Dermoscopic features of nails in Leprosy patients in a tertiary referral hospital in West Java, Indonesia.

INTRODUCTION: Leprosy is a chronic granulomatous infectious disease, mainly affecting the skin and peripheral nerves, caused by the obligate intracellular bacteria Mycobacterium leprae. The disease has been discussed in several review articles in recent research, but as far as we know, only a few have addressed the effects of leprosy on nails, especially those who examine the dermoscopic features of nails in leprosy patients. PURPOSES: We aimed to document nail changes in leprosy patients and identify any particular findings through dermoscopic examination. METHOD: This was an observational study conducted in the Dermatology and Venereology Clinic of Hasan Sadikin Hospital, West Java, Indonesia, from March 2023 through May 2023. All patients have established cases of leprosy, and the diagnosis is based on clinical and bacteriological examinations. Recruitment was done through total sampling. Dermoscopic examination of all fingernails and toenails was performed at 10x magnification using a handheld dermatoscope (Heine DELTA 20 T Dermatoscope) in polarized mode without the linkage fluid to document the dermoscopic features. RESULT: Of a total of 19 patients, 15 had nail changes due to leprosy. Out of 15 patients, 13 patients were male. Patients below 25 years old had more nail changes. Most of the patients had a duration of disease greater than two years. Both fingers and toes were involved in nine patients. In this study, the most common dermoscopic feature found was the longitudinal ridge. Other dermoscopic features found in this study were transverse lines, onycholysis, longitudinal melanonychia, leukonychia, subungual hemorrhage, subungual hyperkeratosis, anonychia, and onychorrexis. CONCLUSION: Nail changes are found in leprosy patients and have a wide variety of clinical appearances. A dermoscopy should be performed to assess nail changes in leprosy.

Uña y Lepra / No disponible

En la lepra, las uñas pueden verse afectadas hasta en tres de cada cuatro pacientes que presentan la enfermedad. Los cambios ungueales no son específicos de la lepra, pueden ser muy variados y afectar al tamaño, el grosor, la superficie, la consistencia, el color de la relación placa-lecho y el tejido ungueal en general. Los cambios de las uñas en los pacientes con lepra son muy variados como estrías longitudinales, melanoniquia longitudinal, braquioniquia, uña en raqueta, anoniquia, onicauxis, onicogrifosis, hapaloniquia, onicorrexis, líneas de Beau, pterigium unguis dorsal, onicolisis, palidez de la uña y hematoma subungueal (AU)

In leprosy, the nails may be affected by up to three quarters of patients with the disease. Nail changes are not specific leprosy, can vary widely and affect the size, thickness, surface area, consistency, colour and relative bed plate-nail tissue in general. Nail changes in leprosy patients are varied as longitudinal striations, longitudinal melanonychia, brachionychia, nail racket, anonychia, onychauxix, onychogryphosis, hapalonychia onychorrhexis, Beau lines, dorsal pterygium unguis, onycholysis, pallor and subungual hematoma (AU)

Las uñas en la lepra / Nail Involvement in Leprosy

La lepra es una enfermedad causada por Mycobacterium leprae. Afecta principalmente a los nervios y a la piel, y hasta en tres de cada cuatro pacientes también a las uñas. Las causas desencadenantes de las lesiones ungueales en la lepra son múltiples, y de ellas destacan los traumatismos repetidos, la neuropatía, la insuficiencia vascular, las infecciones, las leprorreacciones o los fármacos utilizados en el tratamiento. Entre los cambios más destacados se encuentran los hematomas subungueales, la onicolisis, la onicauxis, la onicogrifosis, el pterigium unguis dorsal o la onicoheterotopia, y en su mayoría pueden atribuirse al daño nervioso y a los traumatismos. Por otro lado, la acrosteolisis que se produce en estadios avanzados puede cursar con braquioniquia, uñas en raqueta o incluso llegar a la anoniquia. Las infecciones de las uñas, con la aparición de paroniquia y onicomicosis, constituyen otro de los capítulos a tener en cuenta en la lepra. Además hay otras alteraciones caracterísiticas como las estrías longitudinales, los pits, la macrolúnula, las uñas de Terry, la leuconiquia, la hapaloniquia o las líneas de Beau. A lo largo de esta revisión se describen los principales cambios que se producen en las uñas por esta enfermedad, que son muy variados y de origen muy diverso, y de hecho son el reflejo de la amplia morbilidad que causa la infección por M. leprae (AU)

