1
|
Yu Q, Hu S, Li W, Yang L. Case report: Green nail syndrome in an epidemic prevention volunteer during the outbreak of the Omicron in Shanghai. Front Public Health 2022; 10:1009517. [PMID: 36203662 PMCID: PMC9530803 DOI: 10.3389/fpubh.2022.1009517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/05/2022] [Indexed: 01/27/2023] Open
Abstract
Green nail syndrome (GNS) is an infectious disorder characterized by greenish discoloration of the nail plate. Pseudomonas aeruginosa is the most common organism that causes GNS. It is an opportunistic human pathogen that preferentially colonizes moist environments, and thus, it usually affects patients with a history of prolonged exposure to moist environments. Here, we describe a case of GNS in an epidemic prevention volunteer that was caused by wearing personal protective equipment for prolonged durations. The case was reported during the outbreak caused by the SARS-CoV-2 Omicron variant in Shanghai. After receiving information about his condition and proper treatment, the patient was cured.
Collapse
Affiliation(s)
- Qian Yu
- Department of Medical Mycology, Shanghai Dermatology Hospital, Tongji University School of Medicine, Shanghai, China
| | - Sheng Hu
- Central Laboratory, Shanghai Dermatology Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wei Li
- Department of Medical Cosmetology, Shanghai Dermatology Hospital, Tongji University School of Medicine, Shanghai, China,*Correspondence: Wei Li
| | - Lianjuan Yang
- Department of Medical Mycology, Shanghai Dermatology Hospital, Tongji University School of Medicine, Shanghai, China,Lianjuan Yang
| |
Collapse
|
2
|
Yu Q, Wang Y, Yang H, Li W, Yang L. Case report: Novel use of the conventional method- chemical nail avulsion may be effective for treatment of green nail syndrome. Front Med (Lausanne) 2022; 9:991918. [PMID: 36091683 PMCID: PMC9452826 DOI: 10.3389/fmed.2022.991918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/11/2022] [Indexed: 11/30/2022] Open
Abstract
Green nail syndrome (GNS) is a triad of green discoloration of the nail plate, proximal paronychia, and distal onycholysis. Pseudomonas aeruginosa is known to be the most common causative agent; however, there is no unified standard for the diagnosis and treatment of GNS. Thus, treatment is challenging and often refractory. Here, we report three representative cases with different predisposing factors, including trauma-related, occupation-related, and onychosis-related GNS. Patients with GNS accompanied by onycholysis were instructed to undergo chemical nail avulsion combined with topical antibiotics, and favorable curative effects were observed in all cases. Chemical nail avulsion with urea powder as a conventional method may be an effective treatment for GNS and warrants clinical generalization.
Collapse
Affiliation(s)
- Qian Yu
- Department of Medical Mycology, Shanghai Dermatology Hospital, Shanghai, China
| | - Yuanyuan Wang
- Department of Medical Mycology, Shanghai Dermatology Hospital, Shanghai, China
| | - Hong Yang
- Department of Medical Mycology, Shanghai Dermatology Hospital, Shanghai, China
| | - Wei Li
- Department of Medical Cosmetology, Shanghai Dermatology Hospital, Shanghai, China
- Wei Li,
| | - Lianjuan Yang
- Department of Medical Mycology, Shanghai Dermatology Hospital, Shanghai, China
- *Correspondence: Lianjuan Yang,
| |
Collapse
|
3
|
Ouzounova-Raykova VV. Green nail syndrome on the nail plate and bed related with Enterococcus and Fusarium coinfection. Folia Med (Plovdiv) 2022; 64:547-550. [PMID: 35856120 DOI: 10.3897/folmed.64.e64004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/27/2021] [Indexed: 11/12/2022] Open
Abstract
Abstract.
