الفهرس 
NAIL APPARATUSOnly 14 pages are availabe for public view
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Abstract
Dermoscopy is a non-invasive technique that allows the visualization of subtle clinical features of the skin surface and appendages details not visible to the naked eye, allowing magnifications of up to 200x. It is widely used for evaluating and diagnosing all nail diseases, as it provides important information. As any other examination, nail dermoscopy (onychoscopy) requires a good knowledge of nail anatomy & physiology and the pathogenesis of the nail diseases, and it is helpful for the diagnosis of numerous nail diseases and tumors.
All nail disorders can be observed by dermoscopy. Dermoscopic features of nail signs are always very interesting and may help to understand the nails diseases.
End stage renal disease is due to the progressive loss of renal excretory capacity. Diabetes mellitus and arterial hypertension are among the main causes that lead patients to ESRD and dialysis. Cutaneous and nail disorders are common in ESRD patients.
The objective of this thesis was to study the dermoscopic findings of nail changes in patients with ESRD undergoing regular hemodialysis by both polarized and non polarized modes of dermoscope, aiming to assist clinicians correctly to evaluate and diagnose nail changes with the help of dermoscopy.
We conducted an observational cross-sectional study on 100 patients with ESRD undergoing regular hemodialysis. Patients were randomly recruited from hemodialysis units and out-patient clinic at Ain Shams University Hospitals during the period from August 2021 till October 2021. And the age of patients ranged from 18 to 77 years.
Our study revealed that the most common nail changes found in patients were scales followed by leukonychia, thickening and crumbling, longitudinal striations, transverse striations, onycholysis, splinter hemorrhage, subungual hematoma, trachyonychia, subungual hyperkeratosis, Terry’s nail, onychomycosis, pincer nail, melanonychia, pitting, Lindsay nail, onychomadesis, dilated nail bed capillaries, Beau’s lines, Muehrcke’s lines, onychodystrophy, Mee’s line, absent lunula, koilonychia and onychogryphosis.
The present study revealed that there was statistical significant difference between clinical examination and dermoscopic examination in detecting scales, leukonychia, longitudinal striations, transverse striations, splinter hemorrhage, subungual hematoma, subungual hyperkeratosis and dilated nail bed capillaries. Dermoscopic examination was better than clinical examination in detecting these nail changes. There was no statistical significant difference between different dermoscopic modes in detecting them except for scales and dilated nail bed capillaries. Polarized dry dermoscopy was significant for detecting scales because they are superficial and more apparent on dry nail plate. Polarized dermoscopy with or without fluid was significant for detecting dilated nail bed capillaries because the polarized light penetrates more deeply so, it can detect deep nail changes.
On the other hand, there was no statistical significant difference between clinical and dermoscopic examination in detecting onycholysis, trachyonychia, Terry’s nail, onychomycosis, pincer nail deformity, melanonychia, pitting, Lindsay nail, Beau’s line, Muehrcke’s line, onychodystrophy, absent lunula, koilonychia, onychogryphosis, thickening and crumbling, onychomadesis and Mee’s line. Dermoscopic examination detected these nail changes in higher frequency than clinical examination because dermoscopic light is composed of polarized and non polarized light. Non polarized light can detect the superficial nail changes and polarized light can penetrate deeply and detect the deep nail changes.
The current study revealed that there was statistical significant positive correlation between age of patients, onychomycosis, onycholysis, subungual hyperkeratosis, koilonychia and longitudinal striations. On the other side, there was statistical significant negative correlation between age, Mee’s lines and onychogryphosis. Also, this study revealed that there were statistical significant positive correlation between duration of hemodialysis and trachyonychia; statistical significant negative correlation between hemoglobin level and onychomycosis; statistical significant positive correlation between phosphate level and koilonychia; and statistical significant ppositive correlation between PTH level, Beau’s lines and onychodystrophy. In addition, there was no statistical significant correlation between nail changes and serum calcium level.
As we correlated between nail changes, type of vascular access and etiology of renal disease, we found that there was no statistical significant correlation between nail changes and type of vascular access. Also, there was statistical significant correlation between etiology of renal disease, leukonychia, onychomadesis, nail plate thickening and crumbling.
Finally, this study confirmed that a handheld dermoscope is a very efficient and simple tool for detection of any nail abnormality.