Nail Involvement in Pemphigus: A Clinical and Dermoscopic Prospective Study

Nail involvement in pemphigus (NIP) was considered as a rare finding and a predictor factor of the severity of pemphigus. The diagnosis of NIP can be challenging, as it can be mistaken for other nail disorders. The aim of our study was to provide an overview of NIP, with a focus on the dermoscopy role to detect these nail changes.

A monocentric prospective study was performed from January 2018 to December 2022, investigating clinically and with a dermoscope NIP.

Our study included 32 patients, among them 6 patients with NIP. The mean age was 53 years. The average duration of the disease at presentation was 4.5 months. Five patients (83%) had pemphigus vulgaris and 1 patient was diagnosed with paraneoplastic pemphigus. In 5 cases (83%), the disease was severe, with 4 cases having frequent exacerbations (66.7%). The average number of nails involved was 9. In 3 cases, only the fingernails were involved. The nail lesions were concomitant to the mucocutaneous lesions in half our cases. Onycholysis and subungual hemorrhage were the most frequent dermoscopic findings (83%). Paronychia and dyschromia were seen in 4 patients. In 3 cases, cuticular loss and onychomadesis were seen.

Dermoscopic features such as subungual hemorrhage, onycholysis, and paronychia can help distinguish pemphigus-related nail changes from other conditions.