Nail Changes In Patients Research Articles

Nail changes in patients receiving systemic isotretinoin therapy

In this study, it was aimed to describe isotretinoin-induced nail changes and increase patients’ treatment compliance. A total of 200 patients diagnosed with acne vulgaris were included in the study. 100 of the patients were started systemic isotretinoin treatment and 100 control patients were receiving topical acne treatment. Age and gender of all of the participants, duration of treatment, total doses per month, and type of nail changes were recorded. Patients with persistent nail changes were followed at the 3rd and 6th months after treatment. A total of 34 patients had nail changes in the isotretinoin group. These changes included onychoschizia (55.9%), leukonychia (11.8%), onychorexis (8.8%), median nail dystrophy (5.9%), pyogenic granulomas (5.9%), chronic paronychia and granulation tissue (5.9%), onycholysis (2.9%) and Beau’s line (2.9%). The rate of nail changes in the isotretinoin group was significantly higher than in the topical treatment group (34% vs. 11%, p:0.001). Isotretinoin increases the risk of nail changes, primarily onychoschizia. The risk of developing nail changes is not associated with treatment duration but is associated with the total cumulative dose. Nail findings induced by isotretinoin are completely reversible.

Questionnaire survey of healthcare professionals on taxane-induced nail change in Japan.

Taxanes are widely used chemotherapeutic agents that frequently cause nail changes and have a significant impact on patients' quality of life. Despite the prevalence of taxane-induced nail toxicity, limited data are available regarding evidence-based management strategies for the prevention or treatment of taxane-induced nail changes. Therefore, we aimed to gain insights into the prevention, treatment, and evaluation of nail changes in patients with cancer in Japan by conducting a questionnaire survey of physicians, pharmacists, and nurses involved in oncology treatment. The questions addressed prophylactic methods, evaluation practices, and treatment approaches for various nail disorders. The questionnaires were distributed on March 1, 2022, with a response deadline of December 1, 2022. Of the 120 questionnaires distributed, 88 (73.3%) were returned, and all of them were analyzed. The respondents included 69 physicians (32 oncologists, 26 breast surgeons, 6 dermatologists, 3 obstetricians/gynecologists, 1 gastroenterological surgeon, and 1 urologist), 9 pharmacists, and 10 nurses. Prophylactic measures included moisturizing (58.0%), protection (42.0%), cooling therapy (37.5%), and cleanliness (33.0%). Approximately 70% of the respondents used the Common Criteria for Adverse Events (CTCAE), while approximately 30% did not use a specific evaluation method. Opinions regarding treatment with antimicrobial or corticosteroid ointments varied; however, all severe cases were referred by dermatologists. Our survey revealed that the management of chemotherapy-induced nail changes varies in clinical practice in Japan. These findings emphasize the need for standardized management strategies and further research.

Dermoscopic Evaluation of Nail Changes in Patients with End-Stage Renal Disease on Regular Hemodialysis

Introduction: Chronic renal failure can impact various body systems, including the skin and its appendages. Patients with uremic conditions have been observed to experience a variety of nail changes. This study was conducted to evaluate the presence and type of fingernail changes in patients with end-stage renal failure (ESRF) on regular hemodialysis (HD) by nail dermoscopy. Methods: A total of 100 patients with ESRF on regular HD three times a week. Nails were examined by dermoscopy for the presence of subtle nail changes. Results: Nail changes were found in 91% of patients, while 9% did not have nail changes. The most common dermoscopic findings were as follows; scales in lateral nail fold in 91% of the patients, dry cuticle in 84%, onychoschizia in 72%, and longitudinal striation in 69%. There was no significant relation between nail changes and sex, duration of HD, and albumin level. Conclusion: Patients with end-stage renal disease on HD are more likely to experience nail disorders. Scales in LNF, dry cuticle, onychoschizia, longitudinal striation, terry’s nails, and half-and-half nails were the most common nail changes in HD patients.

Nail changes in pemphigus: a systematic review and meta-analysis.