Collapse
|
4
|
Forouzan P, Cohen PR. Fungal Viridionychia: Onychomycosis-Induced Chloronychia Caused by Candida parapsilosis-Associated Green Nail Discoloration. Cureus 2021; 13:e20335. [PMID: 35036181 PMCID: PMC8752341 DOI: 10.7759/cureus.20335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 11/05/2022] Open
Abstract
Green nail syndrome is a form of chromonychia, discoloration of the nail plate, that describes fingernails or toenails that are green in appearance. Bacterial-associated green nail syndrome, referred to as chloronychia, is most common; however, fungal and polymicrobial etiologies have been reported. Two 70-year-old women presented with green discoloration of their nails for over five months; both women had prior unsuccessful treatments and were referred for further evaluation and treatment. The affected nails were biopsied and cultured. Bacterial cultures did not yield any organisms; however, fungal cultures grew Candida parapsilosis after four weeks. Both women were treated with a topical alcohol-based solution and ketoconazole cream with improvement in their nail discoloration after two months. We introduce a term that specifically describes fungal etiology-associated green nail syndrome: viridionychia.
Collapse
|
5
|
Rajput CD, Nikam BP, Gore SB, Malani SS. Nail Changes in Leprosy: An Observational Study of 125 Patients. Indian Dermatol Online J 2020; 11:195-201. [PMID: 32477978 PMCID: PMC7247625 DOI: 10.4103/idoj.idoj_172_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Leprosy is a disease primarily affecting skin and nerve. Nail involvement, although indirect, is observed in several patients. This is a study to determine the pattern of nail changes in leprosy. Methods It was an observational study involving 125 patients. Apart from cutaneous and neurological examination, nails were examined. Diagnosis was confirmed by previous records in already diagnosed cases, while by slit skin smear and histopathologically in new cases. Patients were grouped as per Ridley-Jopling classification and further subdivided as per age, sex, and duration and reaction status. Nail changes in these groups were summarized and compared. Results Overall prevalence of nail changes was 80% with 66.6% in TT patients, 79.4% in BT patients 50% in BB patients, 83.7% in BL patients and 84.3% in LL patients. Longitudinal melanonychia and longitudinal ridges were frequent finger nail changes with longitudinal melanonychia being more common among tuberculoid pole and longitudinal ridges among lepromatous pole. Brachyonychia, subungual hyperkeratosis and brown black pigmentation were frequent finger nail changes, with onychorrhexis being commonest among TT patients, subungual hyperkeratosis among BT patients, while brachyonychia among BL and LL patients. Anonychia and rudimentary nails were not found in tuberculoid pole. Beau's lines, terry nails, pterygium, pincer nail, and onychorrhexis were significantly more frequent in ENL patients. Onychomadesis, which is not reported yet in leprosy, was found in one patient after severe ENL. Conclusion Various changes in leprosy are due to multiple causes like neuropathic, traumatic, vascular, osseous, infections and drugs reflecting extensive systemic morbidity caused by Mycobacterium leprae.
Collapse
Affiliation(s)
- Chetan D Rajput
- Department of Skin and VD, SBH Govt. Medical College, Dhule, Maharashtra, India
| | | | - Sanjay B Gore
- Department of Skin and VD, SBH Govt. Medical College, Dhule, Maharashtra, India
| | - Shailesh S Malani
- Department of Skin and VD, SBH Govt. Medical College, Dhule, Maharashtra, India
| |
Collapse
|
6
|
Retrospective Case Series on Risk Factors, Diagnosis and Treatment of Pseudomonas aeruginosa Nail Infections. Am J Clin Dermatol 2020; 21:297-302. [PMID: 31595433 DOI: 10.1007/s40257-019-00476-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Pseudomonas aeruginosa is the most common pathogen causing bacterial nail infections, producing a classic blue-green pigment, known as chloronychia. Clinical examination and dermoscopic findings, as well as diagnosis and treatment, have not been well characterized. OBJECTIVE The aim was to characterize the clinical and dermoscopic findings of P. aeruginosa infection of the nails and assess treatment efficacy. METHODS This is a retrospective study of patients with P. aeruginosa nail infection diagnosed between January 27, 2017 and May 28, 2019. Demographics, history, clinical and dermoscopic findings, diagnostics tests, and treatment were documented and analyzed. RESULTS Twenty-six patients with P. aeruginosa nail infections were analyzed, with 21 patients completing treatment, two lost to follow-up, and three still undergoing treatment. Clinical examination findings were notable for onycholysis in 76.9% of patients. Green discoloration was seen in 38.5% of patients and green-brown discoloration in 30.8%. A majority of the patients had only one nail involved (73.1%). Dermoscopic findings were significant for greenish pigmentation in 37.5% of patients and 88.9% of cases presenting with a fading border. Wound cultures of nail plates were more sensitive (40%) than dermatopathology (16.7%), but the difference was not statistically significant (p value = 0.1596). All patients were treated with ophthalmic 0.3% gentamicin topical solution nightly for a 3-month period and those who completed therapy had complete resolution of their infection. LIMITATIONS The limitations of the study were the retrospective design and the small cohort size. CONCLUSION Clinical examination findings of onycholysis coupled with a green or green-brown discoloration involving one or more digits and dermoscopic findings of greenish discoloration with a fading border are consistent with a diagnosis of Pseudomonas nail infection. Gentamicin topical solution is an effective, inexpensive, easy-to-use treatment for this condition. Larger randomized clinical trials are necessary to compare efficacy with other therapeutic options.
