Onychomadesis Following Cutaneous Vasculitis

Area of Science:

• Dermatology
• Nail Disorders
• Immunology

Background:

• Beau lines and onychomadesis are nail abnormalities resulting from temporary nail matrix arrest (NMA).
• These conditions can be associated with various systemic and dermatologic conditions.
• Nail changes severity depends on the underlying cause, duration, and environmental factors.

Purpose of the Study:

• To present a case of onychomadesis following cutaneous leukocytoclastic vasculitis (CLCV).
• To explore the potential link between vasculitis and nail matrix arrest.
• To expand the spectrum of known causes for nail matrix arrest.

Main Methods:

• A case study of a 61-year-old woman with a purpuric rash diagnosed as CLCV.
• Clinical examination and biopsy confirmed CLCV.
• Observation of nail changes (Beau lines and onychomadesis) developing weeks after CLCV resolution.

Main Results:

• The patient developed Beau lines and subsequent onychomadesis seven weeks after the onset of CLCV.
• Nail changes affected all 10 fingernails, with four experiencing complete nail shedding.
• Nail abnormalities resolved spontaneously within four months without specific treatment.

Conclusions:

• Cutaneous leukocytoclastic vasculitis may act as a trigger for nail matrix arrest, leading to Beau lines and onychomadesis.
• The proposed mechanism involves circulating immune complexes potentially damaging nail bed microvasculature.
• This case expands the recognized etiological spectrum for nail matrix arrest.