Dermoscopic Evaluation of Inflammatory Nail Disorders and Their Mimics
DOI:
https://doi.org/10.2340/00015555-3917Keywords:
trachyonychia, psoriasis, lichen planus, lichen striatus, onychotillomania, allergic contact dermatitisAbstract
Nail dermoscopy (onychoscopy) is a valuable diagnostic tool for evaluating diseases in the nail apparatus. It is non-invasive, allowing clinicians to prioritize particular nails for biopsy. Thus, it can improve diagnostic accuracy and expedite treatment. Evaluating inflammatory nail disorders using onychoscopy is a relatively new approach to clinical assessment and has the potential to augment clinical care. This review highlights key dermoscopic features of major inflammatory nail disorders, including trachyonychia, nail psoriasis, nail lichen planus, onychotillomania, nail lichen striatus and allergic contact dermatitis due to artificial nails. It also illustrates their management and differential diagnoses, including onychomycosis, onycholysis, nail dystrophy due to systemic amyloidosis and malignant nail tumours. Limitations of this review included the low amount of literature on this topic and non-standardized terminology used among researchers. As onychoscopy is a relatively new technique, further studies and standardization of terminology are warranted to consolidate the role of dermoscopy in evaluating inflammatory nail disorders.
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References
Jacobsen AA, Tosti A. Trachyonychia and twenty-nail dystrophy: a comprehensive review and discussion of diagnostic accuracy. Skin Appendage Disord 2016; 2: 7–13.
Alkiewicz J. Trachyonychia. Ann Dermatol Venereol 1950; 10: 136–140.
Starace M, Alessandrini A, Bruni F, Piraccini BM. Trachyonychia: a retrospective study of 122 patients in a period of 30 years. J Eur Acad Dermatol Venereol 2020; 34: 880–884.
Haber JS, Chairatchaneeboon M, Rubin AI. Trachyonychia: review and update on clinical aspects, histology, and therapy. Skin Appendage Disord 2016; 2: 109–115.
Tosti A, Fanti PA, Morelli R, Bardazzi F. Trachyonychia associated with alopecia areata: a clinical and pathologic study. J Am Acad Dermatol 1991; 25: 266–270.
Chernoff KA, Scher RK. Nail disorders: kids are not just little people. Clin Dermatol 2016; 34: 736–741.
Tosti A, Bardazzi F, Piraccini BM, Fanti PA. Idiopathic trachyonychia (twenty-nail dystrophy): a pathological study of 23 patients. Br J Dermatol 1994; 131: 866–872.
Jo G, Park JS, Yu DA, Ohn J, Sheu SL, Mun JH. Onychoscopy of trachyonychia: an analysis of 30 patients and comparison with onychomycosis. Br J Dermatol 2018; 179: 491–493.
Lee YB, Cheon MS, Eun YS, Cho BK, Park YG, Park HJ. Cyclosporin administration improves clinical manifestations and quality of life in patients with 20-nail dystrophy: case series and survey study. J Dermatol 2012; 39: 1064–1065.
Park JM, Cho HH, Kim WJ, Mun JH, Song M, Kim HS, et al. Efficacy and safety of calcipotriol/betamethasone dipropionate ointment for the treatment of trachyonychia: an open-label study. Ann Dermatol 2015; 27: 371–375.
Yorulmaz A, Artuz F. A study of dermoscopic features of nail psoriasis. Postepy Dermatol Alergol 2017; 34: 28–35.
Tan ES, Chong WS, Tey HL. Nail psoriasis: a review. Am J Clin Dermatol 2012; 13: 375–388.
Augustin M, Reich K, Blome C, Schafer I, Laass A, Radtke MA. Nail psoriasis in Germany: epidemiology and burden of disease. Br J Dermatol 2010; 163: 580–585.
Jones SM, Armas JB, Cohen MG, Lovell CR, Evison G, McHugh NJ. Psoriatic arthritis: outcome of disease subsets and relationship of joint disease to nail and skin disease. Br J Rheumatol 1994; 33: 834–839.
Zenke Y, Ohara Y, Kobayashi D, Arai S, Kishimoto M, Okada M, et al. Nail findings in patients with psoriatic arthritis: a cross-sectional study with special reference to transverse grooves. J Am Acad Dermatol 2017; 77: 863–867.
