Nail abnormalities in upper extremity transplantation: Perspectives and insights from systemic diseases and organ transplantation

Nail changes following upper extremity transplantation (UET) cannot be overlooked as they possess diagnostic and prognostic relevance in allotransplantation of upper limbs. This comprehensive review explores nail and nail bed related changes encountered in UET recipients in the literature. The differential diagnosis of nail abnormalities in UET includes a wide range of systemic, local and iatrogenic conditions other than immune responses to the allograft. It requires interdisciplinary evaluation by primary transplant surgeons, pathologists, dermatologists and immunologists. The possible underlying mechanisms of nail pathology in UET and the management are discussed. It also underscores the importance of onychodystrophy and need for timely intervention and to improve outcomes in UET recipients.