Pemphigus is a group of autoimmune mucocutaneous bullous disorders characterized by acantholysis resulting from autoantibodies targeting epithelial cell surface antigens. Studies reflect the presence of nail manifestations in some patients and suggest a potential correlation with clinical severity. This study examines the overall prevalence and characterizes the diverse manifestations of nail changes in pemphigus. We searched Cochrane, MEDLINE, EMBASE, and LILACS from 1990 to June 26, 2023 for studies reporting different nail changes in pemphigus patients. Data were collected and pooled to obtain proportions of the prevalence of nail changes in patients with pemphigus and subgroup analysis for pemphigus foliaceous and pemphigus vulgaris. The risk of bias was assessed with the Joanna Briggs Institute Checklist. Of 321 studies screened, 14 studies with 1,208 patients were included. Paronychia (n = 185) and Beau's lines (n = 104) were the most common nail changes identified. The pooled prevalence of nail disease in pemphigus patients was 0.389 (number of studies; [95% CI]: n = 9; [0.160-0.680], with high heterogeneity between studies (I2 = 95.0%, P < 0.001). Subgroup analysis revealed the highest prevalence in pemphigus foliaceous at 0.342 (n = 3; [0.109-0.688]) and pemphigus vulgaris at 0.396 (n = 5; [0.114-0.769]). Nail changes exhibited varied temporal relationships with disease onset and flares, preceding, concurrent, or following these events. Correlation with disease severity was noted, although discrepancies between studies were reported. Nail changes in pemphigus, particularly pemphigus vulgaris and pemphigus foliaceous, may be underrecognized. Observations regarding temporal associations and potential correlations with disease severity highlight the diagnostic and prognostic implications of nail changes in pemphigus. The limitations of this study include study heterogeneity and possible bias. Further research to establish the correlation of the presence and severity of nail changes on the overall disease course would be helpful.

Dermoscopy of subclinical nail involvement in patients with diabetes mellitus: a case-control study.

Diabetes mellitus (DM) is a chronic disease characterized by elevated blood glucose levels that can lead to serious complications. Nails are a mirror for general health so changes in nails can be an indicator of disease progression in patients with DM. To detect subclinical nail changes in patients with DM using dermoscopy. In total, 100 participants were recruited, all of them from outpatient clinics, made up of a group with DM (n = 50) and an age- and sex-matched control group without DM (n = 50). All patients had clinically apparently normal nails. In both groups, dermoscopic examinations were conducted and compared. It was found that 33 patients in the DM group (66%) had dermoscopic nail findings in the form of microhaemorrhage (26%), longitudinal striations (24%), distal subungual onychomycosis (24%), superficial pitting (20%), distal onycholysis (18%), splinter haemorrhage (14%), subungual hyperkeratosis (12%), dilated vessels (10%) and distal yellowish discoloration (8%). Nail examination can be accomplished with the help of dermoscopy to detect subclinical nail changes in patients diagnosed with DM and, therefore, can give us an idea about disease progression and help with control of DM and treatment plans.

Nail involvement in patients with epidermolysis bullosa: Asystematic review.

Nail changes in patients with congenital epidermolysis bullosa (EB) are caused by abnormalities of the nail matrix and bed secondary to pathogenic alterations of the dermoepidermal junction. Even though ungual alterations are extremely frequent in these patients, there are scarce studies about their frequency and/or association with subtypes or clinical course of EB. To systematically review nail abnormalities in patients with EB reported in the literature. We searched all published articles in electronic databases until June 2020 reporting patients with EB with detailed descriptions of malformed/diseased nails using specific terms and inclusion/exclusion criteria. Clinical data were extracted by two independent authors. Descriptive statistics were used. We included 36 articles reporting 74 individual patients with a mean age of 28.23years: 29 (39.2%) had dominant dystrophic EB, 27 (36.4%) had junctional EB, 8 (10.8%) had EB simplex, 6 (8.1%) had Kindler syndrome and 4 (5.4%) had recessive dystrophic EB. The most common abnormalities were dystrophic nails (48.6%), anonychia (43.2%) and pachyonychia (40.5%). Anonychia was considered the most severe abnormality and was reported more frequently in patients with junctional (62.9%) and recessive dystrophic EB (50%). Multiple organ involvement was present in 52.7% of patients. Patients with severe junctional epidermolysis bullosa and recessive dominant epidermolysis bullosa presented anonychia since birth. In this summary of nail abnormalities in patients with EB, anonychia was more frequent in patients with severe EB subtypes and multiple organ involvement. Further prospective studies are required to understand the associations between nail abnormalities in specific EB subtypes and/or patient outcomes.

