Clinical and Dermoscopic Study of Hair and Nail Changes in Chronic Renal Failure Patients on Hemodialysis–An Observational Study

Abstract

Chronic renal disease is a progressive loss of renal function over a period of three months or more. Atleast 50% of patients with CKD develop dermatological manifestations. Though many studies have described the skin, nail and hair changes in patients with chronic renal disease on hemodialysis there are very few studies which describe the dermoscopic changes in hair and nails in patients with chronic renal disease.

Methodology: This cross sectional study was conducted in a tertiary care setting in rural Puducherry. We interviewed the participants using a standardized questionnaire after obtaining informed from them. Then the dermoscopic examination of their hair and nail changes was done using dermlite DL4 (3rdgeneration).

Results: Majority of the patients were between 41-60 years of age (67.3%) with a Male: Female ratio of 5:1. The median duration of disease in our study population was 42 months while that for hemodialysis was 30 months.The mean haemoglobin level was 8.6 g/dL ± 1.7 g/dL. It had a positive association with telogen effluvium. Most common nail finding noted in our study was Beau’s line seen in 55.7% followed by trachyonychia (44.2%). Beau’s line had a positive association with duration of dialysis. Half and half nail was noted in 12.8% and did not have a positive association. Most common hair change noted in CKD patients clinically was dry lustureless hair seen in 119(76.3%) and sparseness in 113(72.4%). Telogen effluvium and androgenetic alopecia was 37.8 % and 54.4% respectively both of which had a positive association with single pilosebaceous unit and decreased hair density diameter by less than 10%.

Conclusion: Despite the fact that the clinical assessment of changes in hair and nails has been the subject of numerous research, not all of them have demonstrated a clear correlation with chronic renal disease. Our effort to use dermoscopy to reexamine this region and search for any particular peculiarities showed that telogen effluvium had a positive correlation with decreasing hemoglobin value and Beau's line showed a positive correlation with dialysis time. This could be because many subtle changes which are missed during clinical examination can be picked up using dermoscope.

Clinical and dermoscopic study of hair and nail changes in chronic renal failure patients on hemodialysis–Anobservational study