EADV Symposium 2025
Interactive clinical cases
- Fri 23 May 2025, 14:00 - 15:30
- 14:00 - 15:30
- South Hall 2
Hair and nail disorders in systemic diseases
Alexander Katoulis, Greece
Lecture description
Skin, including hair and nails, are rightly described as “windows” to systemic diseases, as they frequently display visible clues reflecting underlying conditions. This clinical case-based presentation explores the diagnostic significance of hair and nail manifestations in systemic disorders, highlighting the diagnostic and therapeutic complexities.
Systemic or auto-inflammatory diseases may affect also the scalp, causing secondary scarring alopecia, providing insights for the primary disease diagnosis and treatment. Especially hair involvement (non-scarring alopecia, lupus hair and chronic telogen effluvium) plays an important diagnostic role in systemic lupus erythematosus (SLE), representing one of the diagnostic criteria for SLE.
Internal cancer may manifest itself in multiple ways through hair: skin metastases from breast or lung cancer may appear as patches of alopecia; acquired hair disorders, such as hypertrichosis lanuginosa, represent paraneoplastic syndromes serving as markers of internal malignancy; chemotherapy-induced alopecia is the most distressing adverse reaction of cytotoxic chemotherapy; modern immunotherapy and targeted therapies for advanced neoplasms are not uncommonly associated with autoimmune hair disorders; and secondary scarring alopecia may develop at the sites of radiotherapy treatment.
Nail abnormalities, including changes in shape, texture, and color, often reflect systemic pathologies. Systemic illnesses, such as cardiovascular diseases, may cause splinter hemorrhages, while clubbing can signal chronic pulmonary disorders. Yellow nail syndrome is associated with lymphedema and respiratory conditions, and koilonychia may indicate iron deficiency anemia. Terry’s white nails are commonly linked to liver cirrhosis, congestive heart failure, or diabetes. Beau’s transverse lines of the nail plate, often reflect periods of systemic stress, such as severe illness or malnutrition.
Hair and nail manifestations provide vital diagnostic and prognostic insights into systemic diseases. Recognizing these signs can facilitate early diagnosis and tailored management of conditions like lupus and cancer. Future directions in this domain include the development of targeted therapies to mitigate treatment-induced hair and nail changes and the integration of trichoscopy and dermoscopy into routine clinical practice. Clinicians equipped with the tools to identify and manage hair and nail manifestations in systemic diseases can foster a multidisciplinary approach to patient care.
Learning objectives:
- Identify visible signs of systemic diseases in hair and nails
- Recognize the diagnostic value of hair and nail abnormalities in systemic conditions
- Assess the diagnostic importance of observing hair and nail changes during clinical evaluations
- Integrate observations of hair and nail changes into holistic patient evaluations
Dystrophic nails
Marcel Pasch, Netherlands
Lecture description
Disease management for patients with dystrophic nails can be bothersome and sometimes frustrating in daily practice. To an untrained eye, many nail dystrophies look alike but successful treatment depends first and foremost on a correct diagnosis.
Numerous causes can be responsible for disruption of normal nail growth, with infectious (onychomycosis), inflammatory (lichen planus, psoriasis, alopecia areata), traumatic (onychotillomania) and oncologic (melanoma, squamous cell carcinoma) being the most frequent. Participants in this session will be taken through history taking, investigations, diagnosis and management in an interactive manner with interactive polls.
Through clinical cases with detailed clinical photographs, tools will be provided that will make the correct diagnosis and effective treatment of patients with nail dystrophy much easier than generally thought. In a number of patients, we will also discuss pitfalls that you do not want to miss and may serve as red flags that require immediate action.
Learning objectives
- Successful treatment of nail dystrophy depends on a correct diagnosis.
- The most frequent causes for nail dystrophy are infectious (onychomycosis), inflammatory (lichen planus, psoriasis, alopecia areata), traumatic (onychotillomania) and oncologic (melanoma, squamous cell carcinoma).
- Making the correct diagnosis and effective treatment of patients with nail dystrophy is easier than generally thought.
- Some clinical signs in nail dystrophy can serve as red flags requiring prompt action.
