Nail involvement in autoimmune bullous disorders

Area of Science:

• Dermatology
• Autoimmunology
• Nail Medicine

Background:

• Autoimmune bullous disorders (AIBDs) frequently manifest with nail abnormalities.
• Nail findings in pemphigus vulgaris (PV) can precede skin lesions and indicate disease activity.
• Nail changes in AIBDs can range from paronychia and onychomadesis to nail loss and scarring.

Purpose of the Study:

• To review the spectrum of nail abnormalities in autoimmune bullous disorders.
• To highlight the diagnostic and prognostic significance of nail findings in PV.
• To discuss rare nail complications in other AIBDs like bullous pemphigoid and epidermolysis bullosa acquisita.

Main Methods:

• Literature review of autoimmune bullous disorders and associated nail changes.
• Analysis of clinical presentations and prognostic implications of nail lesions.
• Synthesis of reported cases and observations regarding nail involvement in PV, bullous pemphigoid, and epidermolysis bullosa acquisita.

Main Results:

• Nail abnormalities, including paronychia and onychomadesis, are common in AIBDs.
• In PV, nail lesions may precede skin manifestations and correlate with disease severity and recurrence.
• Hemorrhagic nail changes in PV are associated with a poor prognosis; nail scarring and loss are rare in other AIBDs.

Conclusions:

• Nail assessment is crucial for early diagnosis and monitoring of AIBDs, particularly PV.
• Nail manifestations can serve as important indicators of disease activity and prognosis in autoimmune bullous disorders.
• Understanding nail involvement aids in comprehensive patient management and predicting disease course.