A case of unilateral koilonychia with rapid response to combined treatment with vitamin B12 and folic acid
Öz
Introduction
Koilonychia, also called spoon-shaped nail, is a nail deformity characterized by concavity of the nail plate. Its diagnosis is based on clinical findings. Koilonychia can be idiopathic, genetic, or acquired due to related causes such as anemia, malnutrition, trauma, or thyroid hormone dysregulation.
Case
A 20-year-old woman presented with deformity of the nails on her right hand for 2 weeks. The patient stated that her hands had been intermittently exposed to chlorine bleach (sodium hypochlorite 5.25%) for household cleaning for about 3 months. Dermatologic examination revealed thinning, fragility, concavities in the distal part of the nails, and orangish discoloration in the second to fifth nails on the right hand. These findings were compatible with koilonychia. Examination of the left-hand nails was normal. A vitamin B12 level of less than 100 ng/L and folate level of 3.59 ng/mL were detected. A clinical diagnosis of sodium hypochlorite–induced koilonychia was made. The patient was recommended to stop contact with chlorinated bleach and to stop household cleaning. The following medications were started: 1000 mcg/ml cyanocobalamin administered by intramuscular injection once a week and 5 mg/day folic acid administered orally. No topical treatment was applied to the nails. After 1 month, it was observed that the koilonychia regressed.
Discussion
Our case is valuable in terms of the association of vitamin B12 and folic acid deficiencies with unilateral koilonychia and the rapid improvement of koilonychia due to vitamin B12 and folic acid replacement. In conclusion, this preliminary observation suggests the need to check vitamin B12 and folic acid levels in patients with unilateral koilonychia and that replacement of these vitamins in cases of deficiency may be part of the treatment for koilonychia.
Anahtar Kelimeler
folic acid deficiency, nails, nail abnormalities, vitamin B12 deficiency
Destekleyen Kurum
YOKTUR
Etik Beyan
VAKA BİLDİRİMİ İÇİN ETİK KURUL ONAYI GEREKMEMEKTEDİR.
Teşekkür
YOKTUR
Kaynakça
- 1. Gupta I, Tyagi M, Dayal S, Singh J. Unilateral koilonychia secondary to chemical depilatory product. Skin Appendage Disord 2021;7(1):25-8.
- 2. Walker J, Baran R, Vélez N, Jellinek N. Koilonychia: an update on pathophysiology, differential diagnosis, and clinical relevance. J Eur Acad Dermatol Venereol 2016;30(11):1985-91.
- 3. Balestri R, Rech G, Girardelli CR, Piraccini BM, La Placa M. Acute koilonychia of fingernails due to lye. Skin Appendage Disord 2017;2(3-4):183-4.
- 4. Chung I, Ryu H, Yoon SY, Ha JC. Health effects of sodium hypochlorite: review of published case reports. Environ Anal Health Toxicol 2022;37(1):e2022006-0.
- 5. Hartnett KM, Fulginiti LC, Di Modica F. The effects of corrosive substances on human bone, teeth, hair, nails, and soft tissue. J Forensic Sci 2011;56(4):954-9.
- 6. Hagman JH, Ginebri A, Mordenti C, De Simoni I, Chimenti S. Treatment of occupational koilonychia with tazarotene gel. Acta Derm Venereol 2003;83(4):296-7.
- 7. S Addor FA. Nutrient supplementation influence on keratinocytes’ metabolism: an in vitro study. Surg Cosmet Dermatol 2012;4(2):150-4.
- 8. Mahmood L. The metabolic processes of folic acid and vitamin B12 deficiency. J Health Res Rev 2014;1:5-9
- 9. Aşkın Ö, Uzunçakmak TKÜ, Altunkalem N, Tüzün Y. Vitamin deficiencies/hypervitaminosis and the skin. Clin Dermatol 2021;39(5):847-57.
- 10. Brosnan JT, Brosnan ME. The sulfur-containing amino acids: an overview. J Nutr 2006;136(6 Suppl):1636S-1640S.