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Abstract

Nail dermoscopy was initially used only in the assessment of nail melanocytic lesions, but more recently it is being used for expanded diagnosis of all nail disorders and has become a routine diagnostic instrument. In daily practice, dermoscopy may be a useful tool with which to elucidate common findings about specific diseases in order to reinforce presumptive clinical diagnoses, as well as guide the management and prognoses of different nail diseases. The use of dermoscopy can be applied to all visible parts of the nail unit, but it is also possible to observe the nail matrix, the only non-visible part, in conjunction with intra-operative methods. A good knowledge of the pathogenesis of nail diseases is important in order to know on which part of the nail to focus. The nail is visible as a whole only with 10× magnification, but with a magnification range from 20 to 70×, observation can be improved by moving the lens back and forth and transversally. In most cases nail dermoscopy only permits a better visualization of symptoms already evident to the naked eye. However, in a few diseases, the technique can provide important diagnostic information.

The first part of the chapter, we explain techniques and problems of nail dermoscopy and will help the reader perform this exam on the nails. The second part we show how to identify the normal nail with dermoscopy, followed by sections on the main features of the most commonly encountered nail diseases.

Pictures of the dermoscopic features described in the text are provided, sometimes with the corresponding clinical picture helping to underline the fact the nail dermoscopy is useless without the clinical observation of the signs.

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References

  1. Cutolo M, Sulli A, Secchi ME, et al. The contribution of capillaroscopy to the differential diagnosis of connective autoimmune diseases. Best Pract Res Clin Rheumatol. 2007;21:1093–108.

    Article  PubMed  Google Scholar 

  2. Hirata SH, Yamada S, Enokihara MY, Di Chiacchio N, et al. Pattern of nail matrix and nail bed of longitudinal melanonychia by intraoperative dermatoscopy. J Am Acad Dermatol. 2011;65:297–303.

    Article  PubMed  Google Scholar 

  3. Hasegawa M. Dermoscopy findings of nail fold capillaries in connective tissue disease. J Dermatol. 2011;38(1):66–70.

    Article  PubMed  Google Scholar 

  4. Cutolo M, Sulli A, Smith V. Assessment microvascular changes in systemic sclerosis diagnosis and management. Nat Rev Rheumatol. 2010;6:578–87.

    Article  PubMed  Google Scholar 

  5. Pizzorni C, Sulli A, Smith V, et al. Capillaroscopy in 2016: new perspective in systemic sclerosis. Acta Rheumatol Port. 2016;41:8–14.

    CAS  Google Scholar 

  6. Shenavandeh S, Nezhad MZ. Association of nailfold capillary changes with disease activity, clinical and laboratory findings in patients with dermatomyositis. Med J Islam Repub Iran. 2015;29:233.

    PubMed  PubMed Central  Google Scholar 

  7. Dias SS, Isenberg DA. Advanced in systemic lupus erythematous. Medicine. 2014;42(3):126–33.

    Article  Google Scholar 

  8. Grossman JM, Kalunian KC. Definition, classification, activity and damage indices. In: Dj W, Hahn BH, editors. Dubois lupus erythematous. Philadelphia., 2002: Lippincott Williams & Wilkins; 2002. p. 19–31.

    Google Scholar 

  9. HM B, Abramson SB, Lie JT. Pathology and pathogenesis of vascular injury in systemic lupus erythematous. Interaction of inflammatory cells and activated endothelium. Arthritis Rheum. 1996;39(1):9–22.

    Article  Google Scholar 

  10. Hurairah H, Ferro A. The role of the endothelium in the control of vascular function. Int J Clin Pract. 2004;58(2):173–83.

    Article  CAS  PubMed  Google Scholar 

  11. Lambova SN, Muller-Ladner U. Capillaroscopic pattern in systemic lupus erythematous and undifferentiated connective tissue disease: what we still have to learn? Rheumatol Int. 2013;33(3):689–95.

    Article  PubMed  Google Scholar 

  12. Piraccini BM, Balestri R, Starace M, et al. Nail digital dermoscopy (Onychoscopy) in the diagnosis of onychomycosis. J Eur Acad Dermatol Venereol. 2013;27(4):509–13.

