Nail Patterns in Papulosquamous Disorders- An Observational Study from Southern India

Abstract

Introduction: Nail changes are always a cause of physical handicap and psychological stress in this era where utmost importance is given to cosmetic appearance. Other than trauma and infections, Papulosquamous disorders are major contributor to nail changes. Thorough knowledge of their patterns will aid in early detection and treatment before irreversible damage to nails occurs. Aim: To observe the clinical patterns of nail changes in various papulosquamous disorders. Materials and Methods: This observational descriptive cross- sectional study was conducted in a tertiary care set up at Government Coimbatore Medical College, Coimbatore from June 2016 to June 2017. The study group comprised of 104 cases of various papulosquamous disorders. The type of papulosquamous disorder, presence of nail changes, their onset, duration, various patterns and associated co-morbidities were noted in detail. The observed data were entered in Microsoft Excel and data analysis was done in Epi Info system. Results: Out of the 104 cases taken for study 71 (68%) had nail changes. Majority of them were in 31-45 years age group (n=29; 41%). More of males (n=38, 54%) had nail changes than the females (n=33, 46%). Psoriasis (n=47; 66%) was the most common papulosquamous disorder with nail changes followed by lichen planus (n=9; 13%) and pityriasis rubrapilaris (n=7; 10%). Pitting of nails was the most common nail pattern (n=44; 62%), followed by subungual hyperkeratosis (n=24; 34%), thickened nail plate and longitudinal striations (both n=19; 27%). Finger nails were more affected than toe nails. Psoriasis and pityriasis rubrapilaris had 100% nail involvement. The patterns of nail changes were maximum in psoriasis and lichen planus. Beaus lines was observed in most of the papulosquamous disorders except Lichen nitidus and Lichen striatus. The time gap for onset of nail changes was longer for psoriasis (4.2 years) and shorter for pityriasis rosea (two months). In lichen striatus and lichen nitidus, nails were involved only in children. Minimal nail changes were observed in para psoriasis and pityriasis lichenoides. More number of co-morbidities like diabetes, hypertension, atopy and arthritis were seen in psoriasis. Conclusion: In the present study, it was observed that the nail changes were more common in psoriasis, lichen planus and pityriasis rubra pilaris among the papulosquamous disorders. The highly frequent nail patterns were pitting and subungual hyperkeratosis.

Onychomadesis following pityriasis lichenoides et varioliformis acuta treated with methotrexate

“…Moreover, nail involvement in pityriasis lichenoides is very rare -even though distal subungual hyperkeratosis in acral pityriasis lichenoides, 7 and Beau lines formation in PLC have been reported in unique case reports. 8 Due to the rarity of this manifestation and the involvement of nails at different levels, which is atypical for drug toxicities, 9 other potential causes should also be considered, including the damage on the nail matrix resulting from lichenoid inflammation, the presence of an unnoticed subclinical systemic infection, and direct inflammation spreading from adjacent skin lesions. 3 However, the latter would not explain the occurrence of onychomadesis in unaffected fingers and toes in this case.…”

Onychomadese nach Pityriasis lichenoides et varioliformis acuta, behandelt mit Methotrexat

“…Darüber hinaus ist eine Nagelbeteiligung bei Pityriasis lichenoides sehr selten -auch wenn vereinzelt über distale subunguale Hyperkeratose bei akraler Pityriasis lichenoides 7 und die Bildung von Beau-Linien bei PLC berichtet wurde. 8 Da diese Manifestation selten ist und die Nägel auf verschiedenen Ebenen betroffen sind, was für Arzneimitteltoxizitäten untypisch ist, 9 sollten auch andere potenzielle Ursachen in Betracht gezogen werden. Diese umfassen die Schädigung der Nagelmatrix infolge einer lichenoiden Entzündung, eine unbemerkte subklinische systemische Infektion und eine direkte Entzündung, die sich von benachbarten Hautläsionen ausbreitet.…”