Nail Involvement in Alopecia Areata: A Questionnaire-Based Survey on Clinical Signs, Impact on Quality of Life, and Review of the Literature

January 2018

Yvonne Roest, Henriët van Middendorp, Andrea W M Evers, P.C.M. van de Kerkhof, Marcel C. Pasch

alopecia areata AA nail involvement pitting trachyonychia red spots on the lunula alopecia areata universalis AAU quality of life QoL

TLDR Most people with alopecia areata have nail changes, which are common but don't greatly affect their quality of life.

In a 2018 study of 256 patients with alopecia areata (AA), 64.1% experienced nail involvement, with pitting (29.7%) and trachyonychia (18.0%) being the most common nail changes. Red spots on the lunula were less frequent (5.1%) but indicated severe AA. Nail changes were more prevalent in patients with alopecia areata universalis (AAU) compared to other forms of AA. Despite the commonality of nail symptoms, they had minimal impact on patients' quality of life (QoL), and only 13.8% of those affected had sought treatment, with 35% desiring effective treatment options. The study highlighted that nail involvement is a frequent but often untreated aspect of AA, which can signify disease severity but does not significantly affect QoL for the majority of patients.

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