McGonagle D, Ash Z, Dickie L, McDermott M, Aydin SZ. The early phase of psoriatic arthritis. Ann Rheum Dis 2011; 70: i71–76.
Raposo I, Torres T. Nail psoriasis as a predictor of the development of psoriatic arthritis. Actas Dermosifiliogr 2015; 106: 452–457.
Yadav TA, Khopkar US. Dermoscopy to detect signs of subclinical nail involvement in chronic plaque psoriasis: a study of 68 patients. Indian J Dermatol 2015; 60: 272–275.
Golinska J, Sar-Pomian M, Rudnicka L. Dermoscopic features of psoriasis of the skin, scalp and nails – a systematic review. J Eur Acad Dermatol Venereol 2019; 33: 648–660.
Bhat YJ, Mir MA, Keen A, Hassan I. Onychoscopy: an observational study in 237 patients from the Kashmir Valley of North India. Dermatol Pract Concept 2018; 8: 283–291.
Tosti A. Dermoscopy of the hair and nails. 2nd edn. Boca Raton, FL: CRC Press; 2015.
Nakamura RC, Costa MC. Dermatoscopic findings in the most frequent onychopathies: descriptive analysis of 500 cases. Int J Dermatol 2012; 51: 483–485.
Iorizzo M, Dahdah M, Vincenzi C, Tosti A. Videodermoscopy of the hyponychium in nail bed psoriasis. J Am Acad Dermatol 2008; 58: 714–715.
Hashimoto Y, Uyama M, Takada Y, Yoshida K, Ishiko A. Dermoscopic features of nail psoriasis treated with biologics. J Dermatol 2017; 44: 538–541.
Piraccini BM, Alessandrini A, Starace M. Onychoscopy: dermoscopy of the nails. Dermatol Clin 2018; 36: 431–438.
Piraccini BM, Bruni F, Starace M. Dermoscopy of non-skin cancer nail disorders. Dermatol Ther 2012; 25: 594–602.
Rigopoulos D, Baran R, Chiheb S, Daniel CR, 3rd, Di Chiacchio N, Gregoriou S, et al. Recommendations for the definition, evaluation, and treatment of nail psoriasis in adult patients with no or mild skin psoriasis: a dermatologist and nail expert group consensus. J Am Acad Dermatol 2019; 81: 228–240.
Friedman P, Sabban EC, Marcucci C, Peralta R, Cabo H. Dermoscopic findings in different clinical variants of lichen planus. Is dermoscopy useful? Dermatol Pract Concept 2015; 5: 51–55.
Nakamura R, Broce AA, Palencia DP, Ortiz NI, Leverone A. Dermatoscopy of nail lichen planus. Int J Dermatol 2013; 52: 684–687.
Goettmann S, Zaraa I, Moulonguet I. Nail lichen planus: epidemiological, clinical, pathological, therapeutic and prognosis study of 67 cases. J Eur Acad Dermatol Venereol 2012; 26: 1304–1309.
Grover C, Kharghoria G, Bhattacharya SN. Linear nail bed dyschromia: a distinctive dermoscopic feature of nail lichen planus. Clin Exp Dermatol 2019; 44: 697–699.
Lipner SR. Nail lichen planus: a true nail emergency. J Am Acad Dermatol 2019; 80: e177–e178.
Iorizzo M, Tosti A, Starace M, Baran R, Daniel CR, 3rd, Di Chiacchio N, et al. Isolated nail lichen planus: an expert consensus on treatment of the classical form. J Am Acad Dermatol 2020; 83: 1717–1723.
Maddy AJ, Tosti A. Dermoscopic features of onychotillomania: a study of 36 cases. J Am Acad Dermatol 2018; 79: 702–705.
Rieder EA, Tosti A. Onychotillomania: an underrecognized disorder. J Am Acad Dermatol 2016; 75: 1245–1250.
Sidiropoulou P, Sgouros D, Theodoropoulos K, Katoulis A, Rigopoulos D. Onychotillomania: a chameleon-like disorder: case report and review of literature. Skin Appendage Disord 2019; 5: 104–107.
Schumer MC, Bartley CA, Bloch MH. Systematic review of pharmacological and behavioral treatments for skin picking disorder. J Clin Psychopharmacol 2016; 36: 147–152.