Nail changes in pemphigus and bullous pemphigoid: A single-center study in China

Common autoimmune bullous diseases (AIBDs) include pemphigus and bullous pemphigoid (BP), which are primarily caused by IgG autoantibodies against the structural proteins of desmosomes at the cell–cell junction and hemidesmosomes at the epidermal–dermal junction. Few studies have assessed nail changes in patients with pemphigus or BP. In the present study, we collected the clinical data of 191 patients with AIBDs (108 patients with pemphigus and 83 patients with BP) and 200 control subjects. Nail changes were observed in 77.0% (147/191), 77.8% (84/108), and 75.9% (63/83) of patients with AIBDs, pemphigus, and BP, respectively, and 14.5% (29/200) of control subjects. Beau's lines and paronychia were the most common nail involvement, observed in 22.5% (43/191) and 22.5% (43/191) of patients with AIBDs, 25.0% (27/108) and 25.9% (28/108) of patients with pemphigus, 19.3% (16/83) and 18.1% (15/83) of patients with BP, respectively. The autoimmune bullous skin disorder intensity score (ABSIS) and the onset time of patients with pemphigus or BP with nail changes were different. Onychomycosis accounted for 21.5% (41/191) of all patients with AIBDs. The ABSIS was correlated with nail involvement in patients with BP (r = 0.46, p < 0.001), and weakly correlated with nail involvement in patients with AIBDs (r = 0.37, p < 0.001), pemphigus (r = 0.29, p = 0.009), and pemphigus vulgaris (PV; r = 0.35, p = 0.008). No correlation was observed between nail involvement and disease antibody titers. In conclusion, nail changes are frequently observed in patients with pemphigus and BP. The type and onset time of nail changes may indicate the severity of pemphigus and BP, which warrants the attention of dermatologists.

A dermoscopic study of nail involvement in chronic plaque psoriasis at a tertiary care center

Background: Psoriasis is a chronic inflammatory disease that affects millions of people throughout the world. Nail involvement is a common feature in psoriasis which is often overlooked despite causing significant functional impairment, disfigurement, and psychological stress to the patient. Dermoscopy is a non-invasive novel tool that enables a rapid and magnified visualization of the nail changes which are often imperceptible to the unaided eye. Aims and Objectives: To study the dermoscopic profile of nail changes in patients with chronic plaque psoriasis. Materials and Methods: The study was conducted from December 2018 to May 2020, in the Department of Dermatology of a tertiary care center in Kerala, including 155 patients of clinically diagnosed chronic plaque psoriasis who had nail involvement. A detailed history was noted along with a clinical and dermoscopic examination of all 20 nails of each patient. Results: The most common finding on dermoscopic examination of the nails was onycholysis seen in 91%, followed by pitting (78.8%) and subungual hyperkeratosis (78.1%). Other findings noted in our study which are not commonly described are wavy lamellar microsplitting (41.9%), cuticular hypertrophy (18.1%), pseudofiber sign (16.1%), dilated nailfold capillaries (12.3%), capillary prominence at onychodermal band (7.7%), dilated hyponychial capillaries (7.7%), and fuzzy lunula (7.1%). Conclusion: Nails are frequently involved in psoriasis but often overlooked. Dermoscope is an effective tool that facilitates the assessment of nail changes in psoriasis.

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 &nbsp; HIV infected individuals and to correlate the severity of nail changes &nbsp; with CD4 count. Material and Method: This was a cross sectional study, conducted in Skin &amp; 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. &nbsp; 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 &nbsp; 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

Prevalence of nail changes in patients with psoriasis and correlation of NAPSI (Nail area psoriasis severity index) with BSA (Body surface area)

Introduction: Nail involvement is an often-overlooked clinical symptom of Psoriasis. It causes psychologic stress, pain, impairment of manual dexterity and a significant negative impact on a patient’s quality of life. Objective: The present study was conducted to study the prevalence of nail changes in psoriasis patients, assessment of the severity of nail involvement using NAPSI score and to correlate the relationship between NAPSI and BSA in those patients. Materials and Methods: This was a cross sectional study, conducted in Dermatology department in a tertiary care hospital between January 2016-August 2017. A total of 100 psoriasis patients were included in the study. The severity of nail involvement was assessed with NAPSI. Cutaneous disease severity was assessed with BSA. Data were coded and analyzed. Results: Most common nail change in our study was Nail pitting (83.1%), followed by onycholysis (73.8%), subungual hyperkeratosis (23.1%), Longitudinal ridges (23.1%) and Beau’s lines (21.5%). We observed that BSA showed a positive and statistically significant correlation with NAPSI, demonstrating worsening of nail involvement with increased severity of skin disease. Conclusion: Nail psoriasis seems to be an ignored feature of the disease and further research must focus on the effect of psoriasis treatment on the nails. This study is the first to compare NAPSI in correlation with body surface area (BSA), leading to lesser inter observer variability in assessing the severity of skin and nail involvement when compared with PASI. Keywords: Body surface area, Nail area psoriasis severity index, Nail psoriasis, Psoriasis vulgaris, Pitting.

