The red half‐moon nail sign: a novel manifestation of coronavirus infection

Neri, Iria; Guglielmo, Alba; Virdi, Annalucia; Gaspari, Valeria; Starace, Michela; Piraccini, Bianca Maria

doi:10.1111/jdv.16747

Cited by 46 publications

(75 citation statements)

References 7 publications

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“…Multiple cutaneous dermatologic manifestations have been reported in patients infected with SARS‐CoV‐2, especially pernio‐like lesions 1 . Interestingly, nail apparatus manifestations of SARS‐CoV‐2 have been scarcely reported, with only one published report in the literature to date 2 …”

Section: Figurementioning

confidence: 99%

COVID‐19 and nail manifestation: be on the lookout for the red half‐moon nail sign

2020

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COVID-19 and nail manifestation: be on the lookout for the red half-moon nail sign Dear Editor, Multiple cutaneous dermatologic manifestations have been reported in patients infected with SARS-CoV-2, especially pernio-like lesions. 1 Interestingly, nail apparatus manifestations of SARS-CoV-2 have been scarcely reported, with only one published report in the literature to date. 2 We report the case of a 37-year-old woman who presented with anosmia, dry cough, persistent fever, and relatively normal oxygen saturation (>92%). A positive nasal swab polymerase chain reaction for SARS-CoV-2 confirmed the infection. Two days after the symptoms began, the patient noticed changes in the nail bed characterized by a red-violet band, above the nail lunule. These changes were asymptomatic and lasted for 1 week before gradually returning to normal (Fig. 1). The patient was managed at home and did not require supplemental oxygen. Cutaneous manifestations, such as erythematous rash, rash with petechiae, vesicular rash, acral ischemia, livedo reticularis, and widespread urticaria, can present in up to 20% of patients with SARS-CoV-2 infection. 1 The chilblain-like lesions in patients with SARS-CoV-2 infection range from mild to severe acral ischemia lesions. Recently Neri et al., reported a case of "transversal red bands of the nail" also referred to as the "red half-moon nail sign". 2 We believe that our case confirms this finding. The pathophysiology of this nail manifestation remains to be elusive; however, similar to Neri et al., we hypothesized that this transient phenomenon could be secondary to vascular inflammation. 2 We did not perform a biopsy because of its morbidity and possible permanent cosmetic results. Therefore, the associated histological findings of the red half-moon nail sign associated with SARS-CoV-2 infection remain uncertain. In summary, it is important to emphasize a complete and detailed dermatological review, in search of these nail changes in all patients with SARS-CoV-2 infection.

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Section: Figurementioning

confidence: 99%

COVID‐19 and nail manifestation: be on the lookout for the red half‐moon nail sign

2020

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“…The characteristics of skin lesions in patients with COVID-19, as described recently in case reports or case series, are summarized in the Table 1 [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ,…”

Section: Introductionmentioning

confidence: 99%

Clinical and Histopathological Features and Potential Pathological Mechanisms of Skin Lesions in COVID-19: Review of the Literature

2020

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In recent weeks, several reports have emerged of skin lesions with different clinical presentations in COVID-19 cases. All dermatologists should be aware of these cutaneous lesions, which may be early clinical symptoms of infection. We reviewed the literature on cutaneous manifestations in the PubMed database from December 2019 and June 2020. From the cases described as case reports or series in 57 recent articles, it appears that skin lesions (i) are highly varied, (ii) may not be related to the severity of the condition and (iii) resolve spontaneously in a few days. The frequency of these lesions in COVID-19 patients varies between 1.8% and 20.4%. The major clinical forms described were maculopapular eruptions, acral areas of erythema with vesicles or pustules (pseudochilblain), urticarial lesions, other vesicular eruptions and livedo or necrosis. The lesions were mainly localized in the trunk and extremities. The majority of patients were male, aged between 4.5 and 89 years. A minority of the patients were children presenting with acral, chilblain-like lesions, papulo-vesicular eruptions or Kawasaki disease-like pediatric inflammatory multisystem syndrome. The mean duration of the lesions was a few days, but some lasting as little as 20 min and others as long as four weeks have been reported. The mean latency time in the majority of cases was between 1 and 14 days; however, in some patients, lesions appeared 2 to 5 days before the onset of COVID-19 symptoms. The histopathological features of these lesions also vary, corresponding to the diversity of clinical manifestations. These features underline the nature of epidermal and dermal vascular lesions—and in severe cases, microvascular injury and thrombosis—associated with COVID-19, and provide important clues to their pathological mechanisms.

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“…Livedo or necrosis was associated with increased disease severity. 24 Recently, nail changes have been identified in patients with COVID-19 manifesting as a convex half-moon shaped erythematous band at the distal margin of the lunula and coined ‘the red half-moon nail sign.’ 25 , 26…”

Section: Cutaneous Manifestations In Adultsmentioning

confidence: 99%

Cutaneous manifestations of COVID-19 in children (and adults): A virus that does not discriminate

Lavery

Thompson

2021

Clinics in Dermatology

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COVID-19 is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a beta coronavirus with a characteristic S-glycoprotein ‘spike’ on the cell surface. 1 Initial reports did not include cutaneous manifestations as a feature of COVID-19; however, there is a growing repertoire of reports demonstrating an array of dermatologic manifestations on the skin in children and adults. Dermatologic afflictions have been summarized into different categories several times, with the most recent analysis identifying six clinical patterns: urticaria, maculopapular-morbilliform eruption, papulovesicular exanthem, chilblain-like acral pattern, livedo reticularis-livedo racemose pattern, and purpuric ‘vasculitic’ pattern. 2 In children, the dermatologic features appear to occur before or concomitantly with other COVID-19 manifestations. Dermatologists play a key role in diagnosing patients with COVID-19 who may present for the first time unwittingly exhibiting early signs of COVID-19. We have reviewed the current evidence on the dermatologic impact of COVID-19 in both the adult and pediatric population.

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The red half‐moon nail sign: a novel manifestation of coronavirus infection

Abstract: Telemedicine and support groups in order to improve the adherence to treatment and health related quality of life in patients affected by inflammatory skin conditions during COVID-19 emergency [published online ahead of print, 2020 Apr 18].

Cited by 46 publications

References 7 publications

COVID‐19 and nail manifestation: be on the lookout for the red half‐moon nail sign

COVID‐19 and nail manifestation: be on the lookout for the red half‐moon nail sign

Clinical and Histopathological Features and Potential Pathological Mechanisms of Skin Lesions in COVID-19: Review of the Literature

Cutaneous manifestations of COVID-19 in children (and adults): A virus that does not discriminate

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