dermatologist. Specific investigations such as nail biopsy, potassium hydroxide mount, and fungal culture were done if necessary. Laboratory data were completed for HD patients. Demographic characteristics, the causes of end stage renal disease, and laboratory data were tested in a multivariate analysis. Results In this study, 62 HD patients had at least one nail disorder, with leukonychia being the most common in both groups. Clinical onychomycosis, absent lunula and half and half nail were the other common findings in HD patients. Positive mycological culture was noted in four HD patients and in none of the control individuals. The mean duration of HD was a significant predictor associated with the positive clinical onychomycosis ( p Conclusion The prevalence of nail disorder in this study was correlated with age, DM, and gender. To decrease the prevalence of nail disorder, attention to duration of HD, age, male sex, and DM is very important.

The association between absent lunula and depression in depressive outpatients: A case-control study

Absent lunula can progressively develop in a person who previously had a normal-sized lunula and can be associated with various systemic disorders. In this case-control study we hypothesised that absent lunula is associated with depression. The study comprised 332 depressive outpatients as well as 367 age- and sex-matched controls, all of whom were assessed and screened by the Zung Self-rating Depression Scale (ZSDS). The presence of absent lunula in all fingers except the little finger on the right hand of subjects was examined and the number of absent lunula was calculated as 0, 1, 2, 3 and 4. It was revealed that there was no significant difference in age and gender between controls and depressive outpatients. In the order of 0, 1, 2, 3 and 4 absent lunula, the percentages were 68.1, 7.4, 9.5, 5.2 and 9.8 in controls, while it was 17.2, 15.4, 22.3, 21.4 and 23.7 in depressive outpatients with significant difference while they were 17.2, 15.4, 22.3, 21.4 and 23.7 in depressive outpatients, significantly different compared with controls. Logistic regression analysis on depressive outpatients indicated that severe depression was not associated with age and sex but markedly associated with number of absent lunula. Our study found that depression was associated with absent lunula, and severe depression was associated with a greater number of absent lunula.

Half and half nails.

This 68-year-old patient with Stage 4 chronic kidney disease was reviewed in our low clearance clinic 2 months after formation of a left arteriovenous fistula. The prominent ‘half-and-half’ appearance of his nails was noted. Nail disorders are common in chronic renal failure, affecting up to 70% of haemodialysis patients [1]. Half-and-half or Lindsay nails [2], where the proximal half of the nail is white and the distal half red or brown (first described by Bean in 1964) [3], are thought to be present in up to one-third of patients starting haemodialysis [1]. The disorder does not improve with haemodialysis, but sometimes regresses after transplantation. The precise aetiology is not known but is thought to be related to uraemia. Other common nail disorders associated with chronic renal failure include absent lunula and splinter haemorrhages. This patient also demonstrates hyperaemia of his fistula hand (left), which is visibly more erythematous than the non-fistula hand. It was also noticeably warmer to the touch due to increased blood flow through the arm from the fistula. Fig. 1. Half and half nails. Note also hyperaemia of patient's left hand.

Comparison of cutaneous manifestations in chronic kidney disease with or without dialysis

PurposeTo study and compare dermatological manifestations in patients with various stages of chronic kidney disease (CKD) and end stage renal disease (ESRD), undialysed and dialysed, in a developing country.Study design200...

Alterações ungueais nos pacientes portadores de insuficiência renal crônica em hemodiálise

Chronic renal failure affects almost all the systems of the body, including the skin and appendages. The nail disorders most commonly found in patients with chronic renal failure are half and half nails, absent lunula and splinter hemorrhages. To evaluate the spectrum and the frequency of nail disorders in patients with chronic renal failure submitted to hemodialysis and compare them with a paired sample from the general population. A case-controlled study paired for gender and age was conducted in which nail disorders were investigated in the two groups. At least one nail disorder was found in 86% of the hemodialysis patients and in 75% of subjects in the control group. Absent lunula (62.9%) and half and half nails (14.4%) were more common in the hemodialysis group compared to the control group and this difference was statistically significant (p < 0.05). Longitudinal striae were more common in the control group compared to the hemodialysis group (24.1%). Absent lunula and half and half nails were the most common nail disorders found in patients on hemodialysis, corroborating the findings of previous studies. Longitudinal striae were more common in the control group and future studies may clarify whether structural abnormalities such as absent lunula may be related to this finding.

Nail changes in kidney transplant recipients

Nail changes are common complications of end-stage renal disease, and reports of nail changes in kidney transplant recipients (KTR) are rare. Few reports have documented a higher prevalence of onychomycosis in KTR compared with controls, while others found no significant differences. In this study, we investigated the prevalence and nature of nail changes in a large series of KTR. Three hundred and two KTR (216 males and 86 females) were included in this study, and the mean transplant duration was 6.57 years (range 1.5 month-23 years). They were screened for the presence of nail changes. Nail clippings were collected when indicated and cultures were performed for patients with suspected onychomycosis. The patients were compared with 302 age- and sex-matched healthy controls (220 males and 82 females). One hundred and twenty-one KTR (40.1%) had nail changes compared with 104 (34.4%) in controls. Onychomycosis, Muehrcke's nail and leuconychia were significantly more common in KTR [23 (7.6%), 13.3 (4.3%), 11 (3.6%), respectively] compared with controls [7 (2.3%), 1(0.3%), 2 (0.66%), P = 0.002, 0.001 and 0.02, respectively]. However, the most frequent nail change among KTR and controls was absent lunula, 90 (29.8%) and 80 (26.5%), respectively P = 0.36. Longitudinal ridging was also a frequent nail pathology among KTR and controls, 21 (6.9%) and 19 (6.3%), respectively, P = 0.74. KTR have higher prevalence rates of onychomycosis, Muehrcke's nail and leuconychia than the healthy population. On the other hand, absent lunula could be a normal variation among Egyptian people.

Nail changes in chronic renal failure patients under haemodialysis

Chronic renal failure is known to cause various nail pathologies. They may be directly related to the renal condition itself or its complications or to the therapy. To compare nail changes in end-stage renal failure patients under haemodialysis with healthy persons and to study the potential relationship with various parameters in the patients. The study comprised 100 patients with chronic renal failure under regular haemodialysis as well as 100 healthy control subjects of matched age and sex. Both groups were subjected to full history taking and thorough general and nail examination. Complete blood picture, liver and kidney function tests and fasting blood glucose level were investigated. Nail disorders were more prevalent in patients (76%) than in control group (30%). The half and half nail was the most common finding (20%) followed by - in descending manner - absent lunula, onycholysis, brittle nail, Beau's lines, clubbing, longitudinal ridging, onychomycosis, subungual hyperkeratosis, koilonychias, total leukonychia, splinter hemorrhage, pitting and pincer nail deformity. There was non-significant correlation between nail changes and age of the patients or duration of haemodialysis. In addition, no evidence of significant relation was found between nail changes and both haemoglobin and albumin levels. Frequent nail changes are observed on systematic nail examination of uraemic patients undergoing haemodialysis; however, the cause of them remains obscure and could not be traced to a particular abnormality in the renal condition, medication or the procedure itself and it needs further investigations.