COVID‐19 and nail manifestation: be on the lookout for the red half‐moon nail sign

Abstract

COVID-19 and nail manifestation: be on the lookout for the red half-moon nail sign Dear Editor, Multiple cutaneous dermatologic manifestations have been reported in patients infected with SARS-CoV-2, especially pernio-like lesions. 1 Interestingly, nail apparatus manifestations of SARS-CoV-2 have been scarcely reported, with only one published report in the literature to date. 2 We report the case of a 37-year-old woman who presented with anosmia, dry cough, persistent fever, and relatively normal oxygen saturation (>92%). A positive nasal swab polymerase chain reaction for SARS-CoV-2 confirmed the infection. Two days after the symptoms began, the patient noticed changes in the nail bed characterized by a red-violet band, above the nail lunule. These changes were asymptomatic and lasted for 1 week before gradually returning to normal (Fig. 1). The patient was managed at home and did not require supplemental oxygen. Cutaneous manifestations, such as erythematous rash, rash with petechiae, vesicular rash, acral ischemia, livedo reticularis, and widespread urticaria, can present in up to 20% of patients with SARS-CoV-2 infection. 1 The chilblain-like lesions in patients with SARS-CoV-2 infection range from mild to severe acral ischemia lesions. Recently Neri et al., reported a case of "transversal red bands of the nail" also referred to as the "red half-moon nail sign". 2 We believe that our case confirms this finding. The pathophysiology of this nail manifestation remains to be elusive; however, similar to Neri et al., we hypothesized that this transient phenomenon could be secondary to vascular inflammation. 2 We did not perform a biopsy because of its morbidity and possible permanent cosmetic results. Therefore, the associated histological findings of the red half-moon nail sign associated with SARS-CoV-2 infection remain uncertain. In summary, it is important to emphasize a complete and detailed dermatological review, in search of these nail changes in all patients with SARS-CoV-2 infection.

Clarifying Terminology of Signs in COVID-19

“…The red half-moon nail sign has been observed in COVID-19 patients and represents a reversible red-violet band above the nail lunula (47). Although the etiology remains unknown, it is hypothesized to represent micro-vascular injury secondary to pro-coagulation and the inflammatory state (48).…”

Manifestaciones clínicas y complicaciones de la enfermedad por coronavirus 2019 (COVID-19): revisión de la literatura

“…Las lesiones de uñas son raras, aunque se han reportado lesiones descritas como bandas rojas transversales, denominadas "signo media luna roja", considerado un fenómeno transitorio secundario a inflamación vascular (Mendez-Flores et al, 2020).…”

Heterogeneous red–white discoloration of the nail bed and distal onycholysis in a patient with COVID‐19

“…Reports include half-moon-shaped transversal red bands; 3 Beau lines; 4 leukonychia in addition to Beau lines; 5 and red half-moon nail signs. 6 This case report describes nail symptoms detected in a patient who applied to the dermatology outpatient clinic.A 23-year-old male patient applied to the dermatology outpatient clinic with a complaint of discoloration in his nails. He stated that he had been isolated at home with the diagnosis of COVID-19 together with his parent and sister and had complaints of fever, sore throat and joint pain, but used no medications, 4 months ago.…”

“…Reports include half-moon-shaped transversal red bands; 3 Beau lines; 4 leukonychia in addition to Beau lines; 5 and red half-moon nail signs. 6 This case report describes nail symptoms detected in a patient who applied to the dermatology outpatient clinic.…”