Mottled Lunulae in Nail Psoriasis: Report of Three Cases

Peña-Romero, Adriana Guadalupe; Toussaint–Caire, Sonia; Domínguez‐Cherit, Judith

doi:10.1159/000448253

Cited by 7 publications

(5 citation statements)

References 9 publications

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“…The pathogenesis of red lunula is proposed to be either increased transparency of the lunula causing exaggerated visualization of the underlying nail bed vasculature or an engorged vasculature due to vessel entrapment secondary to nail bed swelling. [9][10][11][12] Our study confirms that LLBs are seen as a feature of nail LP, as a variant of red lunula. Red lunula occurs as a result of increased, dilated and tortuous vasculature in the nail bed and matrix.…”

Section: Reportsupporting

confidence: 81%

Intraoperative onychoscopy and histopathological correlation of red lunula in nail lichen planus: a case series

Kaur

Jakhar

2020

Clin Exp Dermatol

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Summary The lunula is the white half‐moon‐shaped area located at the base of the fingernails and toenails, and is the only visible part of nail matrix. Red lunula can present as a complete form (the whole lunula is red), incomplete form (only the proximal lunula is red) or mottled form. Red lunula has been associated with a number of dermatological and systemic conditions. It is one of the less common manifestations of nail lichen planus (LP). However, the pathogenesis of the red lunula is not yet clear. We present a series of six patients with nail LP presenting with red lunula, and describe the findings of intraoperative onychoscopy and histopathology in an attempt to understand the pathogenesis underlying the condition.

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Section: Reportsupporting

confidence: 81%

Intraoperative onychoscopy and histopathological correlation of red lunula in nail lichen planus: a case series

Kaur

Jakhar

2020

Clin Exp Dermatol

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“…Some authors prefer to call the RSL as ML [21]. We only designate RSL, when red spots are seen in the lunula (Fig.…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…Typical dermoscopic features of nail psoriasis include SH, DO, SP, SUH and pitting, which are also seen with a naked eye. Dermoscopy allows for the recognition of characteristic features of nail psoriasis that are difficult to differentiate with a naked eye, such as erythematous border around the onycholytic area [20] and ML [21]. In the present study, we assessed both classical and novel dermoscopic features of nail psoriasis.…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…In 2016, Peña-Romero et al [21] described the presence of ML in three patients with psoriasis, one of whose histopathological examination of nail biopsy specimens demonstrated dilated capillaries in the superficial papillary dermis and thinning of the suprapapillary plate. It was postulated that RSL was the clinical representation of dilated blood vessels in the lunula [21]. Lichen planus is another dermatological disorder with a known cause of RSL.…”

Section: Discussion/conclusionmentioning

confidence: 99%

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Dermoscopic Features of Nail Psoriasis: Revisited

Yorulmaz¹,

Aksoy²

2022

Skin Appendage Disord

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Introduction: Nail psoriasis poses a diagnostic challenge in a context of clinical findings that are not evident. We aimed at exploring dermoscopic findings of nail psoriasis and assessing the relationship between these features with disease severity and the risk of arthritis. Methods: We enrolled 35 patients (26 men, 9 women) with severe nail psoriasis (Nail Psoriasis Severity Index [NAPSI] score of more than 50). A complete clinical evaluation, including musculoskeletal assessment and videodermoscopic examination of all nails, was carried out for each patient. Results: Splinter haemorrhage was the most common finding (94.3%), followed by distal onycholysis (88.6%) and pitting (74.3%). The presence of subungual hyperkeratosis (SUH) and the absence of mottled lunula were associated with disease severity (p < 0.05). Both SUH and nail plate crumbling (NPC) were observed more in patients with arthritis. The presence of a combination of SUH and NPC was associated to a 15-fold increase in the risk of arthritis (%95 confidence intervals: 1.55–145.2, p < 0.05). Discussion/Conclusion: This study presents preliminary evidence for the use of dermoscopy as a first step in the diagnosis of nail psoriasis. Dermoscopy is an indispensable tool in the primary evaluation of patients with nail psoriasis, which provides predictive information about the course of the disease.

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“…Several types of erythematous alterations within the lunula may be distinguished depending on their shape. Perpendicular dilated capillaries in the onychodermis may manifest as red spots or mottled lunula [18]. Another lunular abnormality, firstly described by Chauhan et al [13] in 2020, was fuzzy lunula, defined as irregular, wide white lunula.…”

Section: Nail Psoriasismentioning

confidence: 99%

Dermoscopic Nail Changes in Psoriasis, Lichen Planus, and Lichen Striatus

Sar-Pomian,

Starace,

Lencastre

et al. 2024

Skin Appendage Disord

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Background: Onychoscopy is a noninvasive method helpful in diagnosing nail disorders. The aim of the study was to review literature on the usability of onychoscopy in nail psoriasis, nail lichen planus, and nail lichen striatus. Summary: Onychoscopic features of nail psoriasis are pitting, onycholysis with erythematous border, salmon patches, splinter hemorrhages, dotted vessels in lateral and proximal folds, and hyponychium. Onychoscopic features of nail lichen planus are onychorrhexis, onycholysis, longitudinal melanonychia, and red lunula. The literature on the usability of onychoscopy in nail lichen striatus is scarce. Keynotes: Onychoscopy facilitates evaluation of nail abnormalities compared to the clinical examination. Lunular alterations, salmon patches, erythematous border of onycholysis as well as splinter hemorrhages in nail psoriasis are better visualized with onychoscopy compared to the naked eye. Onychoscopy enhances detection of melanonychia, dyschromia, and lunular changes in nail lichen planus. Onychoscopic features are different in fingernails and toenails.

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Mottled Lunulae in Nail Psoriasis: Report of Three Cases

Cited by 7 publications

References 9 publications

Intraoperative onychoscopy and histopathological correlation of red lunula in nail lichen planus: a case series

Intraoperative onychoscopy and histopathological correlation of red lunula in nail lichen planus: a case series

Dermoscopic Features of Nail Psoriasis: Revisited

Dermoscopic Nail Changes in Psoriasis, Lichen Planus, and Lichen Striatus

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