DOI: https://doi.org/10.36347/sjmcr.2026.v14i03.059

Pages: 565-566

Background: Nail involvement in alopecia areata [AA] is not uncommon and may present with various clinical and dermoscopic patterns. In children, nail changes are frequently underrecognized and may have prognostic implications. Objective: To evaluate the clinical and dermoscopic characteristics of nail involvement in pediatric alopecia areata. Methods: A retrospective descriptive study was conducted including 42 children diagnosed with alopecia areata in a pediatric dermatology department. Diagnosis was based on clinical examination, medical history, and negative mycological testing. All patients underwent dermoscopic evaluation. Demographic data, clinical type of AA, presence of nail involvement, and specific clinical and dermoscopic nail findings were recorded. Results: Nail involvement was observed in 18 out of 42 patients [42.8%], with a mean age of 11 years and a female predominance. Family history of AA was present in three patients. Nail abnormalities were previously unrecognized in 16 patients. Nail involvement was concomitant with scalp lesions in five cases. Twelve patients had moderate AA, while six presented severe forms. Fingernails were predominantly affected [n=16]. Clinically, findings included onychorrhexis [n=6], pitting [n=6], leukonychia [n=4], trachyonychia [n=3], onycholysis [n=2], melanonychia [n=2], koilonychia [n=1], onychomadesis [n=1], and Beau’s lines [n=1]. Dermoscopic examination revealed fine pitting [n=14], longitudinal ridging [n=6], nail plate thinning [n=5], distal onycholysis [n=6], dilation of distal nail bed capillaries [n=6], cuticle thickening [n=4], periungual keratosis [n=3], and melanonychia [n=2]. Conclusion: Nail involvement in pediatric alopecia areata is common and often underdiagnosed. Dermoscopy enhances detection of subtle nail changes and may provide prognostic information. Combined clinical and dermoscopic evaluation should be systematically performed in children with AA.