Nail dermoscopy was initially used only in the assessment of nail pigmentation, but now it is widely utilized for the evaluation of many nail disorders. In daily practice, dermoscopy may confirm clinical diagnoses and guides in the management of nail diseases and treatments, permitting a better visualization of symptoms. Dry dermoscopy is required for evaluation of the nail plate surface, while gel as an interface is necessary for assessment of nail pigmentation and onycholysis, as well as for the evaluation of the distal nail margin. In this review, we describe the dermoscopic features of the most important nail disorders, looking at the different areas of the nail. Dermatoscopic changes that usually accompany specific nail diseases are also reviewed.

Keywords:
Dermoscopy, Onychoscopy, Onycholysis, Splinter hemorrhages, Capillary alterations, Subungual hyperkeratosis, Melanonychia, Nail tumor, Hyponychium
1.
Piraccini BM, Bruni F, Starace M: Dermoscopy of non-skin cancer nail disorders. Dermatol Ther 2012;25:594-602.
2.
Hasegawa M: Dermoscopy findings of nail fold capillaries in connective tissue disease. J Dermatol 2011;38:66-70.
3.
Cutolo M, Sulli A, Secchi ME, Oliveri M, Pizzorni C: The contribution of capillaroscopy to the differential diagnosis of connective autoimmune diseases. Best Pract Res Clin Rheumatol 2007;21:1093-1108.
4.
Pizzorni C, Sulli A, Smith V, Lladó A, Paolino S, Cutolo M, Ruaro B: Capillaroscopy in 2016: new perspectives in systemic sclerosis. Acta Rheumatol Port 2016;41:8-14.
5.
Shenavandeh S, Zarei Nezhad M: Association of nailfold capillary changes with disease activity, clinical and laboratory findings in patients with dermatomyositis. Med J Islam Repub Iran 2015;29:233.
6.
Lambova SN, Müller-Ladner U: Capillaroscopic pattern in systemic lupus erythematosus and undifferentiated connective tissue disease: what we still have to learn? Rheumatol Int 2013;33:689-695.
7.
Piraccini BM, Bellavista S, Misciali C, Tosti A, de Berker D, Richert B: Periungual and subungual pyogenic granuloma. Br J Dermatol 2010;163:941-953.
8.
Perruchoud DL, Varonier C, Haneke E, Hunger RE, Beltraminelli H, Borradori L, Ehnis Pérez A: Bowen disease of the nail unit: a retrospective study of 12 cases and their association with human papillomaviruses. J Eur Acad Dermatol Venereol 2016;30:1503-1506.
9.
Rigopoulos D, Ralph D: Management of simple brittle nails. Dermatol Ther 2012;25:596-573.
10.
Baran R, Perrin C: Transverse leukonychia of toenails due to repeated microtrauma. Br J Dermatol 1995;133:267-269.
11.
Tosti A, Schneider SL, Ramirez-Quizon MN, Zaiac M, Miteva M: Clinical, dermoscopic, and pathologic features of onychopapilloma: a review of 47 cases. J Am Acad Dermatol 2016;74:521-526.
12.
Chiriac A, Brzezinski P, Foia L, Marincu I: Chloronychia: green nail syndrome caused by Pseudomonas aeruginosa in elderly persons. Clin Interv Aging 2015;10:265-267.
13.
Leung LK, Harding J: A chemical mixer with dark-green nails. BMJ Case Rep 2015;2015:bcr2014209203.
14.
Perrin C: Tumors of the nail unit. A review. Part I: acquired localized longitudinal melanonychia and erythronychia. Am J Dermatopathol 2013;35:621-636.
15.
Kallis P, Miteva M, Patel T, Zaiac M, Tosti A: Onychomatricoma with concomitant subungual glomus tumor. Skin Appendage Disord 2015;1:14-17.
16.
Maehara Lde S, Ohe EM, Enokihara MY, Michalany NS, Yamada S, Hirata SH: Diagnosis of glomus tumor by nail bed and matrix dermoscopy. An Bras Dermatol 2010;85:236-238.
17.
de Berker D: Erythronychia. Dermatol Ther 2012;25:603-611.
18.
Thatte SS, Chikhalkar SB, Khopkar US: “Pink glow”: a new sign for the diagnosis of glomus tumor on ultraviolet light dermoscopy. Indian Dermatol Online J 2015;6(suppl 1):S21-S23.
19.
Rai AK: Role of intraoperative dermoscopy in excision of nail unit glomus tumor. Indian Dermatol Online J 2016;7:448-450.
20.
Piraccini BM, Balestri R, Starace M, Rech G: Nail digital dermoscopy (onychoscopy) in the diagnosis of onychomycosis. J Eur Acad Dermatol Venereol 2013;27:509-513.
21.
Jesús-Silva MA, Fernández-Martínez R, Roldán-Marín R, Arenas R: Dermoscopic patterns in patients with a clinical diagnosis of onychomycosis - result of a prospective study including data of potassium hydroxide (KHO) and culture examination. Dermatol Pract Concept 2015;5:39-44.
22.
Ronger S, Touzet S, Ligeron C, Balme B, Viallard AM, Barrut D, Colin C, Thomas L: Dermoscopic examination of nail pigmentation. Arch Dermatol 2002;138:1327-1333.
