Ann Dermatol.  2019 Apr;31(2):121-126. 10.5021/ad.2019.31.2.121.

Nail Dystrophy in Patients with Atopic Dermatitis and Its Association with Disease Severity

Affiliations
  • 1Department of Dermatology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea. dermap@daum.net

Abstract

BACKGROUND
Nail dystrophy arises from various inflammatory dermatologic diseases. However, there have been few reports on the prevalence of nail abnormality in atopic dermatitis (AD) or on the relationship of this condition with the severity of the disease.
OBJECTIVE
This study was intended to determine the prevalence and types of nail abnormalities associated with AD and to evaluate the relation between nail abnormalities and the severity of AD.
METHODS
AD patients aged 2 to 19 who visited the outpatient clinic were thoroughly examined for nail abnormalities. Demographic information was collected and eczema area and severity index (EASI) score for severity of AD were checked.
RESULTS
A total of 235 AD patients (children and adolescents) were investigated. There were 24 (10.2%) patients with nail abnormalities: transverse groove (Beau's line) (25.0%), nail pitting (16.7%), koilonychia (16.7%), trachyonychia (12.5%), leukonychia (12.5%), brachyonychia (8.3%), melanonychia (8.3%), onychomadesis (8.3%), onychoschizia (8.3%), and onycholysis (8.3%). There was no statistically significant difference in the total EASI score associated with development of nail abnormalities (p=0.236). However, when the EASI score was confined to the lower extremities, it showed a relation to the prevalence of toe nail dystrophy (odds ratio, 1.115; 95% confidence interval, 1.014~1.316; p=0.030).
CONCLUSION
Nail abnormalities in AD are thought to be caused mainly by pathologic change in the nail matrix region, and the EASI score confined to lower limbs, might be used as a predictor of toe nail changes in patients with AD.

Keyword

Atopic dermatitis; Eczema area and severity index; Nails; malformed

MeSH Terms

Ambulatory Care Facilities
Dermatitis, Atopic*
Eczema
Humans
Lower Extremity
Nails, Malformed
Onycholysis
Prevalence
Toes

Figure

  • Fig. 1 Clinical pictures of nail abnormalities in patients with atopic dermatitis. (A) Transverse groove (male/12), (B) nail pitting (female/9), (C) koilonychia and trachyonychia (male/11), (D) leukonychia (male/10), (E) brachyonychia (female/15), (F) melanonychia (female/15), (G) onychomadesis (male/14), (H) onychoschizia (male/17), (I) onycholysis (male/11).