Patrizi A, Neri I, Fiorentini C, Bonci A, Ricci G. Lichen striatus: clinical and laboratory features of 115 children. Pediatr Dermatol 2004; 21: 197–204.
Mun JH, Park HJ, Kim HS, Kim SH, Ko HC, Kim BS, et al. Lichen striatus occurring after allogenic peripheral blood stem cell transplantation in an adult with aplastic anemia. Ann Dermatol 2012; 24: 87–89.
Kim TW, Mun JH, Jwa SW, Song M, Kim HS, Ko HC, et al. Lichen striatus-induced pterygium unguis. Korean J Dermatol 2012; 50: 799–802.
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.
Jakhar D, Kaur I. Onychoscopy of nail involvement in lichen striatus. Indian Dermatol Online J 2018; 9: 360–361.
Iorizzo M, Rubin AI, Starace M. Nail lichen striatus: is dermoscopy useful for the diagnosis? Pediatr Dermatol 2019; 36: 859–863.
Coto-Segura P, Costa-Romero M, Gonzalvo P, Mallo-Garcia S, Curto-Iglesias JR, Santos-Juanes J. Lichen striatus in an adult following trauma with central nail plate involvement and its dermoscopy features. Int J Dermatol 2008; 47: 1324–1325.
Cheon DU, Ro YS, Kim JE. Treatment of nail lichen striatus with intralesional steroid injection: a case report and literature review. Dermatol Ther 2018; 31: e12713.
Goncalo M, Pinho A, Agner T, Andersen KE, Bruze M, Diepgen T, et al. Allergic contact dermatitis caused by nail acrylates in Europe. An EECDRG study. Contact Derm 2018; 78: 254–260.
Gregoriou S, Tagka A, Velissariou E, Tsimpidakis A, Hatzidimitriou E, Platsidaki E, et al. The rising incidence of allergic contact dermatitis to acrylates. Dermatitis 2020; 31: 140–143.
Maddy AJ, Tosti A. What’s New in Nail Disorders. Dermatol Clin 2019; 37: 143–147.
Mattos Simoes Mendonca M, LaSenna C, Tosti A. Severe onychodystrophy due to allergic contact dermatitis from acrylic nails. Skin Appendage Disord 2015; 1: 91–94.
Piccolo V, Piraccini BM, Argenziano G, Russo T, Alessandrini A, Starace M. Onychoscopy of allergic contact dermatitis due to artificial nails: a double-centre retrospective study on 35 patients. J Am Acad Dermatol 2020; 83: 1485–1487.
Rolls S, Chowdhury MM, Cooper S, Cousen P, Flynn AM, Ghaffar SA, et al. Recommendation to include hydroxyethyl (meth)acrylate in the British baseline patch test series. Br J Dermatol 2019; 181: 811–817.
Raposo I, Lobo I, Amaro C, Lobo ML, Melo H, Parente J, et al. Allergic contact dermatitis caused by (meth)acrylates in nail cosmetic products in users and nail technicians – a 5-year study. Contact Derm 2017; 77: 356–359.
Lipner SR, Scher RK. Onychomycosis: clinical overview and diagnosis. J Am Acad Dermatol 2019; 80: 835–851.
Lipner SR, Scher RK. Onychomycosis: treatment and prevention of recurrence. J Am Acad Dermatol 2019; 80: 853–867.
Jesus-Silva MA, Fernandez-Martinez R, Roldan-Marin R, Arenas R. Dermoscopic patterns in patients with a clinical diagnosis of onychomycosis-results of a prospective study including data of potassium hydroxide (KOH) and culture examination. Dermatol Pract Concept 2015; 5: 39–44.
Piraccini BM, Balestri R, Starace M, Rech G. Nail digital dermoscopy (onychoscopy) in the diagnosis of onychomycosis. J Eur Acad Dermatol Venereol 2011; 27: 509–513.
Ramos Pinheiro R, Dias Domingues T, Sousa V, Galhardas C, Apetato M, Lencastre A. A comparative study of onychomycosis and traumatic toenail onychodystrophy dermoscopic patterns. J Eur Acad Dermatol Venereol 2019; 33: 786–792.