Leprosy, a disease caused by Mycobacterium leprae, primarily affects the skin and nerves, but the nails are also involved in as many as 3 out of 4 patients .The factors that trigger nail changes in leprosy are numerous and include repeated trauma, neuropathy, vascular impairment, infections, lepra reactions, and the drugs used to manage the disease. The changes most often reported include subungual hematomas, onycholysis, onychauxis, onychogryphosis, pterygium unguis, and onychoheterotopia, most of which can be attributed to nerve damage and trauma. Furthermore, the acro-osteolysis that occurs in the advanced stages of the disease may present with brachyonychia, racquet nails, or even anonychia. Infections of the nail bed leading to paronychia and onychomycosis should also be taken into account in leprosy. Other typical changes include longitudinal striae, pitting, macrolunula, Terry nails, leukonychia, hapalonychia, and Beau lines. In this review, we describe the principal nail changes associated with leprosy. These changes, which are highly varied and diverse in origin, are in fact a reflection of the significant morbidity caused by M leprae infection (AU)

[Nail involvement in leprosy]. / Las uñas en la lepra.

Leprosy, a disease caused by Mycobacterium leprae, primarily affects the skin and nerves, but the nails are also involved in as many as 3 out of 4 patients .The factors that trigger nail changes in leprosy are numerous and include repeated trauma, neuropathy, vascular impairment, infections, lepra reactions, and the drugs used to manage the disease. The changes most often reported include subungual hematomas, onycholysis, onychauxis, onychogryphosis, pterygium unguis, and onychoheterotopia, most of which can be attributed to nerve damage and trauma. Furthermore, the acro-osteolysis that occurs in the advanced stages of the disease may present with brachyonychia, racquet nails, or even anonychia. Infections of the nail bed leading to paronychia and onychomycosis should also be taken into account in leprosy. Other typical changes include longitudinal striae, pitting, macrolunula, Terry nails, leukonychia, hapalonychia, and Beau lines. In this review, we describe the principal nail changes associated with leprosy. These changes, which are highly varied and diverse in origin, are in fact a reflection of the significant morbidity caused by M. leprae infection.

Nail dyschromias.

Nail dyschromias have a wide variety of presentation. There are numerous causes of discoloration of the nail affecting the nail plate, nail attachments, or the substance of the nail. The chromonychia may also be caused due to the exogenous deposition of pigments over the nail plate. Careful examination of the nail and few bed side tests may help in identifying the root cause of the nail dyschromia and many a times unravels some underlying systemic disorder too.

Nails in systemic disease.

Nail abnormalities secondary to systemic disease could be classified as nail abnormalities associated with systemic disease, disease of specific organ system or associated with syndromes and genodermatoses. Because nail findings are easily observable and yield valuable information, careful examination of nails could be an important diagnostic tool for a dermatologist. A brief review of the common and not so common nail changes in systemic illness is presented.

Lesiones ungueales en la lepra / Nails disorders in Lepra

La Lepra produce importantes invalideces y discapacidades por la afectacion neurologica periferica con alteraciones distales, sensitivas, motoras y troficasen pies y manos y también de las uñas, siendo la anestesia un importante factor, asi como traumatismos, deficit vascular e infecciones oportunistas.Exponemos nuestra experiencia observando alteraciones de la uña en un 48% de los casos sin predominio de sexo, siendo las lesiones mas frecuenteslas distroficas onicorrexis, hiperqueratosis, onicogrifosis, opacidad matriz ungueal, estrias paralelas, fragilidad, difusion de la lunula, sequedad, paroniquiae infeccion ,que son de aparicion lenta y mas frecuentes en las formas multibacilares y paucibacilares avanzadas y no es raro el hallazgo demicobacterias, afectando mas los pies que las manos.A esta onicopatía acompaña progresiva reabsorcion de partes blandas y acroosteolisis de falanges terminales y mutilaciones, siendo los restos unguealeslos últimos en desaparecer.El mejor tratamiento es el diagnóstico precoz y la multiterapia específica antes de que aparezca un compromiso neural irreversible que daria lugar aesta patologia ungueal (AU)

