الفهرس 
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Abstract
Nails are characteristically affected in skin diseases such as psoriasis, lichen planus, alopecia areata, atopic dermatitis and systemic diseases as diabetes mellitus and connective tissue diseases. Nail dermoscopy is a noninvasive imaging technique that enables the visualization of submacroscopical structures invisible to the naked eye. Our aim was to detect and determine the percentage of subclinical nail involvement in clinically apparent normal nails in common skin diseases as psoriasis, lichen planus, alopecia areata, atopic dermatitis and autoimmune bullous diseases and in systemic diseases as diabetes mellitus and connective tissue disorders (systemic lupus erthromatosus, scleroderma, dermatomyositis). To the best of our knowledge, this is the first study to focus on Subclinical dermoscopic changes of nail in alopecia areata, atopic dermatitis and systemic diseases as diabetes mellitus and connective tissue diseases. And the first study to evaluate dermoscopic nail changes in autoimmune bullous diseases. 200 patients with clinically apparent normal nails were included in our study. Full history, clinical examination and dermoscopic examination of all nails were done for each patient. 49 psoriatic patients were included in the study, (55.1%) had positive dermoscopic nail findings. The most frequent subclinical dermoscopic nail findings were fine pitting (36.7%), punctate leuconychia (22.4%), splinter haemorrhage (14.3%) and longitudinal striations (10.2%). Each of onycholysis, salmon patch and subungual hyperkeratosis was present in 3 (6.1%), 3 (6.1%) and 2 patients (4.1%) respectively. 40 patients had alopecia areata, (62.5%) had positive nail dermoscopic findings. We found fine pitting in (47.5%), punctate leukonychia in (27.5%) and longitudinal striations in (22.5%).10 patients had atopic dermatitis, 7 (70%) of them had positive dermoscopic nail findings. (60%) patients had punctate leuconychia and (20%) of patients had fine pitting. 12 patients had lichen planus, fine pitting was the only subclinical dermoscopic nail finding in (41.7%) of them. 20 patients had autoimmune bullous diseases, (70%) had different positive dermoscopic nail findings. (55%) of them had splinter haemorrhage, (25%) had onychomycosis, (15%) had lateral distal onycholysis, (15%) had Beaus’ lines and (10%) had longitudinal striations. 26 patients were included with diabetes mellitus, (38.5%) had different positive dermoscopic nail findings. Microhaemorrhages were present in (26.9%), longitudinal striations in (15.4%) and onychomychosis in (11.5%).28 patients had SLE. The prevelance of dermoscopic proximal nail fold findings in SLE was (26.9%). Odd shaped capillaries were detected in (17.9%). Stretched capillary loops were detected in (14.3%). Each of fibrosis, dilated capillary loops, tortuous capillary loops and microhaemorrhage appeared in (7.1%) of the 28 patients. (75%) of patients with systemic sclerosis (8 patients) had proximal nail fold findings. The most frequent finding was microhaemorrhage (37.5%). Capillaries were absent in (37.5%), dilated in (25%) and giant in (12.5%). Fibrosis was seen in (12.5%). (71.4%) of patients with dermatomyositis (7 patients) had proximal nail fold findings. microhaemorrhage appeared in (42.9%). There were dilated capillaries in (42.9%), fibrosis in (28.6%) and giant capillaries in (14.3%).from the previous results, it could be concluded that: Nail dermoscopy is a noninvasive imaging technique that enables the visualization of submacroscopical structures invisible to the naked eye. Subclinical dermoscopic nail findings were detected in 55.1% of psoriatic patients, 62.5% of patients with alopecia areata, 70% of patients with atopic dermatitis, 41.7% of patients with lichen planus, 70% of patients with autoimmune bullous diseases, 38.5% of diabetic patients, 26.9% of patients with systemic lupus erythromatosus, 75% of patients with systemic sclerosis and 71.4% of patients with dermatomyositis. So the percentage of nail involvement is more than that known in some dermatological and systemic diseases. To the best of our knowledge, this is the first study focusing on uncovering apparently invisible nail changes in alopecia areata, atopic dermatitis, diabetes mellitus and connective tissue diseases and the first study focusing on dermoscopic nail changes in autoimmune bullous diseases. Subclinical lesions of nail in such diseases can be appreciated well with the help of the dermoscope, so appropriate treatment can be instituted to prevent permenant damage of the nails. Routine use of dermoscopy in any dermatology clinic is mandatory in order to help in early diagnosis and management of nail changes. Further studies with larger sample sizes are highly recommended to describe, evaluate and follow up the subclinical nail affection in different dermatological and systemic diseases. Future studies on relevant skin and systemic diseases to correlate dermoscopic nail findings with the patients’ demographic and clinical characteristics are very much warranted. Therapeutic trials to evaluate various treatment options of subclinical nail affection in skin and systemic diseases are essential.