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Clinical Study of Various Nail Disorders Presenting to Dermatology Outpatient Department 1Parul Garg, 2Anuj Kumar, 3Praveen K Rathore, 4Sapna Goyal

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Clinical Study of Various Nail Disorders Presenting to Dermatology Outpatient Department 1Parul Garg, 2Anuj Kumar, 3Praveen K Rathore, 4Sapna Goyal IJAIMS Clinical Study of various Nail Disorders presenting10.5005/jp-journals-10050-10090 to Dermatology Outpatient Department ORIGINAL ARTICLE Clinical Study of various Nail Disorders presenting to Dermatology Outpatient Department 1Parul Garg, 2Anuj Kumar, 3Praveen K Rathore, 4Sapna Goyal ABSTRACT small objects, to protect the distal digit, to improve fine Aims and objectives: To study the clinical spectrum of nail touch sensation, and to enhance esthetic appearance disorders including congenital, developmental, infectious, neo- of hands. plastic, degenerative, dermatological, and systemic diseases Nail disorders include those abnormalities that affect affecting the nail unit. any portion of nail unit. The nail unit includes nail plate; Materials and methods: A total of 100 consecutive cases of nail matrix; bed; proximal, lateral, and distal nail fold; nail disorders reporting to the dermatology outpatient depart- and hyponychium. These structures may be affected by ment in Rohilkhand Medical College & Hospital were examined. Complete dermatological, systemic, hematological examina- heredity, skin disorders, infections, systemic disease, tions, Gram staining, scraping for fungus, nail clipping for potas- ageing, internal and external medications, physical and sium hydroxide mount, fungal culture, biopsy from nail bed were environmental agents, trauma, and tumors both benign undertaken in doubtful cases. and malignant. Observations and results: Among 100 cases, the most Nail disorders comprise 10% of all dermatological common was onychomycosis – 28 cases, followed by nail psoriasis – 13 cases, pitting – 10 cases, paronychia – 9 cases, conditions. The accurate recognition and description of trachyonychia – 5 cases, onycholysis – 4 cases, clubbing – nail findings is the crucial first step in diagnosing a nail 3 cases, koilonychia – 3 cases, ingrow toenail – 3 cases, disorder. The worldwide incidence of nail disorders is pterygium – 3 cases, onychogryphosis – 2 cases, subungual increasing and it continues to spread and persist. wart – 2 cases, half and half nail – 2 cases, anonychia – 2 cases, longitudinal grooves – 2 cases, clubbing with resorp- tion of fingers – 2 cases, onychomadesis – 1 case, nail dis- AIMS AND OBJECTIVES coloration – 1 case, melanonychia – 1 case, pachyonychia congenita – 1 case, beau’s line – 1 case, racket nail – 1 case, To study the clinical spectrum of nail disorders includ- transverse groove – 1 case. ing: congenital, developmental, infectious, neoplastic, Conclusion: Among examined cases, onychomycosis was degenerative, dermatological, and systemic diseases most common followed by another nail disorders. affecting the nail unit. Keywords: Nail, Onychomycosis, Pits, Trachyonychia. How to cite this article: Garg P, Kumar A, Rathore PK, Goyal S. MATERIALS AND METHODS Clinical Study of various Nail Disorders presenting to Dermatology Outpatient Department. Int J Adv Integ Med Sci • A total of 100 consecutive cases of nail disorders 2017;2(3):125-129. reporting to dermatology outpatient department in Source of support: Nil Rohilkhand Medical College & Hospital, Bareilly, Conflict of interest: None Uttar Pradesh, India were examined. • Complete dermatological, systemic examination, INTRODUCTION hematological examinations, Gram staining, scrap- ing for fungus, nail clipping for potassium hydroxide Nails are a reflection of both internal and external mount, fungal culture, and biopsy from nail bed were disease. Functions of nail are to assist in picking up undertaken in doubtful cases. 1,2 3,4 Junior Resident, Professor OBSERVATION AND RESULTS 1-4Department of Dermatology and Venereal Diseases Rohilkhand Medical College & Hospital, Bareilly, Uttar Pradesh • A total of 100 cases with nail changes were subjected India to study. Corresponding Author: Parul Garg, Junior Resident • Age group of cases varied from 4 to 74 years, mean Department of Dermatology and Venereal Diseases, Rohilkhand age being 36.05 years. Medical College & Hospital, Bareilly, Uttar Pradesh, India • Duration of nail disorders ranged from 5 to 35 years, Phone: +918006578807, e-mail: [email protected] mean duration being 2.84 years. International Journal of Advanced & Integrated Medical Sciences, July-September 2017;2(3):125-129 125 Parul Garg et al Systemic Diseases Table 1: Spectrum of nail disorders observed From the chart, among the 29 cases, the following were Number Disease of cases observed: Onychomycosis 28 • Nail change in diabetes mellitus: Onychomycosis – 8 cases, onychogryphosis – 1 case, onychomadesis Nail psoriasis 13 – 1 case. Pitting 10 • Chronic renal