    Article  CAS  PubMed  Google Scholar 

  13. Ronger S, Touzet S, Ligeron C, et al. Dermoscopic examination of nail pigmentation. Arch Dermatol. 2002;138:1327–33.

    Article  PubMed  Google Scholar 

  14. Lencastre A, Lamas A, Sà D, et al. Onychoscopy. Clin Dermatol. 2013;31(5):587–93.

    Article  PubMed  Google Scholar 

  15. Haas N, Henz BM. Pitfall in pigmentation: pseudopods in the nail plate. Dermatol Surg. 2002;28(10):966–7.

    PubMed  Google Scholar 

  16. Criscione V, Telang G, Jellinek N. Onychopapilloma presenting as longitudinal leukonychia. J Am Acad Dermatol. 2010;63:541–2.

    Article  PubMed  Google Scholar 

  17. Piraccini BM, Antonucci A, Rech G, et al. Onychomatricoma: first description in a child. Pediatr Dermatol. 2007;24:46–8.

    Article  PubMed  Google Scholar 

  18. Baran R, Perrin C. Transverse leukonychia of toenails due to repeated microtrauma. Br J Dermatol. 1995;133:267–9.

    Article  CAS  PubMed  Google Scholar 

  19. Rigopoulos D, Ralph D. Management of simple brittle nails. Dermatol Ther. 2012;25:596–73.

    Google Scholar 

  20. Herschthal J, MP ML, Zaiac M. Management of ungual warts. Dermatol Ther. 2012;25(6):545–50.

    Article  PubMed  Google Scholar 

  21. Maes M, Richert B, de la Brassinne M. Green nail syndrome or chloro-nychia. Rev Med Liege. 2002;57:233–5.

    CAS  PubMed  Google Scholar 

  22. Chiriac A, Brzezinski P, Foia L, et al. Chloronychia: green nail syndrome caused by Pseudomons aeruginosa in elderly persons. Clin Interv Aging. 2015;14(10):265–7.

    Article  CAS  Google Scholar 

  23. Leung LK, Harding J. A chemical mixer with dark-green nails. BMJ Case Rep. 2015;3:2015.

    Google Scholar 

  24. Bet DL, Reis AL, Di Chiacchio N, et al. Dermoscopy and onychomycosis: guide nail abrasion for mycological samples. An Bras Dermatol. 2015;90(6):904–6.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Elewski BE, Rich P, Tosti A, et al. Onychomycosis: an overview. J Drugs Dermatol. 2013;12(7):s96–s103.

    PubMed  Google Scholar 

  26. Nakamura RC, Costa MC. Dermatoscopic finding in the most frequent onychopathies: descriptive analysis of 500 cases. Int J Dermatol. 2012;51:483–96.

    Article  PubMed  Google Scholar 

  27. Jesùs-Silva MA, Fernandez-Martinez R, Roldan-Marin R, et al. Dermoscopic patterns in patients with a clinical diagnosis of onychomycosis-result of a prospective study including data of potassium hydroxide (KHO) and culture examination. Dermatol Pract Concept. 2015;5(2):39–44.

    PubMed  PubMed Central  Google Scholar 

  28. Kallis P, Tosti A. Skin Appendage Disord. 2015;1:209–12.

    Article  Google Scholar 

  29. Wang YJ, Sun PL. Fungal melanonychia caused by Trichophyton rubrum and the value of dermoscopy. Cutis. 2014;94(3):E5–6.

    PubMed  Google Scholar 

  30. Kilinc Karaarslan I, Acar A, Aytmur D, et al. Dermoscopic features in fungal melanonychia. Clin Exp Dermatol. 2015;40(3):271–8.

    Article  CAS  PubMed  Google Scholar 

  31. Braun RP, Baran R, Le Gal FA, et al. Diagnosis and management of nail pigmentation. J Am Acad Dermatol. 2007;56(5):835–47.

    Article  PubMed  Google Scholar 

  32. Piraccini BM, Tosti A. White superficial onychomycosis: epidemiological, clinical and pathological study of 79 patients. Arch Dermatol. 2004;140(6):696–701.

    Article  PubMed  Google Scholar 

  33. Iorizzo M, Dahdah M, Vincenzi C, et al. Videodermoscopy of the hyponychium in nail bed psoriasis. J Am Acad Dermatol. 2008;58(4):714–5.

