Dermatoscopic Evaluation of Nail Changes among End Stage Renal Disease Patients

Abstract Background Nail changes observed in end stage renal disease (ESRD) patients undergoing regular hemodialysis (HD) are polymorphic and diverse. HD causes heterogeneous pathology of nail which may be related to renal condition itself, complications related to it and drugs. Aim of the Work To study nail changes in ESRD patients undergoing regular HD by clinical and dermoscopic examination and to correlate these changes with age of patients, duration of hemodialysis, laboratory investigations, etiology of renal failure and type of vascular access. Patients and Methods The study consists of 100 ESRD patients on regular hemodialysis. Nails of these 100 patients were examined clinically and by dermoscopy. Different nail changes were detected and their frequencies were noted. Also, we correlated these changes with age of patients, duration of hemodialysis, laboratory investigations, etiology of renal failure and type of vascular access. Results Nail changes found in ESRD patients on HD were scales, leukonychia, thickening and crumbling, longitudinal striations, transverse striations, onycholysis, splinter hemorrhage, subungual hematoma, trachyonychia, subungual hyperkeratosis, Terry’s nail, onychomycosis, pincer nail, melanonychia, pitting, Lindsay nail, onychomadesis, dilated nail bed capillaries, Beau’s lines, Muehrcke’s lines, onychodystrophy, Mee’s line, loss of lunula, koilonychia and onychogryphosis in decreasing manner. Also, we found statistical significant correlation between some of these changes and age of patients, duration of hemodialysis, laboratory investigations, etiology of renal failure and type of vascular access. Conclusion Nail changes that were seen on examination of ESRD patients undergoing regular HD were very frequent and the dermoscopic examination helped us to detect nail changes not seen by clinical examination.