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A small study published as a research letter in the is the first to characterize nail lesions in adults with skin of color (SoC). According to the researchers, some study participants did not receive important follow-up care, potentially because of persistent barriers to access in the SoC population.

The following study excerpts were edited for length and clarity.

What was the impetus for conducting this study?

Research and educational materials related to the diagnosis and treatment of nail lesions in SoC populations are limited. Therefore, researchers aimed to determine the frequency of nail disorders and their clinical features in SoC patients. Their goal was to help facilitate and improve early diagnosis and management of nail disorders.

Who was in the study cohort?

Of 131 patients identified, 80 identified as Black or African American, 14 as Asian, 2 as Native Hawaiian or another Pacific Islander, and 1 as American Indian or Alaskan Native. An additional 15 subjects identified as mixed race. The remaining 19 patients had unreported race and identified as Hispanic or Latino. Across all races, 32 identified their ethnicity as Hispanic or Latino.

What were the key findings?

The predominant clinical finding was nail discoloration, present in 71% of patients (n=93), followed by nail plate surface abnormality in 40% (n=52). Benign discoloration disorders were the most common category of nail disorders identified (27%).

The most common cause of nail discoloration was melanocyte activation, including both physiologic and traumatic melanocyte activation.

Biopsy-proven malignant neoplastic nail lesions were identified in 4% of the population, including squamous cell carcinoma in situ (n=3), melanoma (n=1) and cutaneous T-cell lymphoma (n=1). All patients diagnosed with a malignant neoplasm identified as Black or African American.

Five patients with a possible diagnosis of nail neoplasm requiring a biopsy were lost to follow-up. Three of these patients identified as Black or African American and two identified as mixed race. This may reflect the difficulty this population faces in accessing health care.

What are the implications for dermatologists?

Early identification of treatable nail findings can reduce the increased morbidity and mortality this population faces. This is particularly important for malignant lesions, which are often diagnosed at more advanced stages among racial minorities.

Take-home points

• Among people with skin of color, the predominant clinical nail finding was nail discoloration, followed by nail plate surface abnormality.
• Malignancies were identified in 4% of the study population.
• Treating malignancies and other issues can be more difficult in this population because of challenges related to access.