Nail Patterns in Papulosquamous Disorders- An Observational Study from Southern India

Abstract

Introduction: Nail changes are always a cause of physical handicap and psychological stress in this era where utmost importance is given to cosmetic appearance. Other than trauma and infections, Papulosquamous disorders are major contributor to nail changes. Thorough knowledge of their patterns will aid in early detection and treatment before irreversible damage to nails occurs. Aim: To observe the clinical patterns of nail changes in various papulosquamous disorders. Materials and Methods: This observational descriptive cross- sectional study was conducted in a tertiary care set up at Government Coimbatore Medical College, Coimbatore from June 2016 to June 2017. The study group comprised of 104 cases of various papulosquamous disorders. The type of papulosquamous disorder, presence of nail changes, their onset, duration, various patterns and associated co-morbidities were noted in detail. The observed data were entered in Microsoft Excel and data analysis was done in Epi Info system. Results: Out of the 104 cases taken for study 71 (68%) had nail changes. Majority of them were in 31-45 years age group (n=29; 41%). More of males (n=38, 54%) had nail changes than the females (n=33, 46%). Psoriasis (n=47; 66%) was the most common papulosquamous disorder with nail changes followed by lichen planus (n=9; 13%) and pityriasis rubrapilaris (n=7; 10%). Pitting of nails was the most common nail pattern (n=44; 62%), followed by subungual hyperkeratosis (n=24; 34%), thickened nail plate and longitudinal striations (both n=19; 27%). Finger nails were more affected than toe nails. Psoriasis and pityriasis rubrapilaris had 100% nail involvement. The patterns of nail changes were maximum in psoriasis and lichen planus. Beaus lines was observed in most of the papulosquamous disorders except Lichen nitidus and Lichen striatus. The time gap for onset of nail changes was longer for psoriasis (4.2 years) and shorter for pityriasis rosea (two months). In lichen striatus and lichen nitidus, nails were involved only in children. Minimal nail changes were observed in para psoriasis and pityriasis lichenoides. More number of co-morbidities like diabetes, hypertension, atopy and arthritis were seen in psoriasis. Conclusion: In the present study, it was observed that the nail changes were more common in psoriasis, lichen planus and pityriasis rubra pilaris among the papulosquamous disorders. The highly frequent nail patterns were pitting and subungual hyperkeratosis.