There are many dermatological diseases that can affect the nail. Psoriasis is one of the best known examples with affected nails showing pitting, onycholysis and sub-ungual debris. However, eczema is a disorder that covers a wide range of things from allergy and irritancy to more intrinsic forms such as nummular and atopic eczema. Ultimately, this gives a wide range of pathologies that may be observed in and around the nail plate itself.
In a forthcoming paper in the International Journal of Dermatology has undertaken a systematic review to uncover the most common manifestations of atopic dermatitis or eczema in the nails (1). The review analysed the findings from 12 published papers which covered in total a cohort of 7 515 patients (adults and children).
From a pooled analysis of the data, it suggested that the prevalence of nail changes in patients to be around 11%, much lower than for psoriasis for example where figures suggest around 50% of patients may disease-related nail changes. The frequent nail symptoms and signs reported were:
1. Melanonychial streaks
2. Pitting
3. Paronychia
4. Hangnails
5. Trachonychia
6. Longitudinal or transverse grooves (Beau’s lines)
7. Onychauxis (nail plate thickening)
8. Yellowing of the nail
Patients with atopic dermatitis are more likely to suffer from skin irritancy from household products for example,e which can further exacerbate problems and lead to additional changes in the nail. With the introduction of the first biologic indicated in the treatment of atopic dermatitis (Duplimab®), it will be interesting to see if this drug can improve the nail as well as the skin symptoms.
Reference
1. Chng WQ, Yew YW. Nail manifestations in atopic dermatitis: a systematic review. Int J Dermatol. 2020;n/a(n/a).