Various Studies Are Indicating That “COVID Nails” Are A Common Manifestation In Many COVID-19 'Recovered' Patients

COVID Nails: Numerous studies are indicating that the manifestations of lines and grooves in the fingernails, which the media has labeled as “COVID Nails”is becoming a common occurrence in many COVID-19 recovered patients and could be a possible indicator for those who never got tested and were either asymptomatic or only had mild conditions that they were indeed infected with SARS-CoV-2 then.

Beau Lines

The nail condition is also called “Beau’s lines,” and some experts however say the condition isn’t exclusively associated with COVID. It can occur after any viral infection, injury, or as a result of an underlying health condition.
 
Beau's lines are deep grooved lines that run from side to side on the fingernail or the toenail. They may look like indentations or ridges in the nail plate. These horizontal indentations in the bases of the nails of the fingers and toes, tend to appear four weeks or more after a COVID-19 infection.
 
Beau’s lines occur when there is a temporary interruption in nail growth due to a physical stress on the body, such as an infection, malnutrition or side-effects of medications such as chemotherapy drugs. While it’s plausible that they’re caused by COVID-19, they’re definitely not an exclusive symptom of the disease.
 
As nails grow between 2mm and 5mm a month on average, Beau’s lines tend to become noticeable four to five weeks after the physical stress happens – as the nail grows, the indentation is revealed. The timing of the stressful event can be therefore estimated by looking at how far the Beau’s lines are from the nail base. There’s no specific treatment for Beau’s lines, as they tend to eventually grow out if the underlying condition has resolved.
 
Numerous studies had indicated the manifestation of COVID nails in post-COVID-19 patients since mid 2020.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7323324/
 
https://onlinelibrary.wiley.com/doi/10.1111/ijd.15167
 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7504889/

Another nail condition or symptom is a red half-moon pattern that forms a convex band over the white area at the base of fingernails. This seems to present earlier than other COVID-related nail complaints, with patients noticing it less than two weeks after being diagnosed. Multiple cases have been reported but not many.

Red Half-Moon Nail Patterns
 
The red half-moon nail patterns like this are generally rare, and previously haven’t been seen so close to the nail base. So having this pattern appear like this could exclusively be an indication of a COVID-19 infection.
 
However the mechanism underlying this half-moon patterning remains unclear. A possible cause could be blood vessel damage associated with the virus itself. Alternatively, it may be due to the immune response mounted against the virus causing mini blood clots and discolouration. Importantly, these marks don’t appear to be anything to worry about, as patients are otherwise asymptomatic – although it is unclear how long they stay for, having lasted from between one week to over four weeks in the cases reported.
 
Interestingly researchers have recorded other unusual COVID Nail occurrences as well.
 
One female patient’s nails loosened from the nail base and eventually fell out, three months after her infection. This phenomenon is known as onychomadesis and is thought to happen for similar reasons to Beau’s lines appearing. This patient didn’t receive treatment for these changes as new healthy nails could be seen growing underneath those that detached, indicating that the issue was beginning to resolve itself. https://onlinelibrary.wiley.com/doi/10.1111/dth.14309
 
In another patient, 112 days after testing positive, witnessed orange discoloration to their nail tips. No treatment was given and the discoloration had still not resolved after a month. The underlying mechanism behind this is unknown. https://onlinelibrary.wiley.com/doi/10.1111/dth.14688
 
Yet another patient had horizontal white lines appear on their nails that don’t disappear with pressure. These are known as Mees’ lines or transverse leukonychia. They appeared 45 days after testing positive for COVID-19. These tend to resolve with nail growth and do not require treatment. Mees’ lines are thought to be caused by the abnormal production of proteins in the nail bed due to systemic disorders. https://onlinelibrary.wiley.com/doi/10.1111/dth.13863
 
Currently, the available evidence suggests that there’s no association between the severity of COVID-19 infection and the type or extent of nail changes.
 
But COVID nails could be a sign that an individual could have had COVID.
 
In the past 19 months, we have come across many unusual symptoms of the virus, some of which could loom long after one recovers from the viral infection. From poor, altered taste to hair loss, there can be a lot of symptoms that strike after COVID-19.
 
Experts are now pointed evidence at a symptom that can show up on your nails, post recovering from the illness.
 
Recovery from the SARS-CoV-2 coronavirus can take a while and there could be a lot of lingering symptoms that could remain weeks after testing negative. As some say, some of the symptoms could be 'residual' side-effects or just a way the body copes with the viral infection of such magnitude.
 
These COVID nails can be one such symptom. Initially pointed out by a British epidemiologist Dr Tim Spector, who was the principal investigator of the PREDICT studies and the ZOE COVID Symptom Study app, COVID nails are being looked at as a possible side-effect where nails recover post the infection, with an evident sign being a 'clear line' on the nail bed. https://twitter.com/timspector/status/1389242215961137160
 
Dr Spector's observations soon sparked off responses on the internet, with many COVID survivors talking of recognizing this sign on their nails, weeks on or months after fighting the infection.
 