Evaluation of Subclinical Nail changes in Patients with Chronic Plaque Psoriasis using Dermoscopy

Abstract Background Dermoscopy is a non-invasive technique that allows the visualization of subtle clinical features of the skin surface and appendages details not visible to the naked eye, allowing magnifications of up to 200x. It is widely used for evaluating and diagnosing all nail diseases, as it provides important information. As any other examination, nail dermoscopy (onychoscopy) requires a good knowledge of nail anatomy &amp; physiology and the pathogenesis of the nail diseases, and it is helpful for the diagnosis of numerous nail diseases and tumors. Nail disorders are defined according to their appearance and the part of the nail affected (from distal to proximal): hyponychium, onychodermal band (ODB), nail bed, nail plate, lateral nail folds (perionychium), lunula (distal part of the matrix), cuticle, nail matrix and proximal nail fold. Objective To study the dermoscopic findings of subtle nail changes in patients with chronic plaque psoriasis and compare it with that nail changes in healthy controls by both polarized and non polarized mode of dermoscope, aiming to assist clinicians in correctly evaluating and diagnosing nail changes with the help of dermoscopy. Methods We conducted a comparative descriptive study on 50 patients having chronic plaque psoriasis, 26 were males (52.0%) and 24 were females (48.0%), as well as 50 normal healthy control subjects, 31 were males (62.0%) and 19 were females (38.0%). Patients and controls were randomly recruited from the outpatient clinic of dermatology department at Ain Shams University Hospitals, during the period from February 2018 till September 2018. And the age of both groups ranged from 14 to 70 years. Results Our study revealed that the most common fingernail changes found in psoriatic patients were nail plate thickening and crumbling followed by Dilated nailbed capillaries at the onychodermal band, Oncholysis, Subungual hyperkeratosis, Pitting, Longitudinal ridges, Scales, Salmon patch, Leukonychia, Splinter hemorrhage, Lunula red spot and Trachyonychia. And the most common toenail changes found in psoriatic patients were Subungual hyperkeratosis followed by Nail Plate Thickening &amp;Crumbling, Oncholysis, Pitting, Longitudinal ridges, Scales, Salmon patch, Trachyonychia, Dilated nailbed capillaries at the onychodermal band, Splinter hemorrhage, Leukonychia and Lunula red spot. We found there was no difference between polarized and non polarized mode of dermoscope in examination of fingernails and toenails except that the non polarized mode showed the changes of the Dilated capillaries at the onychodermal band more obviously. And also, there was no difference between wet and dry method of polarized mode of dermoscope. Conclusion This study confirms that a handheld dermoscope is a very efficient and simple tool for detection of any nail abnormality.

Patterns of nail changes in chronic liver diseases

Background: Nail abnormalities were frequently associated with liver diseases. Early detection of these nail changes may help to initiate early treatment and reduce serious complications, sequelae, morbidity, and mortality of chronic liver diseases. Objective: To record the frequency and patterns of nail changes in patients with chronic liver diseases. Patients and methods: The study included 1000 patients who attended the Tropical Medicine and Gastroenterology department in Sohag University Hospital, between October 2017 and October 2018 with clinical and/ or laboratory diagnosis of liver diseases. A full nail examination was performed. Results: In this study, nail changes are found in the majority of patients with liver diseases (80.5% ). White nails were the commonest abnormality noted followed by longitudinal striations, terry's nails, brittle nails, clubbing, flat nails, and onychomycosis. Conclusion: Nail abnormalities are common with liver cirrhosis as well as with HCV and HBV infections. The cause of these changes remains unknown; it may be as a consequence of decreased cell-mediated immunity, immunosuppression, iron deficiency, anemia or old age, but not that of the virus itself. It is important for the clinicians to understand and examine carefully the nails for color, texture, thickness, and curvature to reach a prompt and early diagnosis of patients with liver disease.

Nail Dystrophy in Patients with Atopic Dermatitis and Its Association with Disease Severity.

