Nail in chilblains – Clinical and onychoscopic findings with review of literature

Chilblains, characterised by an abnormal vascular response to cold and damp conditions, leads to cutaneous and nail changes. Though a common entity and a mimicker of other dreadful conditions, less data is available regarding nail changes in chilblains. We report nail findings and onychoscopic features in two patients with chilblains, a middle-aged female and a male. Clinical examination revealed tender violaceous plaques involving the lateral nail folds, dystrophy of the nail plate, distal subungual hyperkeratosis, erythronychia, splinter haemorrhages, hypopigmented scarring, nail pallor, and distal onycholysis. Onychoscopy revealed distorted lunulae, distal onycholysis, splinter haemorrhages, nail pallor, microhemorrhages involving periungual areas and nail-bed erythema. A knowledge of nail changes and onychoscopic findings in a common entity like chilblains, is essential for differentiating mimickers (including nail lichen planus, subungual melanoma) and initiating appropriate treatment.