Beau lines associated with COVID-19

Abstract

45-year-old man presented with a horizontal groove over all his fingernails and toenails. The grooves were most noticeable over his great toenails bilaterally, with a horizontal groove 5 mm from the proximal nailfold (Figure 1). Three and a half months previously, he had been given a diagnosis of coronavirus disease 2019 (COVID-19) after a positive nasopharangeal swab polymerase chain reaction test, owing to symptoms of diarrhea, fever and shortness of breath, which lasted for 10 days and did not require admission to hospital.The cutaneous findings associated with COVID-19 have been classified into 5 distinct patterns: a maculopapular eruption, chilblain lesions, urticarial lesions, a vesicular eruption and livedo reticularis and necrosis. 1 Some of these findings, such as the vesicular eruption, appear early in the disease course; others are seen later, such as the chilblain pattern. 2 Beau lines are transverse grooves in the nail plate that result from transient interruption of the growth of the proximal nail matrix. 3 They are often noticed 2-3 weeks after a systemic insult and their appearance parallels the length of time needed for the nail to grow past the proximal nailfold. As the toenails grow at a rate of about 1.62 mm per month, the distance of the Beau lines from the proximal nailfold in our patient reflects the timing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. 4 Other causes of Beau lines include localized trauma and systemic triggers such as febrile illness, severe malnutrition, pemphigus, Raynaud disease, Kawasaki disease and chemotherapy. There is no specific therapy for Beau lines, as they selfresolve if the underlying condition has resolved.

Patient Recovery from COVID-19 Infections: Follow-Up of Hair, Nail, and Cutaneous Manifestations

“…Their onset typically occurs before and during admission, but cutaneous findings after discharge have been reported by many studies [4][5][6][7][8][9][10]. Although hair and nail disorders may also occur late after recovery from a COVID-19 infection, studies on the hair and nail problems of patients infected with the SARS-CoV-2 virus are rare [11][12][13][14][15][16]. Telephone interview is one tool to assess the patient's condition in this on-going COVID-19 pandemic to comply with infectious disease control policy.…”

Nail changes as manifestation of systemic disease in COVID‐19 infection

“…2 We conducted a literature search in Pubmed, Embase, The Cochrane Library, EBSCO and Google scholar databases regarding all the case reports and series of nail changes associated to COVID-19 infection. Included cases are summarized in Table 1.A total of six case reports were found: two reported beau lines, 3,4 two red half-moon nail sign, 2,5 one onychomadesis 1 and one a distal orange discoloration. 6 Median age was of 53.5 years (range 37 to 89 years).…”

“…A total of six case reports were found: two reported beau lines, 3,4 two red half-moon nail sign, 2,5 one onychomadesis 1 and one a distal orange discoloration. 6 Median age was of 53.5 years (range 37 to 89 years).…”

“…5 Beau lines or transverse grooves in the nail plate can be caused by a temporary interruption of nail matrix growth. 3 In more severe cases, an inhibition of the nail´s proliferation causes a separation of the nail plate from the nail bed with an eventual shedding or onychomadesis. 1 These alterations often occur after a systemic insult, such as infections, critical illnesses, drugs or autoimmune diseases.…”

COVID-19 Associated Onychomadesis

“…To date, various cutaneous manifestations of coronavirus disease 2019 (COVID-19) have been reported, 1 including but not limited to morbilliform, urticarial, pernio-like, livedo-reticularis-like, hair loss, and myriad other presentations. Reported COVID-19 nail changes have included Beau's lines 2 as well as one report of onychomadesis. 3 Three months after his COVID-19 diagnosis, noted rapid darkening of multiple fingernails.…”