failure on dialysis: Onychomycosis – Paronychia 9 3 cases, half and half nail – 2 cases Trachyonychia 5 • Ischemic heart disease and hypertension: Onycholysis 4 Onychomycosis – 3 cases, onychogryphosis Clubbing 3 – 1 case Koilonychia 3 • Human immunodeficiency virus (on highly Ingrow toe nail 3 active antiretroviral therapy): Nail discoloration – Pterygium 3 2 cases Onychogryphosis 2 • Iron deficiency anemia: Koilonychia – 3 cases • Systemic sclerosis: Clubbing with resorption of Subungual wart 2 terminal phalanges – 2 cases Half and half nail 2 • Chronic obstructive pulmonary disease and Koch’s: Anonychia 2 Clubbing – 3 cases. Longitudinal groove 2 Clubbing with resorption of terminal phalanges 2 DISCUSSION Onychomadesis 1 Among 100 cases observed, male to female ratio was 2:1 Nail discoloration 1 (Graph 1). The most common age group involved was Melanonychia 1 31 to 40 years (30%) followed by 21 to 30 years (19%). Pachyonychia congenita 1 Nageshwaramma et al1 did a study and observed most Beau’s lines 1 common age group involved was 21 to 40 years (40%). Racket nail 1 Among 100 cases (Table 1, Figs 1 to 13 and Graph 2), Transverse groove 1 the most common change was onychomycosis – 28%. Total 100 Distal and lateral subungual onychomycosis (DLSO) was observed to be most common morphological pattern – 59.26%. It was comparable to studies done by Veer study and found pitting as a common manifestation in et al2 (50%) and Grover3 (85%) (Table 2). Nail psoriasis psoriasis (70%), followed by subungual hyperkeratosis accounts for 13% of cases. The most common nail finding and onycholysis. Pitting was seen in 10% cases. Cause in psoriasis was pits (46.5%) followed by subungual was idiopathic. Trachyonychia was seen in 5% of cases. hyperkeratosis and onycholysis. Puri and Kaur4 did a Cause was idiopathic in 40% cases, alopecia areata in Graph 1: Sex distribution Fig. 1: Onychomyosis 126 IJAIMS Clinical Study of various Nail Disorders presenting to Dermatology Outpatient Department Fig. 2: Nail psoriasis Fig. 3: Trachyonychia Fig. 4: Clubbing Fig. 5: Pterygium Fig. 6: Subungual wart Fig. 7: Transverse groove Fig. 8: Racket nail Fig. 9: Melanonychia Fig. 10: Nail discoloration International Journal of Advanced & Integrated Medical Sciences, July-September 2017;2(3):125-129 127 Parul Garg et al A B Figs 11A and B: (A) Ingrow toe nail and paronychia; (B) Koilonychia A B Figs 12A and B: (A) Onycholysis; and (B) Half and half nail Fig 13: Pachyonychia congenita 40% cases, and lichen planus in 20% cases. Gordon et al5 did a study and observed most common cause of trachyo- nychia was idiopathic and other being lichen planus and alopecia areata. Graph 2: Spectrum of nail disorders observed CONCLUSION preponderance was seen. Onychomycosis was the most No cutaneous examination is complete without a careful common finding. The DLSO was most common mor- evaluation of the nails. Nails remain an understud- phological pattern observed, followed by nail psoriasis, ied and yet quite accessible structure that lends itself pitting, paronychia, trachyonychia, and other disorders for examination and evaluation. In our study, male (Tables 3 and 4). 128 IJAIMS Clinical Study of various Nail Disorders presenting to Dermatology Outpatient Department Table 2: Morphological pattern of onychomycosis Morphological pattern Total % (this study) Veer et al2 Grover3 DLSO 16 59.26 50 82 PSO 4 12.96 20.4 6 SWO 3 9.26 2 2 TD 2 7.4 14 6 PSO with paronychia 2 7.4 10.2 4 Subungual hyperkeratosis 1 3.7 Total 28 100 DLSO: Distal and lateral subungual onychomycosis; PSO: Proximal subungual onychomycosis; SWO: Superficial white onychomycosis; TD: Total dystrophy Table 3: Nail changes in psoriasis Nail changes Fingernail Toe nail Both Total Percentage Pitting 3 1 2 6 46.15 Pitting and transverse groove 1 1 7.6 Pitting, onycholysis, and subungual hyperkeratosis 1 2 3 23 Total nail dystrophy 1 1 7.6 Transverse groove 1 1 7.6 Yellow discoloration and pitting 1 1 7.6 13 100 Table 4: Causes of trachyonychia dermatoses. IOSR J Dent Med Sci 2279-0861 volume 2016 Mar;15(3):1-6. Associated disease Total Percentage 2. Veer P, Patwardhan N S, Damle A S. Study of onychomyco- Alopecia areata 2 40 sis: prevailing fungi and pattern of infection. Indian J Med Lichen planus 1 20 Microbiol 2007 Jan;25(1):53-56. Idiopathic 2 40 3. Grover S. Clinico-mycological evaluation of onychomycosis Total 5 100 at Bangalore and Johrat. Indian J Dermatol Venerol Leprol 2003 Jul;69(4):284-286. 4. Puri N, Kaur T. A study of nail changes in various dermatosis in Punjab, India. Our Dermatol Online 2012 Feb:3(3):164-170. REFERENCES 5. Gordon KA, Vega JM, Tosti A. Trachyonychia: a comprehen- 1. Nageshwaramma S, Kumari GS, Vani T, Ragini P, Glory GR. sive review. Indian J Dermatol Venerol Leprol 2011 Nov-Dec; A clinico-epidemiological study of nail changes in various 77(6):640-645. International Journal of Advanced & Integrated Medical Sciences, July-September 2017;2(3):125-129 129.
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