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Abstract
Describing and listing all nail symptoms and signs in systemic disorders has already been widely detailed in dedicated textbooks. To be tutorial, this article described most common nails signs and the systemic disorders one may encounter in routine dermatologic consultation. Capsule summaries are presented for each section.
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Affiliation(s)
- Florence Dehavay
- Saint-Pierre, Brugmann and Queen Fabiola Children University Hospitals, Université Libre de Bruxelles, Belgium
| | - Bertrand Richert
- Saint-Pierre, Brugmann and Queen Fabiola Children University Hospitals, Université Libre de Bruxelles, Belgium.
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2
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Abstract
Melanonychia is a very worrisome entity for most patients. It is characterized by brownish black discoloration of nail plate and is a common cause of nail plate pigmentation. The aetiology of melanonychia ranges from more common benign causes to less common invasive and in situ melanomas. Melanonychia especially in a longitudinal band form can be due to both local and systemic causes. An understanding of the epidemiology, pathophysiology and clinical details is necessary for adequate patient care and counseling. It not only helps in the early recognition of melanoma but also prevents unnecessary invasive work up in cases with benign etiology. An early diagnosis of malignant lesion is the key to favourable outcome. Though there are no established guidelines or algorithms for evaluating melanonychia, a systematic stepwise approach has been suggested to arrive at a probable etiology. We, hereby, review the aetiology, clinical features, diagnostic modalities and management protocol for melanonychia.
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Affiliation(s)
- Archana Singal
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Kavita Bisherwal
- Department of Dermatology and STD, Lady Hardinge Medical College and SSK Hospital, New Delhi, India
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Wagner C, Chasset F, Fabacher T, Lipsker D. Lupus érythémateux et atteinte unguéale : revue de la littérature. Ann Dermatol Venereol 2020; 147:18-28. [DOI: 10.1016/j.annder.2019.10.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 09/18/2019] [Accepted: 10/09/2019] [Indexed: 11/29/2022]
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Koch K, Tikly M. Spectrum of cutaneous lupus erythematosus in South Africans with systemic lupus erythematosus. Lupus 2019; 28:1021-1026. [PMID: 31215844 DOI: 10.1177/0961203319856091] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Cutaneous involvement is very common in systemic lupus erythematosus. We describe the prevalence and spectrum of lupus-specific (cutaneous lupus erythematosus) and non-specific cutaneous features amongst mostly black South Africans with systemic lupus erythematosus. PATIENTS AND METHODS A retrospective record review of 298 South Africans (262 blacks and 36 non-blacks) with systemic lupus erythematosus was carried out. Cutaneous features were classified according to the Gilliam and Sontheimer classification of cutaneous lupus. RESULTS Most (81.5%) patients were black African females. The mean (SD) age at diagnosis and follow-up duration were 35.0 (11.8) and 8.0 (5.9) years, respectively. Cutaneous lupus erythematosus was seen in 76.1% of patients, mainly chronic cutaneous lupus erythematosus with the discoid lupus erythematosus subtype seen in 52.1% of patients. Acute cutaneous lupus erythematosus was seen in 30.2% of patients and was more common in non-blacks than blacks (odds ratio = 3.8 (1.9-7.9)); localized acute cutaneous lupus erythematosus was more common than generalized acute cutaneous lupus erythematosus (odds ratio = 2.6 (1.6-4.4)). Non-specific cutaneous features occurred in 77.2%, with oral/nasal ulcers and Raynaud's phenomenon each occurring in approximately 40% of patients. Diffuse melanonychia at initial diagnosis was present in 37.4% of patients and was more common in blacks than non-blacks (odds ratio = 3.1 (1.3-7.3)). Acute cutaneous lupus erythematosus was associated with renal disease (odds ratio = 2.8 (1.6-4.7)) and chronic cutaneous lupus erythematosus with arthritis (odds ratio = 2.02 (1.24-3.29)). Diffuse melanonychia was associated with less renal disease and anti-dsDNA antibody positivity (odds ratio = 0.4 (0.3-0.7) and 0.4 (0.2-0.6), respectively) and significantly lower lupus severity index scores (mean (SD) = 5.99 (1.11) vs 6.56 (1.36) in patients with no melanonychia, p < 0.05)). CONCLUSION In this study of South Africans with systemic lupus erythematosus, the skin was the most commonly affected organ. In general, cutaneous lupus erythematosus was associated with less severe systemic disease. Acute cutaneous lupus erythematosus was less common in blacks, whereas discoid lupus erythematosus was more common than reported in Caucasians. Diffuse melanonychia was a distinctive finding and was associated with milder systemic disease.