23.
Lencastre A, Lamas A, Sá D, Tosti A: Onychoscopy. Clin Dermatol 2013;31:587-593.
24.
Haas N, Henz BM: Pitfall in pigmentation: pseudopods in the nail plate. Dermatol Surg 2002;28:966-967.
25.
Murata Y, Kumano K: Dots and lines: a dermoscopic sign of regression of longitudinal melanonychia in children. Cutis 2012;90:293-296, 301.
26.
Lyall D: Malignant melanoma in infancy. JAMA 1967;202:1153.
27.
Uchiyama M, Minemura K: Two cases of malignant melanoma in young persons. Nippon Hifuka Gakkai Zasshi 1979;89:668.
28.
Chu DH, Rubin AI: Diagnosis and management of nail disorders in children. Pedriatr Clin North Am 2014;61:293-308.
29.
Kikuchi I, Inoue S, Sakaguchi E, Ono T: Regressing nevoid nail melanosis in childhood. Dermatology 1993;186:88-93.
30.
Iorizzo M, Tosti A, Di Chiacchio N, Hirata SH, Misciali C, Michalany N, Domiguez J, Toussaint S: Nail melanoma in children: differential diagnosis and management. Dermatol Surg 2008;34:974-978.
31.
Thomas L, Dalle S: Dermoscopy provides useful information for the management of melanonychia striata. Dermatol Ther 2007;20:3-10.
32.
Di Chiacchio ND, Farias DC, Piraccini BM, Hirata SH, Richert B, Zaiac M, Daniel R, Fanti PA, Andre J, Ruben BS, Fleckman P, Rich P, Haneke E, Chang P, Cherit JD, Scher R, Tosti A: Consensus on melanonychia nail plate dermoscopy. An Bras Dermatol 2013;88:309-313.
33.
Levit EK, Kagen MH, Scher RK, Grossman M, Altman E: The ABC rule for clinical detection of subungual melanoma. J Am Acad Dermatol 2000;42(pt 1):269-274.
34.
Piraccini BM, Dika E, Fanti PA: Tips for diagnosis and treatment of nail pigmentation with practical algorithm. Dermatol Clin 2015;33:185-195.
35.
Benati E, Ribero S, Longo C, Piana S, Puig S, Carrera C, Cicero F, Kittler H, Deinlein T, Zalaudek I, Stolz W, Scope A, Pellacani G, Moscarella E, Piraccini BM, Starace M, Argenziano G: Clinical and dermoscopic clues to differentiate pigmented nail bands: an International Dermoscopy Society study. J Eur Acad Dermatol Venereol 2016, Epub ahead of print.
36.
Hirata SH, Yamada S, Enokihara MY, Di Chiacchio N, de Almeida FA, Enokihara MM, Michalany NS, Zaiac M, Tosti A: Patterns of nail matrix and nail bed of longitudinal melanonychia by intraoperative dermatoscopy. J Am Acad Dermatol 2011;65:297-303.
37.
Hirata SH, Yamada S, Almeida FA, Enokihara MY, Rosa IP, Enokihara MM, Michalany NS: Dermoscopic examination of the nail bed and matrix. Int J Dermatol 2006;45:28-30.
38.
Ackerman AB: Malignant melanoma in situ: the flat, curable stage of malignant melanoma. Pathology 1985;17:298-300.
39.
Ruben BS: Pigmented lesions of the nail unit: clinical and histopathologic features. Semin Cutan Med Surg 2010;29:148-158.
40.
Wang YJ, Sun PL: Fungal melanonychia caused by Trichophyton rubrum and the value of dermoscopy. Cutis 2014;94:E5-E6.
41.
Braun RP, Baran R, Le Gal FA, Dalle S, Ronger S, Pandolfi R, Gaide O, French LE, Laugier P, Saurat JH, Marghoob AA, Thomas L: Diagnosis and management of nail pigmentation. J Am Acad Dermatol 2007;56:835-847.
42.
Kilinc Karaarslan I, Acar A, Aytimur D, Akalin T, Ozdemir F: Dermoscopic features in fungal melanonychia. Clin Exp Dermatol 2015;40:271-278.
43.
De Crignis G, Valgas N, Rezende P, Leverone A, Nakamura R: Dermatoscopy of onychomycosis. Int J Dermatol 2014;53:e97-e99.
44.
Braun R, Baran R, Saurat JH, Thomas L: Surgical Pearl: Dermatoscopy of the free edge of the nail to determine the level of the nail plate pigmentation and the location of its probable origin in the proximal or distal nail matrix. J Am Acad Dermatol 2006;55:512-513.
45.
Lesort C, Debarbieux S, Duru G, Dalle S, Poulhalon N, Thomas L: Dermoscopic features of onychomatricoma: a study of 34 cases. Dermatology 2015;231:177-183.
46.
Iorizzo M, Dahdah M, Vincenzi C, Tosti A: Videodermoscopy of the hyponychium in nail bed psoriasis. J Am Acad Dermatol 2008;58:714-715.
© 2017 S. Karger AG, Basel
2017
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.