Leprosy produce severe discapacity due the neurological peripheric affectation with sensitive , motor and trophics disorders in hands, feet and toes. Inhands also in nails, being the anesthesia an important factor, as well as traumatisms, vascular changes and opportunist infection .We set out our experience observing alterations in the nails in a 48% of patients, in both sex. The most frequent injuries are the distrophia, onicogriphosis,onicorrexis hiperkeratosis, matrix opacity, parallel groove, fragility, difusse lunula, dryness, paroniquia and infecction. They are a very slow process andmore frequent in advances multibacillary and paucibacillary forms, and it is not rare to find mycobacteria affecting the feet more than the hands.This onicopatia goes with a progressive reabsorption of the fingers and toes with acroosteolisis of terminal phalanges being the ungueal remains thelast to disappear.The best treatment is the early diagnosis and specific multitherapy before the irreversible neural affection appears (AU)

Glomus tumor-induced longitudinal splitting of nail mimicking median canaliform dystrophy.

Median canaliform deformity of the nail is an uncommon entity, where there is longitudinal splitting of the nail. Longitudinal splitting of the nail is a rare phenomenon and can also occur following number of growths arising in the nail matrix. On examination there was a longitudinal split in the nail plate, beginning in the distal nail fold and extending proximally all the way to the proximal nail fold. There was a small, almost indiscernible, swelling in that area, which was exquisitely tender. The split part of the nail showed a little discoloration. There was no discharge, bleeding, or subungual mass visible. 'Love test' was positive in this case. After nail avulsion, a small 2 mm x 4 mm nodule was exposed and excised. Histopathological examination of the tumor showed a mantle of glomus cells surrounding the blood vessels.

Cutaneous manifestations in patients with chronic renal failure on hemodialysis.

BACKGROUND: Chronic renal failure (CRF) presents with an array of cutaneous manifestations. Newer changes are being described since the advent of hemodialysis, which prolongs the life expectancy, giving time for these changes to manifest. AIM: The aim of this study was to evaluate the prevalence of dermatologic problems among patients with chronic renal failure (CRF) undergoing hemodialysis. METHODS: One hundred patients with CRF on hemodialysis were examined for cutaneous changes. RESULTS: Eighty-two per cent patients complained of some skin problem. However, on examination, all patients had at least one skin lesion attributable to CRF. The most prevalent finding was xerosis (79%), followed by pallor (60%), pruritus (53%) and cutaneous pigmentation (43%). Other cutaneous manifestations included Kyrle's disease (21%); fungal (30%), bacterial (13%) and viral (12%) infections; uremic frost (3%); purpura (9%); gynecomastia (1%); and dermatitis (2%). The nail changes included half and half nail (21%), koilonychia (18%), onychomycosis (19%), subungual hyperkeratosis (12%), onycholysis (10%), splinter hemorrhages (5%), Mees' lines (7%), Muehrcke's lines (5%) and Beau's lines (2%). Hair changes included sparse body hair (30%), sparse scalp hair (11%) and brittle and lusterless hair (16%). Oral changes included macroglossia with teeth markings (35%), xerostomia (31%), ulcerative stomatitis (29%), angular cheilitis (12%) and uremic breath (8%). Some rare manifestations of CRF like uremic frost, gynecomastia and pseudo-Kaposi's sarcoma were also observed. CONCLUSIONS: CRF is associated with a complex array of cutaneous manifestations caused either by the disease or by treatment. The commonest are xerosis and pruritus and the early recognition of cutaneous signs can relieve suffering and decrease morbidity.

Laugier-Hunziker pigmentation.

