Correspondence
COVID-19 and nail manifestation: be on the lookout for
the red half-moon nail sign
Dear Editor,
Multiple cutaneous dermatologic manifestations have been
reported in patients infected with SARS-CoV-2, especially per-
nio-like lesions.1 Interestingly, nail apparatus manifestations of
SARS-CoV-2 have been scarcely reported, with only one pub-
lished report in the literature to date.2
We report the case of a 37-year-old woman who pre-
sented with anosmia, dry cough, persistent fever, and rela-
tively normal oxygen saturation (>92%). A positive nasal swab
polymerase chain reaction for SARS-CoV-2 confirmed the
infection. Two days after the symptoms began, the patient
noticed changes in the nail bed characterized by a red-violet
band, above the nail lunule. These changes were asymp-
tomatic and lasted for 1 week before gradually returning to
normal (Fig. 1). The patient was managed at home and did not
require supplemental oxygen.
Cutaneous manifestations, such as erythematous rash,
rash with petechiae, vesicular rash, acral ischemia, livedo retic-
Figure 1 Transversal red-violet band above the nail lunule, on the
10 fingernails
ª 2020 the International Society of Dermatology
ularis, and widespread urticaria, can present in up to 20% of
patients with SARS-CoV-2 infection.1
The chilblain-like lesions in patients with SARS-CoV-2
infection range from mild to severe acral ischemia lesions.
Recently Neri et al., reported a case of “transversal red
bands of the nail” also referred to as the “red half-moon nail
sign”.2 We believe that our case confirms this finding. The
pathophysiology of this nail manifestation remains to be elusive;
however, similar to Neri et al., we hypothesized that this tran-
sient phenomenon could be secondary to vascular inflamma-
tion.2 We did not perform a biopsy because of its morbidity and
possible permanent cosmetic results. Therefore, the associated
histological findings of the red half-moon nail sign associated
with SARS-CoV-2 infection remain uncertain.
In summary, it is important to emphasize a complete and
detailed dermatological review, in search of these nail changes
in all patients with SARS-CoV-2 infection.

Silvia Mendez-Flores1
*, MSc
Angela Zaladonis2, BS
Rodrigo Valdes-Rodriguez3, MD
1
Department of Dermatology, Instituto Nacional de Ciencias
dicas y Nutricio
Me n, Mexico City, Mexico
2
Lewis Katz School of Medicine at Temple University,
Philadelphia, PA, USA
3
Department of Dermatology, University of Arkansas for
Medical Science, Little Rock, AR, USA
*E-mail: silvia.mendezflores@gmail.com
Conflict of interest: None.
Funding source: None.
doi: 10.1111/ijd.15167
References
1 Marzano AV, Cassano N, Genovese G, et al. Cutaneous
manifestations in patients with COVID-19: a preliminary review of
an emerging issue. Br J Dermatol 2020. https://doi.org/10.1111/
bjd.19264. [published online ahead of print, 2020 Jun 1].
2 Neri I, Guglielmo A, Virdi A, et al. The red half-moon nail sign: a
novel manifestation of coronavirus infection J Eur Acad Dermatol
Venereol 2020. https://doi.org/10.1111/jdv.16747. [published
online ahead of print, 2020 Jun 13].
International Journal of Dermatology 2020