Clinical study of nail changes in leprosy and comparison with nail changes in diabetic patients

Darouti, MA El; Hussein, Salah F; Tahlawy, SR Al; Fangary, M Al; Mashaly, HM; Nabarawy, Eman El; Tawdy, A Al; Fawzi, May; Hay, Rania Abdel

doi:10.1111/j.1468-3083.2010.03783.x

Cited by 22 publications

(37 citation statements)

References 8 publications

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“…The nail flag sign (alternating horizontal bands of white and pink-red discoloration beginning at the proximal nail fold and extending distally to the end of the nail plate) was originally described in both leprosy patients and individuals with diabetes mellitus [ 10 ]. Subsequently, it was reported in patients with vitiligo [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Diverticulitis and a Review of the Dermatology of Flag Signs in Hair, Skin, and Nails: A Case Report of the Nail Flag Sign

Cohen¹

2018

Cureus

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A sign is a physical feature or microscopic change which can be observed when the patient or their tissue specimen is evaluated. An astute clinician or pathologist may be able to diagnose a patient’s condition by recognizing this unique morphologic feature or pathological change. In dermatology, the flag sign—alternating transverse bands of the skin or its adnexal structures that are analogous to the alternating colors of the stripes of a flag—has been associated with distinctive disorders of the hair, skin, or nails. The hair flag sign is characterized by alternating horizontal bands of hypopigmentation of the hair (in children with kwashiorkor type of protein-calorie malnutrition) or hyperpigmentation of the hair (in a male child who has intravenously received several cycles of high-dose methotrexate). In skin, the flag sign can be observed microscopically in actinic keratosis, and demonstrates by alternating parakeratosis and orthokeratosis of the stratum corneum—corresponding to the type of hyperkeratosis occurring above the interadnexal epidermis or the ostea of the acrosyringia and acrotrichia. The nail flag sign—noted in some individuals who have diabetes mellitus, diverticulitis, leprosy, or vitiligo—presents with alternating white and pink-red horizontal bands beginning at the proximal nail fold and extending distally to the free edge of the nail plate. A man with chronic diverticulitis and the nail flag sign is reported; he also has a history of congenital leukonychia, actinic keratoses, basal cell carcinoma and psoriasis. In addition, the features of hair, skin, and nail flag signs are reviewed. The detection of the dermatology flag sign can prompt a pathologist to consider the diagnosis of actinic keratosis. Alternating horizontal bands of hair color can indicate protein-calorie malnutrition or an effect of chemotherapy in a child. Certain autoimmune, inflammatory, or infectious conditions in individuals present with white and pink-red horizontal bands on their nails.

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Section: Discussionmentioning

confidence: 99%

Diverticulitis and a Review of the Dermatology of Flag Signs in Hair, Skin, and Nails: A Case Report of the Nail Flag Sign

Cohen¹

2018

Cureus

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“…Longitudinal ridging and splitting, increased nail curvature, dystrophic nail changes, and diffuse leukonychia were more frequently seen in paucibacillary patients than in multibacillary patients, whereas nail spooning and the flag sign were more frequently seen in multibacillary than in paucibacillary patients 7 . However, no cases of PU were reported in this study 7 . Hence, the PU observed in our case may be regarded as a rare manifestation of nail changes in leprosy because we excluded factors such as trauma, diabetes, drug use, vasculopathy, and neuropathy.…”

mentioning

confidence: 92%

“…During follow‐up, nail findings remained stable even after four months of therapy. A recently published investigatory article described nail changes in leprosy and compared them with those in patients with diabetic neuropathy 7 . The study included 115 leprosy patients and 60 patients with diabetic peripheral neuropathy.…”

mentioning

confidence: 99%

“…The study included 115 leprosy patients and 60 patients with diabetic peripheral neuropathy. Nail changes were more commonly seen in leprosy patients (86%) than in diabetes patients (68%) 7 . The authors concluded that nail changes in leprosy were multifactorial and could be related to one or more of the following factors: neuropathy; endarteritis; trauma; drugs; and superimposed infections 7 .…”

mentioning

confidence: 99%

“…Nail changes were more commonly seen in leprosy patients (86%) than in diabetes patients (68%) 7 . The authors concluded that nail changes in leprosy were multifactorial and could be related to one or more of the following factors: neuropathy; endarteritis; trauma; drugs; and superimposed infections 7 . Longitudinal ridging and splitting, increased nail curvature, dystrophic nail changes, and diffuse leukonychia were more frequently seen in paucibacillary patients than in multibacillary patients, whereas nail spooning and the flag sign were more frequently seen in multibacillary than in paucibacillary patients 7 .…”

mentioning

confidence: 99%

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