Collapse
|
7
|
Schwartz RA, Reynoso-Vasquez N, Kapila R. Chloronychia: The Goldman-Fox Syndrome - Implications for Patients and Healthcare Workers. Indian J Dermatol 2020; 65:1-4. [PMID: 32029931 PMCID: PMC6986112 DOI: 10.4103/ijd.ijd_277_19] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Nail coloration has many causes and may reflect systemic disease. White nails (leukonychia) are common; rubronychia is rare, whereas green (chloronychia) is occasionally evident. Chloronychia, the Fox-Goldman syndrome, is caused by infection of an often damaged nail plate by Pseudomonas aeruginosa. P. aeruginosa is an opportunistic pathogen known for localized and systemic infections. It can spread cryptically in a variety of ways, whether from an infected nail to a wound either autologously or to a patient as a surgical site infection, and many represent a threat to elderly, neonatal, or immunocompromised patients who are at increased risk of disseminated pseudomonas infection. We will review the Goldman-Fox syndrome as an occupational disorder of homemakers, nurses, plumbers, and others often with wet hands. At a time when hand washing is being stressed, especially in healthcare settings, examination of nails should be emphasized too, recalling the possibility of surgical site infection even with a properly washed and gloved medical care provider. Pseudomonas may be a community-acquired infection or a hospital or medical care setting-acquired one, a difference with therapeutic implications. Since healthcare workers represent a threat of nosocomial infections, possible guidelines are suggested.
Collapse
Affiliation(s)
- Robert A Schwartz
- Department of Dermatology, Infectious Diseases, and Pathology, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Nicole Reynoso-Vasquez
- Department of Dermatology, Infectious Diseases, and Pathology, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Rajendra Kapila
- Department of Dermatology, Infectious Diseases, and Pathology, Rutgers New Jersey Medical School, Newark, New Jersey
| |
Collapse
|
8
|
Abeck D. [Discolorations of the nail plate - the causes are multiple]. MMW Fortschr Med 2018; 160:48-52. [PMID: 30478557 DOI: 10.1007/s15006-018-1176-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Dietrich Abeck
- Hautzentrum Nymphenburg, Renatastraße 72, D-80639, München, Deutschland.
