Nail Changes in COVID-19: A Cross Sectional Study From India

BACKGROUND: Various nail manifestations have been reported with COVID-19; mostly in the form of isolated reports. OBJECTIVE: This cross-sectional study was carried out to assess nail changes in hospitalized patients with moderate to severe COVID-19. METHODS: Nail findings in 43 adults being treated for COVID-19, were evaluated after obtaining informed written consent. Nail changes involving fingernails and toenails were documented as new-onset or pre-existing changes. Disease status, hematological and biochemical tests, inflammatory markers, treatment administered and outcomes were also recorded. The frequency of changes in fingernails and toenails were statistically compared. RESULTS: The red half-moon sign (32.5%) and nail bed erythema (34.8%) were the commonest changes seen in fingernails; while apparent leukonychia (46.5%) and distal brown discoloration (51.1%) were commonest changes in toenails. The difference in frequency of changes seen between fingernails and toenails was statistically significant (p < 0.05). Nail changes correlated with systemic involvement in these patients. LIMITATIONS: Single-center evaluation in a limited number of patients, without using augmented examination techniques like onychoscopy, nail fold capillaroscopy, or fluoroscence. Those with less severe disease or with rapid fatality could not be studied. CONCLUSION: Nail changes in COVID-19 are common and reflect the systemic nature of illness, being a harbinger of underlying complications.