Nail Pitting Eczema

Nail Pitting Eczema, Eczema of the nail folds or nail bed may be associated with eczema elsewhere on the hand or foot and can cause nail unit disturbance in a manner similar to psoriasis. Special patterns of eczema can be relevant for allergic contact sensitivity.

Clinical Features and Diagnosis

The most common pattern of nail changes in eczema is where the nail fold is inflamed as part of an irritant hand eczema or as part of atopic eczema. This acts as a focus of inflammation that in turn disturbs matrix function owing to their adjacency.

 The nail then suffers transverse ridges and alterations of color, which reflect the fluctuating inflammation. Where the eczema is more directed at the digit tip, the nail bed is more likely to be involved, which in turn results in onycholysis. 

Both patterns often manifest most in the dominant hand because trauma, or simply use, increases the likelihood of pathology.

Occupational factors can be important bath for analysis of the cause and for helping patients manage the global situation because they can suffer degrees of incapacitation. 

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Where the occupation plays a part in the pathology, such as irritants in a health care or food-preparation worker, it may be necessary to review career choices. Hairdressers, beauticians, and engineers in certain fields come into contact with a wide range of contact sensitizers. The use of nail cosmetics alone can be relevant. Consider patch testing.

Treatment is as for eczema elsewhere and shares many of the

points made for managing psoriasis of the nail unit: 

Avoidance of irritants, trauma, nail manipulation, and frequent wetting

Use of copious thick emollient

Topical steroid tailored to severity

Hand protection 

Ineffective and chronic paronychia can be a complicating factor in nail unit eczema and requires additional systemic antibiotics in some instances.

Source:

Conn's Current Therapy 2016

De Edward T. Bope,Rick D. Kellerman

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