Maatouk I, Haber R, Benmehidi N. Onychoscopic evaluation of distal and lateral subungual onychomycosis: a cross-sectional study in Lebanon. Curr Med Mycol 2019; 5: 41–44.
Nada EEA, El Taieb MA, El-Feky MA, Ibrahim HM, Hegazy EM, Mohamed AE, et al. Diagnosis of onychomycosis clinically by nail dermoscopy versus microbiological diagnosis. Arch Dermatol Res 2020; 312: 207–212.
Abdallah NA, Said M, Mahmoud MT, Omar MA. Onychomycosis: Correlation between the dermoscopic patterns and fungal culture. J Cosmet Dermatol 2020; 19: 1196–1204.
Zaias N, Escovar SX, Zaiac MN. Finger and toenail onycholysis. J Eur Acad Dermatol Venereol 2015; 29: 848–853.
Prat C, Moreno A, Vinas M, Jucgla A. Nail dystrophy in primary systemic amyloidosis. J Eur Acad Dermatol Venereol 2008; 22: 107–109.
Jo G, Shin DY, Mun JH. Systemic amyloidosis-induced nail dystrophy. J Dtsch Dermatol Ges 2019; 17: 1057–1059.
Lecerf P, Richert B, Theunis A, André J. A retrospective study of squamous cell carcinoma of the nail unit diagnosed in a Belgian general hospital over a 15-year period. J Am Acad Dermatol 2013; 69: 253–261.
Starace M, Alessandrini A, Dika E, Piraccini BM. Squamous cell carcinoma of the nail unit. Dermatol Pract Concept 2018; 8: 238–244.
Teysseire S, Dalle S, Duru G, Phan A, Debarbieux S, Poulhalon N, et al. Dermoscopic features of subungual squamous cell carcinoma: a study of 44 cases. Dermatology (Basel) 2017; 233: 184–191.
Dika E, Fanti PA, Patrizi A, Misciali C, Vaccari S, Piraccini BM. Mohs surgery for squamous cell carcinoma of the nail unit: 10 years of experience. Dermatol Surg 2015; 41: 1015–1019.
Thai KE, Young R, Sinclair RD. Nail apparatus melanoma. Australas J Dermatol 2001; 42: 71–81; quiz 82–73.
Phan A, Dalle S, Touzet S, Ronger-Savlé S, Balme B, Thomas L. Dermoscopic features of acral lentiginous melanoma in a large series of 110 cases in a white population. Br J Dermatol 2010; 162: 765–771.
Phan A, Touzet S, Dalle S, Ronger-Savlé S, Balme B, Thomas L. Acral lentiginous melanoma: a clinicoprognostic study of 126 cases. Br J Dermatol 2006; 155: 561–569.
Starace M, Dika E, Fanti PA, Patrizi A, Misciali C, Alessandrini A, et al. Nail apparatus melanoma: dermoscopic and histopathologic correlations on a series of 23 patients from a single centre. J Eur Acad Dermatol Venereol 2018; 32: 164–173.
Menzies SW, Kreusch J, Byth K, Pizzichetta MA, Marghoob A, Braun R, et al. Dermoscopic evaluation of amelanotic and hypomelanotic melanoma. Arch Dermatol 2008; 144: 1120–1127.
Argenziano G, Zalaudek I, Corona R, Sera F, Cicale L, Petrillo G, et al. Vascular structures in skin tumors: a dermoscopy study. Arch Dermatol 2004; 140: 1485–1489.
Errichetti E, Zalaudek I, Kittler H, Apalla Z, Argenziano G, Bakos R, et al. Standardization of dermoscopic terminology and basic dermoscopic parameters to evaluate in general dermatology (non-neoplastic dermatoses): an expert consensus on behalf of the International Dermoscopy Society. Br J Dermatol 2020; 182: 454–467.
Kittler H, Marghoob AA, Argenziano G, Carrera C, Curiel-Lewandrowski C, Hofmann-Wellenhof R, et al. Standardization of terminology in dermoscopy/dermatoscopy: results of the third consensus conference of the International Society of Dermoscopy. J Am Acad Dermatol 2016; 74: 1093–1106.
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Copyright (c) 2021 Sophie Soyeon Lim, Alex Chamberlain, Keunyoung Hur, Jungyoon Ohn, Byeol Han, Victoria Mar, Je-Ho Mun
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