Nail changes in female pemphigus vulgaris patients on immunosuppressive therapy

Abstract

BackgroundPemphigus vulgaris (PV) patients receiving immunosuppressive therapy may develop nail alterations resulting from infection, skin disorder, or drug regimen.ObjectiveThis study aims to describe nail changes in PV female patients receiving immunosuppressive therapy and to report the frequency of associated fungal and bacterial growth in the patients’ nails.MethodsTwenty-five female PV patients who had at least one acquired finger or toenail abnormality and had been administered at least one immunosuppressive drug were included in the study. Nail alterations were recorded. Nail scrapings were collected from abnormal nails for fungal and bacterial examination.ResultsPositive fungal and bacterial cultures were detected in 20 (80%) of patients’ nail samples. Five patients reported nail alterations coinciding with disease onset, whereas 13 reported nail changes after administration of immunosuppressive therapy.LimitationsLack of a control group (patients on similar immunosuppressive medications for conditions other than PV) which would have further supported the findings demonstrated in this observational study.ConclusionNail abnormalities in severe PV patients are frequently associated with fungal and bacterial growth. Immunosuppressive therapy potentially initiates such changes.

Involvement of Nail Apparatus in Pemphigus Vulgaris in Ethnic Poles Is Infrequent

“…Interestingly, 12% of already treated PV patients in Thai study, were found to have concomitant clinical onychomycosis (although only 5% were confirmed by mycological culture) ( 53 ). Similarly, an Egyptian study on PV female patients on immunosuppressive treatment also indicated 24% prevalence of onychomycosis, yet also 24% prevalence of bacterial periungual infection ( 54 ). What is worth noticing, fungal, and bacterial infection may mimic PV nail apparatus lesions and pose a threat to immunocompromised patients if left untreated, especially considering additional immunosuppressive treatment.…”

Recurrent Paronychia as a Presenting Manifestation of Pemphigus Vulgaris: A Case Report

“…A study by Schlesinger et al [6] noted nail changes in 47% (30 of 64) of patients with PV. Another study by El-Komy et al [7] on 25 patients with PV showed onycholysis and subungual hyperkeratosis in 16 patients (64%) as the most common nail alterations.…”

“…Nail disease can be a part of the initial presentation along with mucosal and cutaneous lesions, can precede a flare of the pre-existing disease, or can be the only sign of the disease [5,6,7,8,9,10,11,12,13]. It manifests as chronic paronychia, onychomadesis, Beau's lines, trachyonychia, onycholysis, subungual hemorrhage, nail plate discoloration, pitting, onychoschizia, and nail dystrophy [6,7,8,9,10,11,12,13,14,15,16,17,18,19].…”

“…It manifests as chronic paronychia, onychomadesis, Beau's lines, trachyonychia, onycholysis, subungual hemorrhage, nail plate discoloration, pitting, onychoschizia, and nail dystrophy [6,7,8,9,10,11,12,13,14,15,16,17,18,19]. Pseudopyogenic granuloma of the proximal or lateral nail fold can also be seen, and it has been reported to be the first symptom of a relapse of the disease [20].…”

Blistering disorders and their impact on women and their families in the International Journal of Women’s Dermatology: Honoring the contributions of Professor Dedee Murrell

“…Professor Murrell has always been an inspiration to us as a devoted mother and wife, an excellent clinician, a great mentor, a dedicated researcher, and a passionate traveler. Both the International Journal of Women’s Dermatology and the Women’s Dermatologic Society owe a debt of gratitude to Professor Murrell for her 8 years of service to the organization in the role of Founding Editor and co-Editor in Chief, for the creative energy that she invested in developing articles for the journal, 2 – 16 and for her solicitation of articles from world-renowned experts 17 – 30 that have improved the lives of women and their families throughout the world with blistering diseases.…”