| |
Collapse
|
9
|
Wollina U, Nenoff P, Haroske G, Haenssle HA. The Diagnosis and Treatment of Nail Disorders. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 113:509-18. [PMID: 27545710 DOI: 10.3238/arztebl.2016.0509] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/25/2016] [Accepted: 04/25/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND Nail disorders can arise at any age. About half of all nail disorders are of infectious origin, 15% are due to inflammatory or metabolic conditions, and 5% are due to malignancies and pigment disturbances. The differential diagnosis of nail disorders is often an area of uncertainty. METHODS This review is based on publications and guidelines retrieved by a selective search in PubMed, including Cochrane reviews, meta-analyses, and AWMF guidelines. RESULTS Nail disorders are a common reason for derma - tologic consultation. They are assessed by clinical inspection, dermatoscopy, diagnostic imaging, microbiological (including mycological) testing, and histopathological examination. Some 10% of the overall population suffers from onychomycosis, with a point prevalence of around 15%. Bacterial infections of the nails are rarer than fungal colonization. High-risk groups for nail disorders include diabetics, dialysis patients, transplant recipients, and cancer patients. Malignant tumors of the nails are often not correctly diagnosed at first. For subungual melanoma, the mean time from the initial symptom to the correct diagnosis is approximately 2 years; this delay is partly responsible for the low 10-year survival rate of only 43%. CONCLUSION Evaluation of the nail organ is an important diagnostic instrument. Aside from onychomycosis, which is a common nail disorder, important differential diagnoses such as malignant diseases, drug side effects, and bacterial infections must be considered.
Collapse
Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Dresden-Friedrichstadt Hospital, Academic Teaching Hospital of the Technical University of Dresden, Laboratory for Medical Microbiology, Mölbis, Georg Schmorl Institute of Pathology, Dresden-Friedrichstadt Hospital, Academic Teaching Hospital of the Technical University of Dresden, Department of Dermatology, Heidelberg University Hospital
| | | | | | | |
Collapse
|
10
|
Abstract
Infections of the finger and the toe nails are most frequently caused by fungi, primarily dermatophytes. Causative agents of tinea unguium are mostly anthropophilic dermatophytes. Both in Germany, and worldwide, Trichophyton rubrum represents the main important causative agent of onychomycoses. Yeasts are isolated from fungal nail infections, both paronychia and onychomycosis far more often than generally expected. This can represent either saprophytic colonization as well as acute or chronic infection of the nail organ. The main yeasts causing nail infections are Candida parapsilosis, and Candida guilliermondii; Candida albicans is only in third place. Onychomycosis due to molds, or so called non-dermatophyte molds (NDM), are being increasingly detected. Molds as cause of an onychomycosis are considered as emerging pathogens. Fusarium species are the most common cause of NDM onychomycosis; however, rare molds like Onychocola canadensis may be found. Bacterial infections of the nails are caused by gram negative bacteria, usually Pseudomonas aeruginosa (recognizable because of green or black coloration of the nails) but also Klebsiella spp. and gram positive bacteria like Staphylococcus aureus. Treatment of onychomycosis includes application of topical antifungal agents (amorolfine, ciclopirox). If more than 50 % of the nail plate is affected or if more than three out of ten nails are affected by the fungal infection, oral treatment using terbinafine (in case of dermatophyte infection), fluconazole (for yeast infections), or alternatively itraconazole are recommended. Bacterial infections are treated topically with antiseptic agents (octenidine), and in some cases with topical antibiotics (nadifloxacin, gentamicin). Pseudomonas infections of the nail organ are treated by ciprofloxacin; other bacteria are treated according to the results of culture and sensitivity testing.
Collapse
|
11
|
Corsello G, Vecchio D. Green nail syndrome. Pediatr Int 2014; 56:801. [PMID: 25336007 DOI: 10.1111/ped.12462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 06/22/2014] [Accepted: 07/15/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Giovanni Corsello
- Department of Sciences for Health Promotion and Mother and Child Care, Pediatric Unit, University of Palermo, Palermo, Italy
| | | |
Collapse
|
12
|
Müller S, Ebnöther M, Itin P. Green Nail Syndrome (Pseudomonas aeruginosa Nail Infection): Two Cases Successfully Treated with Topical Nadifloxacin, an Acne Medication. Case Rep Dermatol 2014; 6:180-4. [PMID: 25202260 PMCID: PMC4152926 DOI: 10.1159/000365863] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Green nail syndrome (GNS) caused by Pseudomonas aeruginosa is the most common bacterial nail infection. The treatment of GNS is challenging in many cases and recommendations based on clinical trials are lacking. We report two cases with GNS successfully treated with off-label use of topical nadifloxacin, a fluoroquinolone approved for acne and bacterial skin infections in some countries.
