Assessment of nail findings in children with atopic dermatitis

Abstract

Background. Cutaneous findings are well known in atopic dermatitis (AD), but nail changes have not received as much attention. Aim. To determine the clinical and disease-related capillaroscopic findings of nail findings in paediatric patients with AD. Methods. In total, 100 participants aged 2-16 years were sourced from the dermatology outpatient clinic: 50 of these had been diagnosed with AD according to the Hanifin-Rajka criteria, and the others were 50 healthy controls (HCs) without AD. The AD severity score (SCORing Atopic Dermatitis; SCORAD) was calculated for all patients with AD. A digital epiluminescence device was used for nailfold capillaroscopy.Results. The nail findings detected in patients with AD were pitting, punctate leuconychia, trachyonychia, onycholysis and onychomadesis. Pitting was significantly (P < 0.01) more frequent in the patient group (26%) than in the HC group (6%). Similarly, the patient group had significantly higher rates for capillary density decrease (P < 0.01), capillary array irregularity (P < 0.001), capillary dilatation increase (P < 0.001), tortuosity (P = 0.04), ramification increase (P = 0.02), bushlike appearance (P = 0.02) and avascular areas (P < 0.01). Significant correlations were determined between pitting and trachyonychia (P < 0.05, r = 0.21), capillary density decrease (P < 0.05, r = 0.25), avascular areas (P < 0.001; r = 0.29) and SCORAD (P < 0.05, r = 0.35). Conclusion. The nailfold capillaroscopic images of children with AD were similar to those of scleroderma spectrum disorder. Thus, we believe it would be beneficial to support detailed clinical examination of patients with a capillaroscopic examination.

Nail unit dermoscopy (onychoscopy) in the differential diagnosis of erythroderma

“…So far, nail alterations in AD have not received as much attention. 4 In our analysis, there was a high incidence of dilated nail bed capillaries and splinter haemorrhages. We believe that these findings are mainly the result of small injuries to the nail apparatus due to intense itching and constant scratching.…”

Häufige Nagelerkrankungen im Kindes- und Jugendalter

“…Bei Kindern mit atopischer Dermatitis zeigten sich in der Kapillarmikroskopie

Kapillarmikroskopie

eine Rarefizierung, pathologische Dilatation und vermehrte Verzweigung der Kapillaren sowie avaskuläre Areale. Das Ausmaß dieser Kapillarveränderungen korrelierte mit der Ausprägung des Hautbefundes der Patienten gemessen an SCORAD (SCORing Atopic Dermatitis) [ 24 ]. Zusätzlich zeigte sich bei Kindern und Jugendlichen mit atopischer Dermatitis eine Korrelation zwischen der Ausprägung des Hautbefundes an unteren Extremitäten und einer Dystrophie der Zehennägel.…”