Original Research Article Clinical study of Nail changes in papulosquamous disorders Vishal Wali1, Trivedi Rahul Prasad2* 1Associate Professor, 2Post Graduate, Department of Dermatology, Venereology and Leprology, Mahadevappa Rampure Medical College, Sedam Road, Kalaburagi (Gulbarga) 585105, Karnataka, INDIA. Email: [email protected] Abstract Background: Nail disorders comprise ~10% of all dermatologic conditions. Nail disorders include those abnormalities that effect any portion of the nail unit. The nail unit includes the plate, matrix, bed, proximal and lateral folds, hyponychium, and some definitions include the underlying distal phalanx. These structures may be effected by heredity, skin disorders, infections, systemic disease, and aging process, internal and external medications, physical and environmental agents, trauma, and tumours, both benign and malignant. The main contributors being papulosquamous disorder. Nail changes in papulosquamous disorder have been inadequately discussed and only limited studies are present. This study aims to throw some light about frequency of nail involvement in papulosquamous disorders and its various patterns. Methodology: This is the descriptive study. It was conducted in department of DVL of Mahadevappa Rampura Medical college and Basaveshwar teaching and general hospital, Kalaburagi from July 2019 to Feb 2021. General, systemic and dermatological examinations were done. Nails were examined in detail. Special investigations like skin biopsy and potassium hydroxide (KOH) mount was done in relevant cases. Results: There were 50 cases of papulosquamous disorder. The most common papulosquamous disorder was psoriasis, followed by lichen planus and PRP. Out of these the most common nail change was pitting (81%) and lest common was dorsal pterygium (%) Conclusion: Nail being an important appendage affecting various dermatosis and acts as window in diagnosis. Hence knowing the normal and its abnormal variants and its association with various papulosquamous disorders helps not only in diagnosis but also for management of the same. Key words: Papulosquamous disorder, nail changes, psoriasis, lichen planus. *Address for Correspondence: Dr Trivedi Rahul Prasad, H No 9-587/56/1/1B, Vishwaradhya colony Shetty’s Layout, Gulbarga, Karnataka, 585101, INDIA. Email: [email protected] Received Date: 03/03/2021 Revised Date: 17/05/2021 Accepted Date: 05/06/2021 DOI: https://doi.org/10.26611/10211924 This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. communication. It protects the terminal phalanx and Access this article online fingertip from trauma and gives deftness and precision in picking up small objects Nail may be diseased in many Quick Response Code: Website: dermatological, as well as, systemic disorders. About 10% www.medpulse.in of the dermatological disorders are associated with nail changes. Papulosquamous disorders is a heterogenous group of diseases, whose nosology is based on the Accessed Date: morphology of clinical lesions which is dominated by scaly papules and plaques. The major diseases included in 08 August 2021 this group are psoriasis, lichen planus, lichen nitidus, lichen striatus, pityriasis rosea, pityriasis rubra pilaris, parapsoriasis and pityriasis lichenoides which are INTRODUCTION characterized by skin and nails lesions. This study was As face is the index of mind, so is nail the index to health. done to find out the nail changes in common Nail is one of the epidermal derivatives that produces the papulosquamous disorders and it’s various patterns. hardest epithelial derivatives that produces the hardest epithelial structure know in mammalian biology. Nails also provide protection, tactile sensation and social How to cite this article: Vishal Wali, Trivedi Rahul Prasad. Clinical study of Nail changes in papulosquamous disorders. MedPulse International Journal of Medicine. August 2021; 19(2): 42-45. https://www.medpulse.in/Medicine/ MedPulse International Journal of Medicine, Print ISSN: 2550-7583, Online ISSN: 2636-4751 Volume 19, Issue 2, August 2021 pp 42-45 METHOD frequently observed in finger nail than toe nail. The most This is the descriptive study. It was conducted in common nail pattern abnormality noted in PRP was department of Dermatology Venerology and Leprosy of thickening of nail plate followed by subungual Mahadevappa Rampura Medical college and Basaveshwar hyperkeratosis and pitting. Only one case of lichen striatus teaching and general hospital, Kalaburagi from July 2019 and pityriasis rosea was reported of which showed thinning to Feb 2021. All the patients with papulosquamous of nail plate and Beaus lines respectively. Histopathology disorders diagnosed clinically as per ICD 10 classification features in