From the Guidelines
Yes, vitiligo can affect the nail beds and digits. Vitiligo is an autoimmune condition that causes depigmentation of the skin, and it can appear anywhere on the body, including the fingers and toes. When vitiligo affects the nail beds, it may cause longitudinal white streaks in the nails called leukonychia, or in some cases, the entire nail matrix can lose pigmentation. Additionally, the skin around the nails and on the digits can develop characteristic white patches due to the destruction of melanocytes (pigment-producing cells). This phenomenon is part of what dermatologists call "acral vitiligo," which refers to vitiligo affecting the extremities such as hands and feet. The same autoimmune process that targets melanocytes in other parts of the body is responsible for these changes in the nail area. Patients with vitiligo affecting their digits should protect these areas from sun exposure, as the depigmented skin lacks natural UV protection. Treatment options for nail and digit vitiligo are similar to those for other body areas and may include topical corticosteroids, calcineurin inhibitors, phototherapy, or systemic treatments in severe cases, as suggested by studies such as 1 and 1.
Some key points to consider in the management of vitiligo affecting the nail beds and digits include:
- The commonest sites to be affected are the fingers and wrists, as well as other areas such as the axillae and groins and the body orifices such as the mouth, eyes, and genitalia 1.
- The use of potent or very potent topical steroids should be considered for a trial period of no more than 2 months, although skin atrophy has been a common side-effect 1.
- Phototherapy, including narrowband ultraviolet B phototherapy, may be effective for the treatment of vitiligo, including acral vitiligo, as shown in studies such as 1.
- Patients with vitiligo often develop autoimmune thyroid disease or other autoimmune diseases, and a history of autoimmune disease in a family member is obtained in 32% of patients, highlighting the importance of screening for associated conditions 1.
Overall, the management of vitiligo affecting the nail beds and digits requires a comprehensive approach that takes into account the autoimmune nature of the condition, the potential for associated diseases, and the need for protection from sun exposure. Treatment should be individualized based on the severity and extent of the disease, as well as the patient's overall health status and medical history, as suggested by studies such as 1.
From the Research
Vitiligo and Nail Bed Affection
- Vitiligo is a skin disease that can affect various parts of the body, including the nail beds and digits 2, 3.
- Studies have shown that nail abnormalities are more prevalent in vitiligo patients than in healthy controls, with longitudinal ridging and leukonychia being the most common findings 2, 3.
- The frequency of nail abnormalities in vitiligo patients can range from 68.1% to 78%, with significant differences compared to control groups 2, 3.
Types of Nail Abnormalities
- Longitudinal ridging is the most common nail abnormality found in vitiligo patients, followed by leukonychia, absent lunula, onycholysis, nail bed pallor, onychomycosis, splinter hemorrhage, and nail plate thinning 2.
- Other reported nail abnormalities in vitiligo patients include punctate leukonychia, pitting, flag sign, and Terry's nails 3.
Clinical Implications
- Awareness of the association between vitiligo and nail abnormalities can help clinicians to carefully examine the nail changes in vitiligo patients and conversely examine patients with nail changes for vitiligo 3.
- The presence of nail abnormalities in vitiligo patients can provide valuable clues for diagnosis and treatment, and highlights the importance of a thorough examination of the nails in these patients 2, 3.