A Prospective Study of Nail Changes in Dermatological and Systemic Illnesses

Background: Some of the nail changes seen in certain dermatological or systemic pathologies may be unique to concerned condition. The knowledge of such nail changes may be immensely helpful in the diagnosis of some of these pathologies. Nail changes may precede other signs in some conditions and in these cases nail changes may help in early diagnosis. Various components of the nails which may get affected may include nail matrix, nail plate, nail bed and vasculature. We conducted this prospective study to know the prevalence of nail changes in various dermatological and systemic illnesses in patients attending dermatology outpatient department and patients admitted in different wards of our teaching institute. Aims and Objectives: (1) To study various nail changes in association with skin and systemic diseases. (2) To assess the diagnostic and prognostic significance of various nail changes. (3) To find our various etiological factors of the nail diseases. Methods: After approval from institutional ethical committee and obtaining informed consent from the patients nail changes were studied in patients attending dermatology OPD and those patients who were admitted in various wards of our institute. History, investigations and general and systemic examination was done in all the patients. Patients were included in this study on the basis of predefined inclusion and exclusion criteria. Nail and toes were examined for the changes such as dystrophy, ridging, thinning of nail plates, presence of Ptrygium, pigmentation and onycholysis. The changes were studied and their association with skin and systemic diseases was determined. Data analysis was carried out using SPSS16.0 version software. Results: In this prospective study of 225 patients there were 142 males (63.1 %) and 83 females (36.9 %) with a M: F ratio of 1:0.58. Most common age group to be affected was found to be 21-30 years and 31-40 years followed by 41-50 years and 51-60 years. The most common nail change was found to be onychomycosis (31.1 %) followed by paronychia (16%), psoriasis (11.5 %) and nail dystrophy (8.8 %). Longitudinal ridging, thinning of nail plates, pitting, Ptrygium and pigmentation were common changes seen in patients with lichen planus. Conclusion: Examining the patients for nail changes which may be seen in association with various dermatological and systemic conditions is an integral part of dermatology practice. These nail changes may precede the other signs and symptoms of the diseases and hence may be crucial in early diagnosis of such conditions

Nevirapine-induced Stevens-Johnson syndrome from a tertiary care hospital in Central India.

A 42 year old man, a known case of AIDS receiving antiretroviral therapy – stavudine, lamivudine, and nevirapine since 4 weeks, was admitted with erythematous rash, with blisters, and abnormal liver function test. A diagnosis of Steven-Johnson syndrome was made excluding other opportunistic infection and differential diagnosis. Nevirapine was discontinued until the patient recovered. After recovery patient was started with stavudine, lamivudine, and efavirenz treatment without re-challenge with nevirapine.

A case of Stevens-Johnson syndrome due to rifampicin.

A 25 year old female known case of category II pulmonary Tuberculosis was on anti-coch’s treatment in the FDC of rifampicin, isoniazid, pyrazinamide, ethambutol and Streptomycin. Fifteen days after the commencement of Cat II anti TB treatment she developed diffuse erythematous rash on face, trunk and both extremities which turned into blisters. There were ulcers on oral and genital cavity. A diagnosis of Stevens Johnson’s syndrome was made. The patient had a history of cat I pulmonary TB and treated for 8 months and at the end of 8th month she was sputum smear negative. Four months later she had a relapse of sputum smear positive for pulmonary TB. She responded to the stoppage of drugs and oral/inj. Corticosteroids, antihistaminics and antibiotics.