Ultrasound Evaluation of Cosmetic Changes in Nails: A Case Series and Literature Review

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BACKGROUND: The use of semi-permanent nail polishes and acrylic nails is rising due to cosmetic appeal, but may lead to underrecognized complications. High-frequency ultrasound (HFUS) offers a non-invasive method for assessing nail structural changes beyond clinical examination. OBJECTIVES: To describe ultrasound findings in patients with complications from semi-permanent polishes and acrylic nails and correlate them with clinical presentations. METHODS: This descriptive study included 13 women over six months who used semi-permanent polishes or acrylic nails and presented with nail alterations. HFUS was performed using 8-22 MHz probes to assess nail structures in grayscale and Doppler. Defined criteria identified brittle nails, onychomadesis, ventral pterygium, and onychocryptosis. Data were analyzed descriptively. RESULTS: Among 13 patients, 69.2% used semi-permanent polishes and 30.8% used acrylic nails. Brittle nails were most common overall (30.8%), primarily in semi-permanent polish users (44.4%), while ventral pterygium predominated among acrylic nail users (50%). HFUS revealed methacrylate deposits within the intermediate plate in 55.6% of semi-permanent polish users. Increased vascularization on Doppler was seen in all cases, suggesting chronic inflammatory processes. Multiple structural alterations were frequently observed in individual patients. CONCLUSION: HFUS effectively identified structural and vascular complications linked to cosmetic nail procedures, often detecting subclinical changes. Methacrylate incorporation into the nail plate may underlie many findings in semi-permanent polish users, while matrix atrophy and ventral pterygium were more typical of acrylic nails. These results highlight the importance of patient education and dermatologic monitoring. Larger studies are warranted to confirm these associations.

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