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Affiliation(s)
- K Koch
- 1 Department of Dermatology, University of Witwatersrand, South Africa
| | - M Tikly
- 2 Division of Rheumatology, University of the Witwatersrand, South Africa
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Leung AKC, Lam JM, Leong KF, Sergi CM. Melanonychia striata: clarifying behind the Black Curtain. A review on clinical evaluation and management of the 21st century. Int J Dermatol 2019; 58:1239-1245. [DOI: 10.1111/ijd.14464] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/16/2019] [Accepted: 03/22/2019] [Indexed: 01/19/2023]
Affiliation(s)
| | - Joseph M. Lam
- Department of Pediatrics Department of Dermatology and Skin Sciences University of British Columbia Vancouver British Columbia Canada
| | - Kin Fon Leong
- Pediatric Institute Kuala Lumpur General Hospital Kuala Lumpur Malaysia
| | - Consolato M. Sergi
- Departments of Pediatrics, Laboratory Medicine, and Pathology The University of Alberta Edmonton Alberta Canada
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Zhang S, Liu X, Cai L, Zhang J, Zhou C. Longitudinal melanonychia and subungual hemorrhage in a patient with systemic lupus erythematosus treated with hydroxychloroquine. Lupus 2018; 28:129-132. [PMID: 30428763 DOI: 10.1177/0961203318812685] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hydroxychloroquine is an antimalarial agent, most commonly prescribed in the treatment of several rheumatic diseases. Although generally well tolerated, a variety of mucocutaneous adverse effects have been reported. Besides the familiar adverse effects, longitudinal melanonychia is rarely seen. Although the incidence is extremely low, systemic lupus erythematosus may also cause nail pigmentation in its own right. We report the case of a 55-year-old woman who was diagnosed with systemic lupus erythematosus and presented with longitudinal melanonychia of all 10 fingernails after 3 years of treatment with hydroxychloroquine, without mucocutaneous hyperpigmentation. The pigment of the nail lasted for more than 15 years. To the best of our knowledge, this is first published report of hydroxychloroquine-induced melanonychia without mucocutaneous hyperpigmentation. This case demonstrates that hydroxychloroquine treatment and the primary disease should be considered in the case of multiple nail changes in patients with systemic lupus erythematosus.
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Affiliation(s)
- S Zhang
- Department of Dermatology, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - X Liu
- Department of Dermatology, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - L Cai
- Department of Dermatology, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - J Zhang
- Department of Dermatology, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - C Zhou
- Department of Dermatology, Peking University People’s Hospital, Beijing, People’s Republic of China
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Elmansour I, Chiheb S, Benchikhi H. Nail changes in connective tissue diseases: a study of 39 cases. Pan Afr Med J 2014; 18:150. [PMID: 25419288 PMCID: PMC4236774 DOI: 10.11604/pamj.2014.18.150.4637] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 06/12/2014] [Indexed: 11/25/2022] Open
Abstract
The objective is to identify nail unit changes associated with connective tissue diseases (CTD) and evaluate their frequency. We carried a prospective study between March 2012 and March2013 in our department. All patients with CTD were included. A clinical examination of the fingernails was done by the same dermatologist. Nail features were noted and classified and photos taken. Thirty nine patients were enrolled including: 16 systemic sclerosis, 14 lupus erythematosus (SLE), 8 dermatomyositis (DM), 1 primary Sjorgen's syndrome. The mean age was 40 years old. The mean duration of the disease was 6 years. Nail unit changes were present in 27 patients (69%). The abnormalities observed were Longitidunal ridging in 11 patients, Peri ungueal erythema in 10 patients, Peri-ungual telangiectasia in 11 patients, Ragged cuticle in 10 patients fingertips scars in 9 patients, Increase of longitudinal curvature and beaking of the nail in 4 patients, Increase in transverse curvature in 4 patients, dyschromia of the proximal nail fold in 3 patients, Subungual hyperkeratosis in 3 patients, onycholysis in 2 patients, splinter haemorrhages in 3 patients, nail plate pigmentation in 2 patients, pseudoclubbing in 1 patient, macrolunula in 1 patients, Red lunulae in one patient, bluish- black discoloration of the nail plate in one patient. The proximal nailfold was found to be most sites affected.