Laugier-Hunziker pigmentation (LHP) is an acquired disorder of hypermelanosis characterized by mucocutaneous hyperpigmentation. LHP may resemble various disorders characterized by mucocutaneous pigmentation. A 58-year-old lady presented with progressively increasing number of variable sized, hyperpigmented macules over the lips, fingers, toes and nails. There was no family history of similar illness. Systemic examination and all relevant investigations were within normal limits. Histopathology of a skin lesion had features consistent with LHP. The diagnosis of LHP must be made only after relevant investigations to rule out any associated systemic involvement. This case further highlights that LHP is not restricted to European countries.

Nail changes and disorders among the elderly.

Nail disorders are frequent among the geriatric population. This is due in part to the impaired circulation and in particular, susceptibility of the senile nail to fungal infections, faulty biomechanics, neoplasms, concurrent dermatological or systemic diseases, and related treatments. With aging, the rate of growth, color, contour, surface, thickness, chemical composition and histology of the nail unit change. Age associated disorders include brittle nails, trachyonychia, onychauxis, pachyonychia, onychogryphosis, onychophosis, onychoclavus, onychocryptosis, onycholysis, infections, infestations, splinter hemorrhages, subungual hematoma, subungual exostosis and malignancies. Awareness of the symptoms, signs and treatment options for these changes and disorders will enable us to assess and manage the conditions involving the nails of this large and growing segment of the population in a better way.

Nail involvement in leprosy: a study of 300 patients.

Three hundred leprosy patients were recruited to study the pattern and frequency of nail changes. Nail changes, like longitudinal ridging in finger nails, transverse striations involving both finger and toe nails etc. which occurred with similar frequency in the PB and MB patients in comparison with the control group, were excluded from the analysis. Out of a total number of 150 PB patients, 84 (56%) showed nail changes. Fifty-eight (38.6%) patients showed changes in the finger nails, with an average of 3.2 involved nails per patient. Fifty-three (35.3%) patients showed changes in the toe nails, with an average of 3.0 nails per patient. The most common change observed was longitudinal melanonychia (32.4%) in the finger nails and longitudinal ridging (46.3%) in the toe nails.In comparison, 131/150 (87.3%) MB patients showed nail changes. Finger nail changes were seen in 102 (68%) patients with an average of 5.5 nails affected per patient. Changes in toe nails were seen in 116 (77.3%) patients, with an average of 6.0 nails involved per patient. The most common nail change observed was longitudinal melanonychia in 89/523, (17%) of the total involved finger nails and subungual hyperkeratosis in 164/702, (23.4%) of the total toe nails involvement. Out of a total of 32 colony patients, 31 (96.9%) showed nail changes both in finger and toe nails with an average of 7.9 and 8.4 affected nails per patient, respectively. The most common nail change observed was rudimentary nail(s) on fingers (29%) and toes (21.1%). Among MB patients, a significantly higher number had finger nail involvement in LL group. The frequency of nail involvement for both fingers and toes was significantly greater in LL as compared to BL group of patients. The frequency of nail involvement was significantly more in patients having disease for more than 5 years and in those having trophic changes secondary to loss of sensations and impaired circulation.

Significance of nail changes in leprosy: a clinical review of 357 cases.

Leprosy can cause many nail changes, which have been observed in up to 64% of infected patients. The manifestations of leprosy (clinical, bacteriologic, and histological) are profoundly affected by the patient's immunological status, which also determines the prognosis. Nail changes in leprosy can be caused by neuropathy and trauma, vascular impairment, infections, and miscellaneous changes. Often more than one factor will be important. Paradoxically, nail changes in tuberculoid and lepromatous patients are similar, despite wide differences in pathology. This may be because etiological factors common to both are implicated. Factors only associated with lepromatous disease are invasion of the bones of terminal phalanges by lepromatous granulomas and endarteritis occurring during type 2 lepra reactions. Otherwise, the only difference from tuberculoid leprosy is the time of onset and the symmetry of lesions. Lepromatous patients develop nail changes late in the course of disease. The presentation is usually bilaterally symmetrical. However, these changes are not specific to leprosy, and may be observed in other peripheral neuropathies.