COVID Nails

What Are COVID Nails?

Patients who recovered from COVID-19 still experience side effects, from low energy levels to hair loss. Along with this, COVID nails, a new post-infection condition, has been reported to keep us on track; this condition is also called Beau's lines, which can occur after a viral infection or when a person has an underlying health condition.

COVID nails are harmless and highly recognized after the infection. They also leave a clear line once they heal. These are known as Beau's lines and are also commonly seen with physiological stress, like an illness. Due to the shifting in the nail cycle, COVID nails appear on all nails and even on toenails. They do not appear right after the infection, and they take at least two months to show up.

What Do COVID Nails Look Like?

COVID nails are not so obvious, and some people do not experience them. In addition, the exact pathogenesis of these nail changes in COVID-19-infected patients is not fully understood. COVID nails often appear with,

• Ridges.

• Grooves.

• Indentations.

• Red half-moon nail sign.

• Beau lines.

• Transverse orange nail lesions.

1. Grooves, Ridges, and Indentations: These lines and grooves run horizontally across the nail plate, which is a sign of COVID-19 infection. A COVID-19 case measured horizontal longitudinal grooves across the great toenails bilaterally (arrows) with 5 mm from the proximal nail fold.

2. Red Half-Moon Nail Sign:

A red half-moon nail sign is present at the end margin of the nail fold, with a horizontal red band surrounding the white crescent of the nail. The red band continues to persist for some time, and this state is more peculiar in the early stage of SARS-COV-19 infection, and it is also thought to be associated with,

• Microvascular injury - Changes in the small blood vessels.

• Inflammatory immune response.

It can also be a sign of many conditions, such as,

• Lupus erythematosus - Autoimmune disorder with extensive inflammation.

• Arthritis - Inflammation of the joints.

• Alopecia areata - A form of hair loss.

3. Transverse Grooves in the Nail Plate:

Beau lines, also called transverse grooves in the nail plate, are a sign of COVID-19 disease. They are caused by a temporary interruption of the nail growth matrix.

4. Transverse Orange Nail Lesions:

There is no clear information on transverse orange nail lesions, but the shape of discoloration can be due to a systemic illness like COVID-19.

Does Having COVID Nails Indicate COVID-19?

COVID-19 does not always cause Beau's lines, and it appears when there is an interruption in regular nail growth. There are many reasons for the appearance of Beau's line, such as,

• Illness.

• Environmental factors.

• Injury.

Many illnesses cause these changes in nail growth, and any kind of systemic disease like the flu causing high fever can result in these nail grooves that can disrupt nail growth. Even chemotherapy causes Beau's line, and there is absolutely nothing to worry about because it just shows that the body has undergone something. The changes in nail appearance can also be due to underlying diseases, which include:

• Clubbing of Nails - Sign of lung problem or inflammatory bowel disease.

• Spoon-Shaped Nails (Koilonychia) - Sign of anemia (insufficient iron in the blood) or hemochromatosis (too much iron in the blood).

• Onycholysis (Separation of the Nails From the Nail Bed) - A sign of overactive thyroid (hyperthyroidism).

Is COVID-19 Always Associated With Beau's Line?

This Beau's line also appears with illnesses that cause high fevers, and as COVID-19 causes temperatures to spike, it contributes to the formation of these nail ridges. It is not unique to COVID-19, and it can appear in any kind of systemic illness like:

• Uncontrolled diabetes.

• Pneumonia.

• Thyroid deficiencies.

• Zinc deficiency.

• Major stress.

Other causes of Beau lines include:

• Localized trauma.

Systemic triggers such as:

• Febrile illness.

• Severe malnutrition.

• Pemphigus.

• Raynaud disease.

• Kawasaki disease.

• Chemotherapy.

Beau’s line in COVID-19 disease takes a long time to appear, and sometimes, it does not appear at all. The good news is that it can be corrected by itself, even without treatment. So, it is understood that once the nail change has happened, it is not permanent, and it is a waiting game for the nail to grow out.

Can COVID-19 Cause Nail Shedding?

More severe cases lead to the inhibition of the nail from proliferating, causing the separation of the nail plate from the bed and resulting in nail shedding. These alterations occur due to the presence of systemic insults such as -

• Infections.

• Critical illnesses.

• Drugs.

• Autoimmune diseases.

Nail shedding does not immediately occur during the disease, and it indicates,

• The severity of the illness.

• Stress that the body has undergone.

This stress affects the nail cycle and appears approximately two months after the disease. Also, the use of steroid medications leads to increased nail shedding, especially in patients with diabetes and patients with a history of fungal infections.

Is It Possible to Fix COVID Nails?

The lines and grooves on the nails can be a reminder of a previous illness. The nail will grow within six months, which means when the underlying cause of Beau's line is treated, it will disappear on its own with time. However, if the lines and grooves do not go, it is best to schedule an appointment with a dermatologist.

Conclusion

The devastating effects of coronavirus are well known, especially with the current interruption of the nail matrix. As the days pass, new signs and symptoms of COVID-19 are being evaluated and managed accordingly. So, in the case of COVID-19, when one notices these harmless, temporary nail changes, contact a healthcare provider and consider getting a COVID-19 test. However, having a few odd lines on the nails does not indicate the presence of infection.

Even if one is diagnosed and treated for this novel coronavirus disease, it is essential to follow COVID-19 safety precautions such as getting the vaccination, washing hands frequently, following social distancing for at least 3.33 feet, not frequently touching the face, especially the eyes, nose, and mouth, wearing masks, not stepping out often unless it is essential, and seeking medical attention when in an emergency to beat the pandemic.