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Affiliation(s)
- Imane Elmansour
- Department of dermatology, Ibn Rushd University Hospital, Casablanca, Morocco
| | - Soumia Chiheb
- Department of dermatology, Ibn Rushd University Hospital, Casablanca, Morocco
| | - Hakima Benchikhi
- Department of dermatology, Ibn Rushd University Hospital, Casablanca, Morocco
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Abstract
Nail abnormalities can arise in conjunction with or as a result of systematic pathologies. These pathologies include single-organ diseases, multisystemic diseases, and drug-induced insults. Clinical signs associated with these conditions include dyschromias, vascular alterations, periungual tissue changes, textural dystrophies, contour alterations, and growth-rate alterations. The associated systemic pathologies may affect any part of the nail apparatus, including the nail matrix, the nail plate, the nail bed, the underlying vasculature, and the periungual tissues. The anatomical location and extent of damage determine the clinically manifested anomaly.
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11
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Finch J, Arenas R, Baran R. Fungal melanonychia. J Am Acad Dermatol 2012; 66:830-41. [DOI: 10.1016/j.jaad.2010.11.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Revised: 11/04/2010] [Accepted: 11/11/2010] [Indexed: 01/19/2023]
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Braun RP, Baran R, Le Gal FA, Dalle S, Ronger S, Pandolfi R, Gaide O, French LE, Laugier P, Saurat JH, Marghoob AA, Thomas L. Diagnosis and management of nail pigmentations. J Am Acad Dermatol 2007; 56:835-47. [PMID: 17320240 DOI: 10.1016/j.jaad.2006.12.021] [Citation(s) in RCA: 149] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2006] [Revised: 06/27/2006] [Accepted: 12/16/2006] [Indexed: 10/23/2022]
Abstract
Longitudinal pigmentation of the nail is very common. The differential diagnosis varies from subungual hematoma, to a fungal infection, to a melanocytic lesion (lentigo, nevus melanoma, etc.) to others. Often, dermatologists do not feel at ease with these pathologies and management is often not clear. In many cases, a biopsy is not helpful because an inadequate technique was chosen. The use of noninvasive techniques such as dermoscopy has been described to be useful for the preoperative evaluation and the management decision. Using these technique, one will be able to reduce the number of unnecessary surgeries and to choose the most adequate biopsy technique. In this article, we will review the management, including diagnosis as well as differential diagnosis of nail pigmentations and propose a new algorithm for the non invasive diagnosis of nail pigmentation.
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Affiliation(s)
- Ralph Peter Braun
- Pigmented Skin Lesion Unit, Department of Dermatology, University Hospital Geneva, Switzerland.
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Abstract
Nail pigmentation is defined by the presence of melanin in the nail plate. It most frequently has the appearance of a longitudinal pigmented band, called longitudinal mel-anonychia (LM). LM is an important aspect of ungual pathology because it can be the first sign of nail apparatus melanoma. The aim of this article is to help distinguish those types of melanonychia that are worrisome and should lead to biopsy from those that are reasonably reassuring and need only be followed clinically. Histology, differential diagnosis, and biopsy techniques also are considered.
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Affiliation(s)
- Josette André
- Department of Dermatology, CHU Saint-Pierre, Brugmann, HUDERF, 129, Bd de Waterloo, B-1000 Brussels, Free University of Brussels, Belgium.
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Ko CJ, Sarantopoulos GP, Pai G, Binder SW. Longitudinal melanonychia of the toenails with presence of Medlar bodies on biopsy. J Cutan Pathol 2005; 32:63-5. [PMID: 15660658 DOI: 10.1111/j.0303-6987.2005.00252.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 9-year-old girl presented with a 2-year history of pigmented streaks on her second right toenail as well as on her fourth and fifth left toenails. The patient was otherwise asymptomatic with no other physical findings. Owing to parental concern, a biopsy was performed, which revealed numerous bacteria as well as Medlar bodies overlying the nail bed with no evidence of a nevomelanocytic lesion. To our knowledge, this is the first report of Medlar bodies causing pigmented streaks in the toenails.
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Affiliation(s)
- Christine J Ko
- Department of Pathology and Laboratory Medicine, UCLA Medical Center, David Geffen School of Medicine, Los Angeles, CA 90095, USA
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Affiliation(s)
- J M L White
- King's College Hospital, Department of Dermatology, London, UK.
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Rizos E, Drosos A, Ioannidis J. Nail Pigmentation and Fatigue in a 39‐Year‐Old Woman. Clin Infect Dis 2003. [DOI: 10.1086/345553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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