psoriasis, nail matrix shows neutrophilic attending the OPD where included in study. Pregnant and infiltrate and nail bed shows epithelial hyperplasia and lactating females, patients who did not give consent for hypergranulosis. In lichen planus, nail plate shows study were excluded. Patients who had history of using orthokeratosis and focal parakeratosis and nail bed features artificial nails, at any time of their lives were also excluded are diffused hypergranulosis and colloid bodies. In cases due to the fact that acrylic nails can induce severe with lichen striatus, pityriasis rubra pilaris, pityriasis rosea onychodystrophy, onycholysis and subungual and erythroderma nail biopsies did not show any specific hyperkeratosis. Detailed history including age, duration, nail changes. site of skin lesion any relevant co-morbid illness were Table 1 obtained. General, systemic and dermatological DIAGNOSIS NO. OF PATIENTS examinations were done. Time duration of nail changes Psoriasis 38 and associated factors and different type of nail changes Lichen planus 6 Pityriasis rubra pilaris 2 were taken. Routine blood investigations like CBC, LFT Pityriasis rosea 1 AND RFT were done for needed patients. Other necessary Lichen Niditus 1 investigations like skin biopsy and KOH mount were taken Lichen striatus 1 in relevant cases. Parapsoriasis 1 Statistical data analysis Data will be analysed using IBM SPSS 20.0 Version Table 2 software. For qualitative data analysis Chi square analysis Nail changes in psoriasis Total no of patients will be applied for significance, for quantitative data Pitting of nails 31 ( 81%) analysis t test will be applied for significance. P value Subungual hyperkeratosis 16 (42%) <0.05 will be considered as significant Onycholysis 11 (29%) Onychomedesis 8 (21%) Oil drop 2 (5%) OBSERVATION AND RESULTS Longitudinal melanonychia 2 (5%) A total of 50 patients were included in the study of which Spinter Haemorrhage 1 (2%) 41 were males and 9 females. The age group ranged from 10 to 45 Years. The common papulosquamous disorders Table 3 included in this study were psoriasis, lichen planus Nail changes in lichen planus Total number of patients followed by pityriasis rubra pilaris. The least common was Thinning of nail plate 4 (66%) parapsoriasis. The most common nail change observed was Longitudinal melanonychia 3(50%) pitting followed by subungual hyperkeratosis and Trachonychia 3(50%) longitudinal melanonychia and the least common was Pterygium 1(16%) pterygium Out of 38 patients of psoriasis the most Dystrophy 1(16%) commonest pattern of nail change observed was pitting(81%) followed by subungual hyperkeratosis (42%) DISCUSSION and onycholysis (29%). The least common nail deformity A total of 50 patients with papulosquamous disorders observed was spinter hemorrhage(2%) Finger nail are presenting with nail changes were included in this study, more involved then toe nail. The most common finger nails comprising of 41 males (84%) and 9 females (18%). Our involved are Thumb, index finger followed by ring finger. study has a male preponderance which correlated with the Among different types of psoriasis, plaque psoriasis was study done by Armesto et al.1 in which about 661 patients most common followed by scalp psoriasis and 47.4% had nail involvement, and male preponderance of plamoplantar psoriasis and guttate psoriasis. In total 6 case 13.5%. Related study claim that 80-90% of patients with of lichen planus were found in the study. The most psoriasis will at some point of time present with nail common nail involvement seen in lichen planus was involvement,2 which is higher than that in than in the study thinning of nail plate (66%) followed by longitudinal conducted by than SN et al., which was 78% nail changes.3 melanonychia (50%). The least common was dorsal Nail involement has been reported in 50% of psoriasis pterygium and Beaus line. Nail changes are more cases but the incidence cumulatively increases to 80-90%.4 Copyright © 2021, Medpulse Publishing Corporation, MedPulse International Journal of Medicine, Volume 19, Issue 2 August 2021 Vishal Wali, Trivedi Rahul Prasad Al-Mutairi N et al.5 studied that nail pitting was found to and index finger are the commonest finger nail involved. be the most common manifestation (61.84%) followed by Ahmed and Nasreen.11 who found that 27 (46%) of 59 onycholysis (30.26%), and discolouration of the nail plate patients of psoriasis had their fingernails involved, 19 (7.9%). In our study common nail changes observed worth (32%) had toenail psoriasis while 13 (22%) patients had psoriasis were pitting (81%), onycholysis (42%), both finger and toenail involved. The most frequent nail subungual hyperkeratosis (29%). Nail pitting was the finding was roughening