BackgroundNail dystrophy arises from various inflammatory dermatologic diseases. However, there have been few reports on the prevalence of nail abnormality in atopic dermatitis (AD) or on the relationship of this condition with the severity of the disease.ObjectiveThis study was intended to determine the prevalence and types of nail abnormalities associated with AD and to evaluate the relation between nail abnormalities and the severity of AD.MethodsAD patients aged 2 to 19 who visited the outpatient clinic were thoroughly examined for nail abnormalities. Demographic information was collected and eczema area and severity index (EASI) score for severity of AD were checked.ResultsA total of 235 AD patients (children and adolescents) were investigated. There were 24 (10.2%) patients with nail abnormalities: transverse groove (Beau's line) (25.0%), nail pitting (16.7%), koilonychia (16.7%), trachyonychia (12.5%), leukonychia (12.5%), brachyonychia (8.3%), melanonychia (8.3%), onychomadesis (8.3%), onychoschizia (8.3%), and onycholysis (8.3%). There was no statistically significant difference in the total EASI score associated with development of nail abnormalities (p=0.236). However, when the EASI score was confined to the lower extremities, it showed a relation to the prevalence of toe nail dystrophy (odds ratio, 1.115; 95% confidence interval, 1.014~1.316; p=0.030).ConclusionNail abnormalities in AD are thought to be caused mainly by pathologic change in the nail matrix region, and the EASI score confined to lower limbs, might be used as a predictor of toe nail changes in patients with AD.

Study of Nail Changes in Psoriasis

Psoriasis is a common, chronic and recurrent inflammatory disease of the skin. Clinically, disease can present with cutaneous and nail lesions. Both fingernails and toenails may be affected. The present study was conducted to study the abnormal nail changes in patients with psoriasis and to find correlation between nail changes and some clinical parameters. The study was undertaken in Skin &amp; VD outpatient department of Rajshahi Medical College Hospital, Rajshahi. One hundred patients of psoriasis of all age and both sexes were enrolled for studying the nail changes, in whom diagnosis of psoriasis was made clinically. In any case of abnormalities clinically suspected of fungal infection, further mycological investigations were performed. Nail changes were present in 60 patients (60%, P&lt;0.05) with psoriasis. Pitting was the most common finding on fingernails (70%), followed by onycholysis (35%). Subungual hyperkeratosis was the most common finding in toenails (34.37%). A very strong association was seen between nail changes and joint pain. There was positive correlation between nail abnormalities and duration of psoriasis. Nail involvement is common in patients with psoriasis. Pitting, onycholysis, subungual hyperkeratosis are the most frequent nail changes in psoriatic patients.TAJ 2016; 29(1): 29-32

Nail involvement in patients with moderate-to-severe alopecia areata treated with oral tofacitinib

Background: A few anecdotal case reports demonstrated that tofacitinib improved nail changes associated with AA.Objective: To investigate nail changes in patients with AA treated with tofacitinib and evaluate the relationship between nail and hair responses to tofacitinib.Methods: This is a retrospective study of 33 adult patients with moderate-to-severe AA treated with oral tofacitinib monotherapy for at least 4 months.Results: Fifteen patients had nail involvement and demonstrated more severe hair loss than those without nail involvement (p = .040). However, there was no significant difference in hair regrowth between two groups. Of 15 patients with nail involvement, 11 (73.3%) showed improvement regardless of type of nail change; the first improvement was observed at a median of 5 months (range, 1–11) after administration. Nail improvement was associated with neither initial severity of hair loss nor hair response to tofacitinib. Nail improvement tended to occur later than hair regrowth.Conclusions: Oral tofacitinib monotherapy improves nail involvement associated with AA. Nail involvement is not a poor prognosis factor in hair regrowth with tofacitinib treatment and there is no evident relationship between nail and hair responses.

A Study of Clinical Pattern of Nail Changes in Patients who attended DVL OPD at Tertiary Care Centre

A Study of Clinical Pattern of Nail Changes in Patients who attended DVL OPD at Tertiary Care Centre

