Nail Changes in COVID-19: A Cross Sectional Study From India.

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.