Dermoscopic Spectrum of Nail Alterations in Pediatric Leprosy: A Cross-Sectional Study from an Endemic Settings

Nail involvement in leprosy has been reported, but data in pediatric patients remain limited. Dermoscopy may detect subtle nail abnormalities not evident on routine examination.

This study evaluated dermoscopic nail alterations in pediatric leprosy patients in an endemic setting.

A descriptive cross-sectional study was conducted among pediatric patients with confirmed leprosy in Papua, Indonesia. All patients younger than 15 years with a clinical and bacteriological diagnosis of leprosy were included. Nail examinations were performed on fingernails and toenails using a handheld dermoscope with 10× magnification. Direct microscopic examination with 10% potassium hydroxide was performed to exclude onychomycosis. The types and distribution of nail alterations were recorded and analyzed descriptively. Dermoscopic images were captured using a 1200D digital single-lens reflex camera attached to the dermoscope in polarized mode without linkage fluid.

A total of 24 pediatric patients with leprosy were included in the study. Among the 18 patients with available leprosy classification, 17 (94.4%) were classified as multibacillary (MB) and 1 (5.6%) as paucibacillary (PB); classification was unknown for 6 patients (25.0%). Nail abnormalities involved both fingernails and toenails (62.5%). Leukonychia was the most frequent nail finding, observed in eight patients (33.3%), followed by transverse nail lines in four patients (16.7%). Other findings included onychorrhexis, longitudinal ridging, onychogryphosis, subungual hyperkeratosis, onycholysis, and longitudinal melanonychia. Several patients also presented with combined nail abnormalities.

Nail alterations are observed in a substantial proportion of pediatric leprosy patients in this study, particularly leukonychia and transverse nail lines. Dermoscopy helps detect subtle abnormalities that may be missed on routine examination, supporting clinical assessment in pediatric leprosy.