Nail Sarcoidosis with and without Systemic Involvement: Report of Two Cases

Abstract

The most commonly seen nail change in sarcoidosis, often associated with chronic systemic disease, is onychodystrophy. Imaging of hands, feet and chest is of paramount importance when nail sarcoidosis is suspected, for evaluation of bone cysts and pulmonary involvement, respectively. We report 2 cases of sarcoidosis that developed nail involvement - one with pulmonary disease, and the other without any evidence of systemic involvement, which is very rare.

Nail Sarcoidosis Presenting with Longitudinal Erythronychia

“…However, nail changes in sarcoidosis are nonspecific, and nail sarcoidosis in the absence of bone involvement has occasionally been reported, as was the case in our patient [6,10,11]. In addition, longitudinal erythronychia as a clinical sign of nail sarcoidosis as seen in our patient has not been described previously.…”

If You Hear Hoof Beats, Sometimes Think Zebras

“…Often, these conditions conceal systemic disease in most patients; therefore, the most severely affected organ usually dictates the treatment regimen, and frequently nail and bone disorders respond to therapy. In case of nail involvement without signs of systemic disease, topical clobetasol in occlusion on the affected nails may be a therapeutic option [6]. In case of persistence or systemic involvement, antimalarials, tetracyclines, or methotrexate, can be successfully administered [7].…”

A Single Nail Dystrophy as a Unique Manifestation of Sarcoidosis: A Case Report

“…Sarcoidosis can virtually affect any organ of the body, leading to a wide variety of clinical manifestation. Isolated sarcoidosis in the hand is rare, with a reported incidence of 0.2% [2, 3], and can manifest with skin, bone, and/or nail abnormalities. Nail involvement rarely occurs in sarcoidosis, ranging from 1 in 400 to 3 in 188, and appears mostly as nail plate dystrophy, including pitting, cracking, thickening, onycholysis, and onychorrhexis, among others [4-9].…”