The correlation between clinical and pathologic manifestations in nail disorders in Razi Hospital

Background: Nail disorders present with a wide range of manifestations. The problems associated with nail biopsies make the diagnosis even more challenging. Identifying the most common features of each nail disorder can prevent unnecessary biopsies and facilitate early diagnosis. Methods: We conducted a cross-sectional study on 528 pathology reports, documented from March 2018 to March 2019 in the Razi Dermatopathology Hospital, Tehran, Iran. We extracted the demographic data and the nails’ clinical and pathologic presentations. We used Fisher’s exact test to determine the nail features’ clinicopathological correlations. Results: The mean age of the 359 included patients was 38.81 ± 18.11 years, and 50.81% were male. Benign melanonychia (12.82%), traumatic nail (11.96%), and junctional nevus (11.11%) were the most prevalent disorders. Onycholysis (P < 0.001), longitudinal ridges (P < 0.001), subungual hyperkeratosis (P = 0.003), dystrophy (P = 0.017), discoloration (P = 0.052), and pitting (P < 0.001) correlated significantly with nail psoriasis. The presence of subungual hyperkeratosis, onycholysis, and longitudinal ridges significantly increased the odds of nail lichen planus. Only 6.79% of patients with longitudinal melanonychia had malignant melanoma, while most (26.54%) correlated with benign melanonychia. Conclusions: A detailed examination can narrow the differential diagnosis and avert unnecessary biopsies. However, in high-risk cases, physicians should regularly monitor the nails’ changes and response to treatment.