Nail Changes in COVID-19

Abstract

Background: Various nail manifestations have been reported with COVID-19; mostly in the form of isolated reports. Objective: This cross-sectional study was carried out to assess nail changes in hospitalized patients with moderate to severe COVID-19. Methods: Nail findings in 43 adults being treated for COVID-19, were evaluated after obtaining informed written consent. Nail changes involving fingernails and toenails were documented as new-onset or pre-existing changes. Disease status, hematological and biochemical tests, inflammatory markers, treatment administered and outcomes were also recorded. The frequency of changes in fingernails and toenails were statistically compared. Results: The red half-moon sign (32.5%) and nail bed erythema (34.8%) were the commonest changes seen in fingernails; while apparent leukonychia (46.5%) and distal brown discoloration (51.1%) were commonest changes in toenails. The difference in frequency of changes seen between fingernails and toenails was statistically significant (p < 0.05). Nail changes correlated with systemic involvement in these patients. Limitations: Single-center evaluation in a limited number of patients, without using augmented examination techniques like onychoscopy, nail fold capillaroscopy, or fluoroscence. Those with less severe disease or with rapid fatality could not be studied. Conclusion: Nail changes in COVID-19 are common and reflect the systemic nature of illness, being a harbinger of underlying complications.

The most common skin symptoms in young adults and adults related to SARS-CoV-2 virus infection

“…Skin changes resulting from COVID-19 also affect the nails. These are rare changes that occur in patients of all ages, regardless of their origin [104,105]. As a result of infection with the SARS-CoV-2 virus, the following have been reported: the following changes on the nails: a red crescent sign, Mees' lines, Beau's lines [106][107][108].…”

“…The red crescent sign is the most common post-COVID-19 change that affects the nails. A raised erythematous line over the distal end of the lunula is described [ 104 , 108 ]. This symptom usually occurs 2–3 weeks after the SARS-CoV infection and disappears spontaneously within 2–3 months [ 106 , 108 , 109 ].…”

“…Most likely, this symptom occurs as a result of an immune reaction resulting from COVID-19 directed at the capillaries of the nail bed [ 105 , 106 , 109 ]. One study conducted on 55 patients indicated that the red crescent symptom occurred in 32.5% of patients (fingernails) and in 2.3% of patients (toe nails) [ 104 ]. Mess lines are abnormal keratinization of the nail plate resulting from systemic diseases [ 107 , 110 ].…”

Onychomadesis in a COVID-19 patient

“…The only systematic study on nail changes in COVID-19 was performed by Grover C. et al. in 2022 [ 14 ]. They studied nail changes in 43 patients with moderately severe disease including 25 men and 18 women with a mean age of 53 years.…”