Collapse
Affiliation(s)
- Simon Müller
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Myriam Ebnöther
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Peter Itin
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
13
|
Nenoff P, Ginter-Hanselmayer G, Tietz HJ. [Fungal nail infections--an update: Part 1--Prevalence, epidemiology, predisposing conditions, and differential diagnosis]. Hautarzt 2012; 63:30-8. [PMID: 22037817 DOI: 10.1007/s00105-011-2251-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Onychomycosis describes a chronic fungal infection of the nails most frequently caused by dermatophytes, primarily Trichophyton rubrum. In addition, yeasts (e. g. Candida parapsilosis), more rarely molds (Scopulariopsis brevicaulis), play a role as causative agents of onychomycosis. However, in every case it has to be decided if these yeasts and molds are contaminants, or if they are growing secondarily on pathological altered nails. The point prevalence of onychomycosis in Germany is 12.4%, as demonstrated within the "Foot-Check-Study", which was a part of the European Achilles project. Although, onychomycosis is rarely diagnosed in children and teens, now an increase of fungal nail infections has been observed in childhood. More and more, diabetes mellitus becomes important as significant disposing factor both for tinea pedis and onychomycosis. By implication, the onychomycosis represents an independent and important predictor for development of diabetic foot syndrome and foot ulcer. When considering onychomycosis, a number of infectious and non-infectious nail changes must be excluded. While psoriasis of the nails does not represent a specific risk factor for onychomycosis, yeasts and molds are increasing isolated from patients with psoriatic nail involvement. In most cases this represents secondary growth of fungi on psoriatic nails. Recently, stigmatization and impairment of quality of life due to the onychomycosis has been proven.
Collapse
Affiliation(s)
- P Nenoff
- Haut- und Laborarzt/Allergologie, Andrologie, Labor für medizinische Mikrobiologie, Strasse des Friedens 8, 04579, Mölbis, Deutschland.
| | | | | |
Collapse
|
14
|
Belinchón Romero I, Ramos Rincón J, Reyes Rabell F. Nail Involvement in Leprosy. ACTAS DERMO-SIFILIOGRAFICAS 2012. [DOI: 10.1016/j.adengl.2012.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
15
|
Belinchón Romero I, Ramos Rincón JM, Reyes Rabell F. [Nail involvement in leprosy]. ACTAS DERMO-SIFILIOGRAFICAS 2011; 103:276-84. [PMID: 22056258 DOI: 10.1016/j.ad.2011.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2011] [Revised: 07/20/2011] [Accepted: 07/26/2011] [Indexed: 11/29/2022] Open
Abstract
Leprosy, a disease caused by Mycobacterium leprae, primarily affects the skin and nerves, but the nails are also involved in as many as 3 out of 4 patients .The factors that trigger nail changes in leprosy are numerous and include repeated trauma, neuropathy, vascular impairment, infections, lepra reactions, and the drugs used to manage the disease. The changes most often reported include subungual hematomas, onycholysis, onychauxis, onychogryphosis, pterygium unguis, and onychoheterotopia, most of which can be attributed to nerve damage and trauma. Furthermore, the acro-osteolysis that occurs in the advanced stages of the disease may present with brachyonychia, racquet nails, or even anonychia. Infections of the nail bed leading to paronychia and onychomycosis should also be taken into account in leprosy. Other typical changes include longitudinal striae, pitting, macrolunula, Terry nails, leukonychia, hapalonychia, and Beau lines. In this review, we describe the principal nail changes associated with leprosy. These changes, which are highly varied and diverse in origin, are in fact a reflection of the significant morbidity caused by M. leprae infection.
Collapse
Affiliation(s)
- I Belinchón Romero
- Sección de Dermatología, Hospital General Universitario de Alicante, España. belinchon
| | | | | |
Collapse
|
16
|
Pseudomonas fingernail infection successfully treated with topical nadifloxacin in HIV-positive patients: report of two cases. AIDS 2010; 24:1087-8. [PMID: 20386383 DOI: 10.1097/qad.0b013e32833819aa] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|