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Nail involvement has rarely been recognized in systemic sclerosis (SSc). Indeed, only a few small series have assessed nail changes in SSc, most of which are case reports.The aims of the current case-control study were to: (1) determine the prevalence of fingernail changes in SSc; and (2) evaluate the correlation between fingernail changes and other features of SSc.In all, 129 patients with SSc and 80 healthy control subjects underwent routine fingernail examination.The prevalence of fingernail changes was 80.6% in SSc. Patients with SSc more frequently exhibited: trachyonychia (P = .006), scleronychia (P < .0001), thickened nails (P < .0001), brachyonychia (P = .0004), parrot beaking (P < .0001), pterygium inversum unguis (P < .0001), splinter hemorrhages (P < .0001), and cuticle abnormalities (P < .0001) than healthy control subjects. The presence of fingernail changes was associated with digital ulcers (P < .0001), calcinosis cutis (P = .004), and higher values of mean nailfold videocapillaroscopy score (P = .0009).The cohort originated from a single center.This study underlines that fingernail changes are correlated with more severe forms of SSc characterized by digital microangiopathy, including digital ulcers and calcinosis cutis. Nail changes should be systematically checked in all patients with SSc, and may be included in the American College of Rheumatology/European League Against Rheumatism classification criteria for SSc.