Type of publication:
Conference abstract
Author(s):
*Mehra S.
Citation:
British Journal of Dermatology. Conference: 105th Annual Meeting of the British Association of Dermatologists, BAD 2025. Glasgow United Kingdom. 193(Supplement 1) (pp i119), 2025. Date of Publication: 01 Jul 2025.
Abstract:
This systematic review evaluates the correlation between nail changes and systemic diseases, assessing their diagnostic utility, sensitivity and specificity. The aim is to highlight the role of nail examination as a noninvasive diagnostic tool, enhancing dermatology practice and interdisciplinary care in line with National Institute for Health and Care Excellence (NICE) guidelines and clinical protocols. This practice is particularly relevant in resource-limited settings, where access to advanced diagnostics may be restricted. A systematic review was conducted following the PRISMA guidelines. The PubMed, MEDLINE and Embase databases were searched for studies published between 2010 and 2023 using keywords such as 'nail changes', 'systemic disease' and 'diagnostic indicators'. Studies were included that analysed correlations between nail abnormalities (e.g. clubbing, Beau's lines, splinter haemorrhages, leuconychia, onycholysis) and systemic diseases like cardiovascular, pulmonary, autoimmune or metabolic conditions. Case reports and studies without statistical analysis were excluded. Data extraction focused on nail abnormalities, associated systemic diseases, and diagnostic metrics such as sensitivity and specificity. Thirty-two studies involving 7250 patients were included. Key findings demonstrated significant correlations between nail changes and systemic diseases. (i) Clubbing was associated with pulmonary and cardiovascular conditions, such as bronchiectasis and congenital heart defects, with a specificity of 92%. (ii) Beau's lines were linked to systemic stressors like severe infections, chemotherapy and malnutrition, with a sensitivity of 81%. (iii) Splinter haemorrhages were observed in vasculitis, infective endocarditis and connective tissue disorders, with a sensitivity of 78%. (iv) Leukonychia was linked to hypoalbuminaemia and liver cirrhosis, with a specificity of 85%. (v) Onycholysis was indicative of thyroid dysfunction, particularly hyperthyroidism, with a diagnostic accuracy of 80%. In 30% of cases, nail changes preceded other clinical manifestations, offering opportunities for early diagnosis and intervention. While nail findings alone lacked specificity in some cases, combining them with clinical history and investigations enhanced utility. These findings are impactful in resource-limited settings, where noninvasive tools can guide early management without expensive testing. This review underscores the value of nail examination as a noninvasive tool for identifying systemic diseases, often serving as an early indicator of pathology. Nail changes such as clubbing, Beau's lines and leuconychia provide clinically significant insights, particularly when integrated with broader assessments. Increased awareness, standardized documentation and incorporation into practice can improve diagnostic accuracy and patient outcomes, especially in settings with limited access to advanced diagnostics. Nail examination is an underutilized diagnostic tool. It bridges dermatology and systemic medicine, prompting timely referrals and collaborative management. In resource-limited settings, it offers an accessible alternative, reducing reliance on costly tests. Standardized protocols should be integrated into NICE guidelines globally.
DOI: 10.1093/bjd/ljaf085.237
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