Search

Background Cutaneous findings are well known in atopic dermatitis (AD), but nail changes are generally overlooked. Objective In the present study, the aim was to determine the clinical and disease-related capillaroscopic findings of nail findings in pediatric patients with AD. Methods A total of 100 participants aged 2-16 years, admitted to the dermatology outpatient clinic, were included in the study. Among the participants there were 50 patients diagnosed with AD according to the Hanifin-Rajka criteria and 50 healthy volunteers. The atopic dermatitis severity score (SCORAD) were calculated for all patients. A digital epiluminescence device manufactured by Grimed was used for nailfold capillaroscopy. Results The nail findings detected in the patients with AD were pitting, punctate leukonychia, trachyonychia, onycholysis and onychomadesis. Pitting of the patient group (26%) was significantly higher than the control group (6%) (p=0.007). It was found that the results of the patient group was significantly higher than those of the control group in terms of capillary density decrease (p=0.007), irregularity in capillary array (p˂0.001), increase in capillary dilatation (p˂0.001), tortuosity (p=0.04), increase in ramification (p=0.02), bush-like appearance (p=0.02) and avascular areas (p=0.002). Significant correlations were determined between pitting with trachyonychia, capillary density decrease, avascular areas and the SCORAD (p˂0.05 r=0.21, p˂0.05 r=0.25 p˂0.001 r=0.29, p˂0.05 r=0.35; respectively). Conclusion In conclusion nailfold capillaroscopic images of pediatric patients with AD were similar to scleroderma spectrum disorder. Hence, it was considered that it would be beneficial to support the detailed clinical examination of the patients with a capillaroscopic examination.

Cronkhite-Canada syndrome is an acquired inflammatory polyposis syndrome in which alopecia, onychomadesis and hyperpigmentation occur concurrently with gastrointestinal symptoms. The pathophysiology of alopecia in Cronkhite-Canada syndrome has not been definitively elucidated. We present evidence for alopecia areata incognita as a possible mechanism of hair loss.

Summary With the exception of acropustulosis, nail disease responds poorly to etretinate. When used to treat other dermatological conditions etretinate is frequently toxic to the normal nail and may affect any or all of its epidermal components. The desquamative dermatitis, induced by etretinate, may account for many of the drug's side-effects on the nail. These include chronic paronychia, onycholysis, onychomadesis, nail shedding, onychoschizia, fragility and the formation of excess granulation tissue. Some of these changes resemble those found in psoriatic paronychia and similarities are drawn between psoriasis and the retinoid dermatitis which presents with identical features in the discharge from beneath the proximal nail-fold. The desquamative reaction in patients taking etretinate always affects the lips and, in addition, may be widespread or mainly localized to the nail apparatus.

In most disorders of the nail in which the aromatic retinoid etretinate has been used, the results have been generally disappointing. The exception is its success in acropustulosis. In other dermatological conditions, the same therapeutic regime may induce a variety of unwanted effects on the nail apparatus, including chronic paronychia, onycholysis, onychomadesis, nail shedding, onychoschizia, fragility and periungual granulation tissue. Many of these changes resemble those found in psoriasis, particularly psoriatic paronychia. In this presentation, parallels will be drawn between psoriatic pathology and retinoid desquamative dermatitis which resembles it in producing similar discharge from beneath the proximal nail fold. This may be the basis for the nail signs induced by etretinate.