    Article  PubMed  Google Scholar 

  34. Shelley WB. The spotted lunula. A neglected nail sign associated with alopecia areata. J Am Acad Dermatol. 1980 May;2(5):385–7.

    Article  CAS  PubMed  Google Scholar 

  35. de Farias D, Tosti A, Di Chiacchio N, et al. Dermoscopy of nail psoriasis. An Bras Dermatol. 2010;85(1):101–3.

    Article  PubMed  Google Scholar 

  36. Ohtsuka T, Yamakage A, Miyachi Y. Statistical definition of nailfold capillary pattern in patients with psoriasis. Int J Dermatol. 1994;33(11):779–82.

    Article  CAS  PubMed  Google Scholar 

  37. Tosti A, Piraccini BM, de Farias D. Nial diseases. Dermatoscopy in clinical practice: beyond pigmented lesions. London: Informa healthcare Ltd; 2010.

    Google Scholar 

  38. Errichetti E, Zabotti A, Stinco G, et al. Dermoscopy of nail fold and elbow in the differential diagnosis of early psoriatic arthritis sine psoriasis and early rheumatoid arthritis. J Dermatol. 2016;43:1217–20.

    Article  CAS  PubMed  Google Scholar 

  39. Piraccini BM, Dika E, Fanti PA. Nail disorders: practical tips for diagnosis and treatment. Dermatol Clin. 2015;33:185–95.

    Article  CAS  PubMed  Google Scholar 

  40. Nakamura R, Broce AAA, Palencia DPC, et al. Dermatoscopy of nail lichen planus. Int J Dermatol. 2013;52:684–7.

    Article  PubMed  Google Scholar 

  41. Friedman P, Sabban EC, Marcucci C, et al. Dermoscopic findings in different clinical variants of lichen planus. Is dermoscopy useful? Dermatol Pract Concept. 2015;5(4):51–5.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Piraccini BM, Bellavista S, Misciali C, et al. Periungual and subungual pyogenic granuloma. Br J Dermatol. 2010;163:941–53.

    Article  CAS  PubMed  Google Scholar 

  43. Maehara Lde S, Ohe EM, Enokihara MY, et al. Diagnosis of glomus tumor by nail bed and matrix dermoscopy. An Bras Dermatol. 2010;85:236–8.

    Article  PubMed  Google Scholar 

  44. de Berker D. Erythronychia. Dermatol Ther. 2012;25:603–11.

    Article  PubMed  Google Scholar 

  45. Rai AK. Role of intraoperative dermoscopy in excision of nail unit glomus tumor. Indian Dermatol Online. 2016;7(5):448–50.

    Article  Google Scholar 

  46. Perrin C. Tumors of the nail unit. A review. Part I acquired localized longitudinal melanonychia and erythronychia. Am J Dermatopathol. 2013;35:621–36.

    Article  PubMed  Google Scholar 

  47. Tosti A, Schneider SL, Ramirez-Quizon MN, et al. Clical, dermoscopic and pathologic features of onychopapilloma: a review of 47 cases. J Am Acad Dermatol. 2016;74(3):521–6.

    Article  PubMed  Google Scholar 

  48. Joo HJ, Mr K, Cho BK, et al. Onychomatricoma: a rare tumor of nail matrix. Ann Dermatol. 2016;28(2):237–41.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Lesort C, Debarbieux S, Duru G, et al. Dermoscopic features of onychomatricoma: a study of 34 cases. Dermatology. 2015;231:177–83.

    Article  PubMed  Google Scholar 

  50. Tosti A, Piraccini BM, de Farias DC. Dealing with melanonychia. Semin Cutan Med Surg. 2009;28:49–54.

    Article  CAS  PubMed  Google Scholar 

  51. Braun R, Baran R, Saurat J, et al. Surgical pearls: dermatoscopy of the free edge of the nail to determinate the level of the nail plate pigmentation and the location of its probable origin in the proximal or distal nail matrix. J Am Acad Dermatol. 2006;58:714–5.

    Google Scholar 

  52. Goettmann-Bonvallott S, André J, Belaich S. Longitudinal melanonychia in children: a clinical and histopathologic study of 40 cases. J Am Acad Dermatol. 1999;41:17–22.

