Hand eczema is a disease frequently observed in dermatological practice, and is sometimes accompanied by nail changes. However, not many studies have been performed on nail dystrophy in hand eczema patients.
This study aims to describe the morphological features of nail dystrophy in hand eczema patients and to investigate the association between the prevalence of nail dystrophy and hand eczema severity. From 2010 to 2011, we investigated 124 patients who were referred to the Eulji Hospital and who had hand eczema. Information about the patients' age, sex, jobs and disease duration was obtained. Thorough nail examination included providing a description with morphological features of the nail dystrophy and the involvement of hand eczema in the fingertip area, checking for the presence of paronychia. The severity of hand eczema was assessed using the HECSI scoring system described by Held et al. in 2005.
Patients were classified into two groups: (i) nail dystrophy; and (ii) non-nail dystrophy . A Mann–Whitney U-test and χ2-test were used and statistical analyses were performed using SPSS ver. 14.0 (SPSS, Chicago, IL, USA). P < 0.05 was considered to be statistically significant.
A total of 124 hand eczema patients were included, of whom 73 were female and 51 were male. The average age was 38.3 years and the average HECSI score for all patients was 30.54. Approximately 40 patients showed nail changes; thus, the prevalence of nail dystrophy was 32.3%. Nail dystrophy predominantly affected individuals in their 30s and 50s. Beau's lines were predominant among both sexes, seen in 33.8% of patients. Nail pitting was observed in 17.6% of patients, and 11.8% had longitudinal ridges (Fig. 1).
The mean disease duration of all hand eczema patients was 2.61 years. The average disease duration for the nail dystrophy group was 4.62 years, and for the non-dystrophy group 1.65 years. Thus, the patients with nail changes were found to have a significantly longer disease duration than those who did have nail changes (P < 0.05).
When examining the relationship between the prevalence of nail dystrophy and the involvement of hand eczema in the periungal area, we found a statistically positive correlation (P < 0.05). Periungal involvement in hand eczema was seen in 90% of the nail dystrophy group but in only 33% of those without nail dystrophy.
The average HECSI score was 34.27 for the nail dystrophy patients and 28.76 for non-nail dystrophy patients. However, we found no statistically significant differences between the two groups. Among the nail dystrophy patients, 40% displayed paronychia, compared to 45% of the non-nail dystrophy patients. No significant association between the presence of paronychia and nail dystrophy was found.
Also, we classified patients into two groups by their jobs: (i) manual; and (ii) non-manual. Hair dressers, housewives and repair workers belong to the manual group, because they frequently do manual jobs using hands and are easily exposed to chemicals or irritants in their occupational environment. Office workers and students belong to the non-manual group. When we compared the incidence and morphological features of nail dystrophy accompanied by hand eczema, there were no statistical differences between the two groups.
In our study, the prevalence of nail change was 32.3%, and the disease duration of hand eczema and periungal involvement were found to be significantly related to nail dystrophy. Beau's lines were the most common subtype of nail dystrophy and the severity of hand eczema was not parallel to the degree of nail change. We could not follow all of the patients who enrolled in this study. However, some of the patients treated with topical ointment and intralesional steroid injection showed improvement of nail changes after several months of treatment. The exact etiology of nail dystrophy has not been fully understood but it can be suggested that eczema causes frequent periungual inflammation, and as such can adversely affect proper functioning of the nail matrix unit. Transient malfunction of the nail matrix can also cause defects in the production of nail plates, leading to Beau's lines or multiple depressive pits. These nail changes are also caused by exogenous factors including frequent water exposure and chemical irritation. These various kinds of nail dystrophy and accompanying hand eczema can cause cosmetic problems and negatively affect patients' quality of life. Thus, when treating hand eczema patients, clinicians should also assess nail disease and consider management of this.