Although it's the first time that people are discovering this unusual COVID side-effect, there is a medical term for the nail bed manifestation, which is known as 'Beau's lines'.
 
However what links Beau's lines to strike when you have COVID-19 is yet clearly unknown, experts believe that undergoing extreme stress or illness which takes a toll on overall body health can very well impact the nails.
 
The phenomena of COVID nails, according to case studies, can come up weeks or months after fighting the virus. It does not just affect the nail bed but appear on the toes as well. However, the most characteristic marker of this side-effect could be 'grooves', usually white in colour that runs across your nail plate.

It should be noted that Beau's lines could also appear in the form of ridges, grooves or indentations, and show up on more than one nail plate at a time. For some, it may not be evident enough to be noticed.
 
Importantly the indentations on the nail bed can be caused by a lot of factors, including severe illness, viral infections and comorbidities like uncontrolled diabetes and some vascular diseases.
 
The nail symptoms could also be considered a way inflammation acts up on the skin, much like how other COVID skin symptoms show. Since COVID-19 is also an illness that takes longer to heal, nail health could be badly impacted.
 
It has been also reported that prolonged use of certain medications can also cause the same. https://onlinelibrary.wiley.com/doi/full/10.1016/j.kjms.2017.09.008
 
https://www.sciencedirect.com/topics/medicine-and-dentistry/beaus-lines
 
https://dermnetnz.org/topics/drug-induced-nail-disease/
 
Because Beau's lines are often caused by systematic illness or medicines, the resolution of the nail symptom majorly depends on recovery from COVID-19.
 
Some also say that it can be nothing major to worry about, and may only be a sign that the body has recovered from the nasty infection and is now making a healthy recovery.
 
It should however be noted that a study in journal: American Family Physician provides a laundry list of other medical issues that can change the appearance of your nails. https://pubmed.ncbi.nlm.nih.gov/15053406/
 
According to that study, “The visual appearance of the fingernails and toenails may suggest an underlying systemic disease.” According to those researchers, changes in nail appearance that suggest underlying diseases include:
clubbing of your nails, which might indicate a lung problem or inflammatory bowel disease, spoon-shaped nails (koilonychia), which could indicate anemia or hemochromatosis (too much iron in the blood), separation of the nails from the nail bed, known as onycholysis, which could be a sign of overactive thyroid (hyperthyroidism).
 
Beau’s lines can also be caused illnesses that cause high fevers.
 
Dr. Michele S. Green, dermatologist at Lenox Hill Hospital in New York said, “COVID can cause temperatures to spike, which can contribute to the formation of these nail ridges.”
 
She added that this symptom could take a long time to appear and sometimes doesn’t occur at all.
 
She said, “It may take several months after having had the illness for Beau’s lines to appear, and they may not appear at all despite having COVID.”
 
Dr Green emphasized that Beau’s lines aren’t unique to COVID-19 and that any kind of systemic illness can cause a disruption in normal nail growth and result in the appearance of Beau’s lines.
 
She further added, “Diabetes, pneumonia, and zinc deficiency are just a few of the other conditions that can lead to the development of Beau’s lines.”
 
She also added, “There is little to do as far as treatment for the appearance of Beau’s lines. The entire fingernail will grow and replace itself within 6 months, meaning that if the underlying cause of the Beau’s line or lines is treated, they’ll disappear on their own with time.”
 
She however, cautioned that if the lines and grooves don’t grow out or if more appear, it’s best to schedule an appointment with a dermatologist.
 
In another interesting study, the usage of the teratogenic drug favipiravir to treat COVID-19 was found to cause a nail condition known as Fingernail lunula luminescence. https://onlinelibrary.wiley.com/doi/10.1111/phpp.12660

Fingernail lunula luminescence.
Many countries inlcuding Turkey and Thailand are using the drug favipiravir to treat COVID-19 despite WHO and US CDC drug trials showing that it does not work. https://www.thailandmedical.news/news/breaking-covid-19-drugs-us-fda-drug-trial-concludes-that-most-drugs-being-used-including-favipiravir,-lopinavir,-ritonavir,-chloroquine-has-no-effects
 
https://www.thailandmedical.news/news/favipiravir-studies-involving-animal-models-shows-favipiravir-has-very-weak-effect-on-sars-cov-2-and-not-viable-as-an-effective-therapeutic
 
In fact the drug was also shown to cause liver injury. https://www.thailandmedical.news/news/covid-19-drugs-latest-japanese-study-shows-association-between-high-serum-favipiravir-concentrations-and-drug-induced-liver-injury
 
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