Reference

1. Kim J, Kook YK, Chun IK, Kim YP. Study of the nail-II. Growth of nails in Korean. Korean J Dermatol. 1983; 21:297–305.
2. Cashman MW, Sloan SB. Nutrition and nail disease. Clin Dermatol. 2010; 28:420–425.
Article
3. Sarifakioglu E, Yilmaz AE, Gorpelioglu C. Nail alterations in 250 infant patients: a clinical study. J Eur Acad Dermatol Venereol. 2008; 22:741–744.
Article
4. Fawcett RS, Linford S, Stulberg DL. Nail abnormalities: clues to systemic disease. Am Fam Physician. 2004; 69:1417–1424.
5. Kim IS, Lee JW, Park KY, Li K, Seo SJ, Hong CK. Nail change after chemotherapy: simultaneous development of Beau's lines and Mees' lines. Ann Dermatol. 2012; 24:238–239.
Article
6. Zhang JA, Yu JB, Li XH, Zhao L. Oral and cutaneous lichenoid eruption with nail changes due to imatinib treatment in a Chinese patient with chronic myeloid leukemia. Ann Dermatol. 2015; 27:228–229.
Article
7. Bieber T. Atopic dermatitis. N Engl J Med. 2008; 358:1483–1494.
Article
8. Lee HI, Han TY, Seo SJ, Kim DW, Kim MN, Kim MB, et al. Dermatologic diseases associated with atopic dermatitis in Koreans: multicenter study. Korean J Dermatol. 2010; 48:191–197.
9. Simpson EL, Thompson MM, Hanifin JM. Prevalence and morphology of hand eczema in patients with atopic dermatitis. Dermatitis. 2006; 17:123–127.
Article
10. Boiko S, Kaufman RA, Lucky AW. Osteomyelitis of the distal phalanges in three children with severe atopic dermatitis. Arch Dermatol. 1988; 124:418–423.
Article
11. Morgan JM, Weller R, Adams SJ. Onycholysis in a case of atopic eczema treated with PUVA photochemotherapy. Clin Exp Dermatol. 1992; 17:65–66.
Article
12. Park YM, Byun DG, Kim JW. Evaluation of minor clinical features of childhood atopic dermatitis in Korea. Korean J Dermatol. 1994; 32:886–894.
13. Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venereol (Stockh). 1980; 92:44–47.
14. Hanifin JM, Thurston M, Omoto M, Cherill R, Tofte SJ, Graeber M. The eczema area and severity index (EASI): assessment of reliability in atopic dermatitis. EASI Evaluator Group. Exp Dermatol. 2001; 10:11–18.
Article
15. Lee JY, Yang HK, Kim M, Kim J, Ahn K. Is the prevalence of atopic dermatitis in Korean children decreasing?: National Database 2009–2014. Asian Pac J Allergy Immunol. 2017; 35:144–149.
16. Gupta AK, Daigle D, Foley KA. The prevalence of culture-confirmed toenail onychomycosis in at-risk patient populations. J Eur Acad Dermatol Venereol. 2015; 29:1039–1044.
Article
17. Sandre MK, Rohekar S. Psoriatic arthritis and nail changes: exploring the relationship. Semin Arthritis Rheum. 2014; 44:162–169.
Article
18. Youn JI. Psoriasis in Korean. Korean J Dermatol. 2012; 50:387–402.
19. Choi JW, Kim BR, Seo E, Youn SW. Identification of nail features associated with psoriasis severity. J Dermatol. 2017; 44:147–153.
Article
20. Augustin M, Reich K, Blome C, Schäfer I, Laass A, Radtke MA. Nail psoriasis in Germany: epidemiology and burden of disease. Br J Dermatol. 2010; 163:580–585.
Article
21. Tosti A, Peluso AM, Fanti PA, Piraccini BM. Nail lichen planus: clinical and pathologic study of twenty-four patients. J Am Acad Dermatol. 1993; 28:724–730.
Article
22. Sonnex TS, Dawber RP, Zachary CB, Millard PR, Griffiths AD. The nails in adult type 1 pityriasis rubra pilaris. A comparison with Sézary syndrome and psoriasis. J Am Acad Dermatol. 1986; 15:956–960.
23. Burge SM, Wilkinson JD. Darier-White disease: a review of the clinical features in 163 patients. J Am Acad Dermatol. 1992; 27:40–50.
Article
24. Puri N. A clinical and histopathological study of Darier’s disease. J Pak Assoc Dermatol. 2011; 21:230–234.
25. Scher RK, Tavakkol A, Sigurgeirsson B, Hay RJ, Joseph WS, Tosti A, et al. Onychomycosis: diagnosis and definition of cure. J Am Acad Dermatol. 2007; 56:939–944.
Article
26. Nicolopoulos J, Goodman GJ, Howard A. Diseases of the generative nail apparatus. Part I: nail matrix. Australas J Dermatol. 2002; 43:81–90.
Article
27. Goodman GJ, Nicolopoulos J, Howard A. Diseases of the generative nail apparatus. Part II: nail bed. Australas J Dermatol. 2002; 43:157–168. quiz 169-170.
Article
28. Sehgal VN. Twenty nail dystrophy trachyonychia: an overview. J Dermatol. 2007; 34:361–366.
Article
29. Tosti A, Peluso AM, Misciali C, Cameli N. Nail lichen striatus: clinical features and long-term follow-up of five patients. J Am Acad Dermatol. 1997; 36:908–913.
Article
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