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COVID-19 and the Nails

Dr. Phoebe Rich discusses COVID nails, including signs of the virus, nail hygiene to prevent spreading, and guidelines for virtual nail visits.

Phoebe Rich, MD, is an adjunct professor at OHSU, Oregon Dermatology and Research, Portland, Oregon.

COVID-19 and the Nails from The Dermatology Digest on Vimeo.

“So let’s talk about COVID nails—a little bit about red lunula, Beau’s lines and onychomadesis; nail hygiene during COVID-19 pandemic. These are all recent publications that have come out,” says Phoebe Rich, MD.

In her presentation, “Nail Disorders 2021 Diagnosis and Therapy,” at Maui Derm 2021, Dr. Rich points out that it’s not surprising to Beau’s lines with COVID because they occur with many serious illnesses.1 Another sign of COVID nails is the red lunula, which may also be present in the toes.2

While there really isn’t any evidence that COVID-19 can be can be found or measured under the nail, the FDA has recommended specific nail hygiene practices for added prevention of disease spread, especially for healthcare workers.3

Virtual visits for nails are challenging. Considerations for management of longitudinal melanonychia were recently published,4 suggesting a routine approach: 

  • Examine all 20 nails with good lighting.
  • Suspicious nail pigmentation should be documented very carefully with photographs and also measured if there is a longitudinal band, including width. 
  • Note all nail features, including color, borders, splitting, ulceration, and ridges.
  • If highly suspicious of melanoma, bring patients in for an in-person visit.

References

  1. Alobaida S, Lam JM. Beau lines associated with COVID-19. CMAJ. 2020 Sep 8;192(36):E1040. doi: 10.1503/cmaj.201619.
  2. Neri I, Guglielmo A, Virdi A, Gaspari V, Starace M, Piraccini BM. The red half-moon nail sign: a novel manifestation of coronavirus infection. J Eur Acad Dermatol Venereol. 2020 Nov;34(11):e663-e665. doi: 10.1111/jdv.16747. Epub 2020 Jun 29.
  3. Wu AG, Lipner SR. A potential hidden reservoir: The role of nail hygiene in preventing transmission of COVID-19. J Am Acad Dermatol. 2020 Sep;83(3):e245-e246. doi: 10.1016/j.jaad.2020.05.119. Epub 2020 Jun 1.
  4. Lipner SR, Iorizzo M, Jellinek N, Piraccini BM, Scher RK. Considerations for management of longitudinal melanonychia during the coronavirus disease 2019 (COVID-19) pandemic: An international perspective. J Am Acad Dermatol. 2020 Aug;83(2):e159-e161. doi: 10.1016/j.jaad.2020.05.028. Epub 2020 May 13.