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Nail involvement in pemphigus vulgaris
N Schlesinger1, M Katz, A Ingber
1Rheumatology Service, UMDNJ/New Jersey Medical School, Newark, NJ 07103, USA.
Background:
Involvement of the nail unit in pemphigus vulgaris (PV) is thought to be rare.
Objectives:
To determine the frequency of nail changes among patients with PV.
Methods:
Nail changes were recorded in patients with PV and were analysed retrospectively. Biopsies were taken from the nail bed and nail matrix for histological and immunofluorescence observations. Microscopic (potassium hydroxide) examination and fungal culture were performed.
Results:
Nail changes were present in 30 of 64 (47%) patients with PV. Sixteen patients had onychomycosis and 14 had nail changes due to PV. These included onychomadesis, discoloration, deformity, onychorrhexis, onycholysis, subungual haemorrhage, subungual hyperkeratosis and paronychia. Onychomycosis affected fingernails and toenails, but changes due to PV occurred only in fingernails, most commonly on the thumb and index finger. No connection was found between the patient's occupation and nail involvement, and there was no correlation with the severity or duration of PV. In a control group of 64 patients of similar sex and age, only two had non-specific fingernail changes.
Conclusions:
Nail changes in PV may be more frequent than previously thought.
Insights
Nail changes in pemphigus vulgaris (PV) are more common than previously believed, affecting nearly half of patients. These nail alterations, distinct from onychomycosis, primarily impact fingernails.
Area of Science:
- Dermatology
- Autoimmune Diseases
- Nail Disorders
Background:
- Pemphigus vulgaris (PV) involvement of the nail unit is traditionally considered infrequent.
- This study investigates the actual prevalence of nail changes in PV patients.
Purpose of the Study:
- To ascertain the frequency of nail alterations in individuals diagnosed with pemphigus vulgaris.
- To differentiate nail changes caused by PV from those due to onychomycosis.
Main Methods:
- Retrospective analysis of nail changes in 64 PV patients.
- Histological and immunofluorescence examination of nail bed and matrix biopsies.
- Microscopic (KOH) testing and fungal cultures were conducted.
Main Results:
- Nail changes were observed in 30 out of 64 (47%) PV patients.
- Sixteen patients had onychomycosis, while 14 exhibited nail changes attributed to PV.
- PV-related nail changes, including onychomadesis, discoloration, and deformity, were exclusively found in fingernails.
Conclusions:
- Nail involvement in pemphigus vulgaris is significantly more common than previously assumed.
- The findings highlight the importance of examining nails in PV patients for accurate diagnosis and management.