A clinico-epidemiological and onychoscopic study of nail changes in papulosquamous disorders at a tertiary care centre in Puducherry

• Author Details:   
• Vijay Venkatesan
• Brinda David
• Manobalan Karunanandhan
• Yogindher Singh

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Background: Nails are an integral part of the integumentary system which aid in protection, tactile perception, motor functions in addition to their cosmetic value. Onychoscopy, a dermoscopy of the nail unit enables visualization of the subtle changes of the nail unit which are invisible to the naked eye.

Aim: To study the onychoscopic findings and clinical patterns of nails in papulosquamous disorders.

Materials and Methods: This is a cross-sectional study with purposive sampling. Following inclusion and exclusion criteria, 62 patients with papulosquamous disorders were recruited. Each fingernail and toenail were numbered from 1 to 10, and detailed clinical assessment was conducted. Utilizing the Heine Delta 20 dermatoscope, detailed onychoscopic examinations were carried out.

Results: Out of the 62 subjects, 47 were male, with Psoriasis being the most prevalent disorder (75.8%). A significant proportion (89%) of patients exhibited nail abnormalities, with onycholysis being the predominant clinical and dermoscopic change in psoriasis. Onychoscopy proved superior in visualizing nail alterations such as onycholysis, splinter hemorrhages, salmon patches, and dilated onychodermal band capillaries.

Conclusion: Onychoscopic evaluation in papulosquamous disorders facilitates the detection of subtle alterations in the nails that are imperceptible to the unaided eye. Despite biopsy serving as the benchmark diagnostic procedure for papulosquamous disorders, its invasiveness, discomfort, and diagnostic delays are noteworthy drawbacks. Onychoscopy, a non-invasive, cost-effective modality, can either complement or serve as an alternative to nail biopsy in papulosquamous disorders.