Inflammatory Nail Disorders in Skin of Color: A Systematic Review of Clinical and Onychoscopic Manifestations

Despite increasing attention regarding skin diseases in individuals with skin of color (SoC), there remains a significant gap in understanding and identifying inflammatory nail disorders in this population. This systematic review aims to synthesize the clinical and onychoscopic features of inflammatory nail disorders in patients with SoC, thereby enhancing diagnostic accuracy and patient outcomes. Our systematic PubMed and Medline (Web of Science) search followed PRISMA guidelines. Studies documenting clinical and onychoscopic features of inflammatory nail disorders in Fitzpatrick skin types IV-VI were included. Data extraction focused on study design, patient demographics, diagnostic methods, and nail findings. Of the 608 articles identified, 60 met the inclusion criteria, encompassing 16 inflammatory nail disorders and 12,743 patient cases. Key disorders included nail psoriasis, nail lichen planus, alopecia areata-associated nail changes, and others. Significant variability was noted in reporting skin type, with only a minority explicitly documenting SoC representation. This review underscores the paucity of literature on inflammatory nail disorders in SoC, highlighting gaps in clinical documentation and diagnostic approaches. Improved awareness and inclusion of SoC in dermatologic research are critical to addressing these disparities and enhancing health equity. Recognition of diverse clinical presentations in SoC patients is essential for accurate and timely diagnosis of inflammatory nail disorders. PROSPERO number: CRD42024568649.