Study of nail changes in psoriasis

Background: Psoriasis is a common, chronic and recurrent inflammatory disease of the skin. Clinically, disease can present with cutaneous and nail lesions. Both fingernails and toenails may be affected.Objectives: The present study was conducted to study the abnormal nail changes in patients with psoriasis and to find correlation between nail changes and some clinical parameters.Materials &amp; Methods: The study was undertaken in Skin &amp; VD outpatient department of Rajshahi Medical College Hospital, Rajshahi. One hundred patients of psoriasis of all age and both sexes were enrolled for studying the nail changes, in whom diagnosis of psoriasis was made clinically. In any case of abnormalities clinically suspected of fungal infection, further mycological investigations were performed.Results: Nail changes were present in 60 patients (60%, P&lt;0.05) with psoriasis. Pitting was the most common finding on fingernails (70%), followed by onycholysis (35%). Subungual hyperkeratosis was the most common finding in toenails (34.37%). A very strong association was seen between nail changes and joint pain. There was positive correlation between nail abnormalities and duration of psoriasis.Conclusion: Nail involvement is common in patients with psoriasis. Pitting, onycholysis, subungual hyperkeratosis are the most frequent nail changes in psoriatic patients.KYAMC Journal Vol. 8, No.-2, Jan 2018, Page 24-26

Nail changes in alopecia areata: an update and review.

Nail changes are a common feature of alopecia areata (AA) and are a significant source of cosmetic disfigurement and functional impairment. This review provides an update of the prevalence, clinical and histopathological features, pathogenesis, differential diagnosis, clinical course, prognosis, and management of nail changes in patients with AA. Searches for peer-reviewed journal articles were conducted using the PubMed/MEDLINE database with the search terms "nail changes alopecia areata," "alopecia areata nails," and specific searches on "trachyonychia alopecia areata" and "pitting alopecia areata." Other sources of articles included the reference lists of retrieved articles. Nail changes are a common feature of AA, with an average prevalence of 30%, and can cause significant disfigurement and loss of function. Pitting and trachyonychia were by far the most common manifestations of AA, with an average prevalence of 20 and 8%, respectively. Red spotted lunulae, onycholysis, and punctate leukonychia were other reported findings. Other etiologies, such as onychomycosis or lichen planus, may coexist with or confound the diagnosis. There is limited published data on the clinical manifestations of AA-associated nail changes and therapeutic options. Larger controlled trials are necessary to guide treatment decisions.

Nail Involvement in Alopecia Areata: A Questionnaire-based Survey on Clinical Signs, Impact on Quality of Life and Review of the Literature.

Alopecia areata (AA) is an immune-mediated disease causing temporary or permanent hair loss. Up to 46% of patients with AA also have nail involvement. The aim of this study was to determine the presence, types, and clinical implications of nail changes in patients with AA. This questionnaire-based survey evaluated 256 patients with AA. General demographic variables, specific nail changes, nail-related quality of life (QoL), and treatment history and need were evaluated. Prevalence of nail involvement in AA was 64.1%. The specific nail signs reported most frequently were pitting (29.7%, p = 0.008) and trachyonychia (18.0%). Red spots on the lunula were less frequent (5.1%), but very specific for severe AA. Nail-related QoL was only minimally affected by nail changes. In conclusion, nail involvement is common in patients with AA and presents mostly with pitting and trachyonychia. The presence of these nail changes reflects the severity of the disease, with red spots on the lunula as a predictor for severe alopecia.

278 Nail dystrophy in patients with atopic dermatitis and its association with disease

Nail dystrophy arises from various inflammatory dermatologic diseases. However, there have been few reports on the prevalence of nail abnormality in atopic dermatitis (AD) or on the relationship of this condition with the severity of the disease. Therefore, This study was intended to determine the prevalence and types of nail abnormalities associated with AD and to evaluate the relation between nail abnormalities and the severity of AD. AD patients aged 2 to 19 who visited the outpatient clinic were thoroughly examined for nail abnormalities. Demographic information was collected and eczema area and severity index (EASI) score for severity of AD were checked. A total of 235 AD patients (children and adolescents) were investigated. There were 24 (10.2%) patients with nail abnormalities: transverse groove (Beau’s line) (25%), nail pitting (16.7%), koilonychia (16.7%), trachyonychia (12.5%), leukonychia (12.5%), brachyonychia (8.3%), melanonychia (8.3%), onychomadesis (8.3%), onychoschizia (8.3%), and onycholysis (8.3%). There was no statistically significant difference in the total EASI score associated with development of nail abnormalities (p = 0.236). However, when the EASI score was confined to the lower extremities, it showed a relation to the prevalence of toe nail dystrophy (odds ratio: 1.115; 95% confidence interval: 1.01–1.32; p = 0.03). In conclusion, Nail abnormalities in AD are thought to be caused mainly by pathologic change in the nail matrix region, and the EASI score, if confined to lower limbs, might be used as a predictor of toe nail changes in patients with AD.