    Article  Google Scholar 

  53. Chu DH, Rubin AI. Diagnosis and management of nail disorders in children. Pedriatr Clin. 2014;61:293–308.

    Google Scholar 

  54. Richert B, André J. Nail disorders in children: diagnosis and management. Am J Acad Dermatol. 2011;12:101–12.

    Article  Google Scholar 

  55. Tosti A, Baran R, Morelli R, et al. Progressive fading of a longitudinal melanonychia due to a nail matrix melanocytic naevus in a child. Arch Dermatol. 1994;130:1076–7.

    Article  CAS  PubMed  Google Scholar 

  56. Kikuchi I, Inoue S, Sakaguchi E, et al. Regressing nevoid nail melanosis in childhood. Dermatology. 1993;186:88–93.

    Article  CAS  PubMed  Google Scholar 

  57. Murata Y, Kumano K. Dots and lines: a dermoscopic sign of regression of longitudinal melanonychia in children. Cutis. 2012;90:293–6.

    PubMed  Google Scholar 

  58. Lyall D. Malignant melanoma in infancy. J Am Med Assoc. 1967;202:93.

    Article  Google Scholar 

  59. Uchiyama M, Minemura K. Two cases of malignant melanoma invyoung persons. Nippon Hifuka Gakkai Zasshi. 1979;89:668.

    Google Scholar 

  60. Iorizzo M, Tosti A, Di Chiacchio N, et al. Nail melanoma in children: differential diagnosis and management. Dermatol Surg. 2008;34:974–8.

    CAS  PubMed  Google Scholar 

  61. Tosti A, Piraccini BM, Cagalli A, et al. In situ melanoma of the nail unit in children: report pf two cases in fair-skinned Caucasian children. Pediatr Dermatol. 2012;29:79–83.

    Article  PubMed  Google Scholar 

  62. Thomas L, Dalle S. Dermoscopy provides useful information for the management of melanonychia striata. Dermatol Ther. 2007;20:3–10.

    Article  PubMed  Google Scholar 

  63. Di Chiacchio N, Hirata AH, Daniel R, et al. Consensus on melanonychia nail plate dermoscopy. An Bras Dermatol. 2013;88:309–13.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Levit EK, Kagen MH, Scher RK, et al. The ABC rule for clinical detection of subungual melanoma. J Am Acad Dermatol. 2000;42:269–74.

    Article  CAS  PubMed  Google Scholar 

  65. Benati E, Riberio S, Longo C, et al. Clinical and dermoscopic clues to differenziate pigmented nail bands: an international dermoscopy society study. J Eur Acad Dermatol Venereol. 2016. https://doi.org/10.1111/jdv.13991.

    Article  PubMed  Google Scholar 

  66. Phan A, Dalle S, Touzet S, et al. Dermoscopic features of acral lentiginous melanoma in a large series of 110 cases in a white population. Br J Dermatol. 2010;162:765–71.

    Article  CAS  PubMed  Google Scholar 

  67. Phan A, Touzet S, Dalle S, et al. Acral lentiginous melanoma: a clinicoprognostic study of 126 cases. Br J Dermatol. 2006;155:561–9.

    Article  CAS  PubMed  Google Scholar 

  68. Hirata SH, Yamada S, Almeida FA, et al. Dermoscopic examination of the nail bed and matrix. Int J Dermatol. 2006;45:28–30.

    Article  CAS  PubMed  Google Scholar 

  69. Sawada M, Yokota K, Matsumoto T, et al. Proposed classification of longitudinal melanonychia based on clinical and dermoscopic criteria. Int J Dermatol. 2014;53:581–5.

    Article  PubMed  Google Scholar 

  70. Ackerman AB. Malignant melanoma in situ: the flat, curable stage of malignant melanoma. Pathology. 1985;17:298–300.

    Article  CAS  PubMed  Google Scholar 

  71. Ruben BS. Pigmented lesions of the nail unit: clinical and histopathology features. Semin Cutan Med Surg. 2010;29:148–58.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Michela Starace .

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Starace, M. (2018). Nail Dermoscopy. In: Rubin, A.I., Jellinek, N.J., Daniel, C.R., Scher, R.K. (eds) Scher and Daniel’s Nails. Springer, Cham. https://doi.org/10.1007/978-3-319-65649-6_31

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  • DOI: https://doi.org/10.1007/978-3-319-65649-6_31

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