Structural, Dermal and Ungual Characteristics of the Foot in Patients with Type II Diabetes

Background and Objectives: Diabetes is a chronic and metabolic disease, considered as an important public health problem. The objective of this study was to determine the prevalence of podiatric pathology in type II diabetic patients. Materials and Methods: An observational descriptive study of prevalence in the endocrinology service of Complexo Hospitalario Universitario A Coruña (CHUAC) (A Coruña-Spain) was carried out (n = 153). Type II diabetic patients included, of legal age who signed the informed consent. Sociodemographic variables were studied (age, sex, body mass index (BMI), smoking habit, alcohol consumption, family history), disease variables (time of evolution of diabetes, treatments, low-density lipoprotein (LDL), high-density lipoprotein (HDL), glucose), podiatric variables: measurement of the footprint, metatarsal and digital formula, nail, skin, hindfoot and forefoot alterations. The data collection was done in 2018 and the data analysis was carried out in 2019. Results: The patients with type II diabetes had greater age, obesity and arterial hypertension it compared to the general population. Diabetic patients had a higher prevalence of flat feet than the general population (71.2% vs. 20.7%, p < 0.001), with a predominance of normal foot according to the podoscope. The predominant podological pathology was the presence of claw toes (94.8%), followed by dermal (78.4%) and nail (71.9%) alterations, and the Hallux Valgus (66.0%). The Clarke angle and the Chippaux index showed a Kappa concordance index of 0.26 with the type of footprint measured with the podoscope. The Staheli index showed a Kappa index of 0.27 associated with an observed agreement of 54%. Conclusions: This study shows that foot problems continue to be prevalent in subjects with type II diabetes mellitus and for this reason, podiatry is essential in its treatment.

The microvascular and morphostructural changes of nails in psoriatic patients with nail disease; a link between ultrasound and videocapillaroscopy findings in the nailfold

OBJECTIVE

The objective of this study is to evaluate the link between nail fold vessel resistive index (NVRI) measured by ultrasound (US) and capillary loops diameters measured using nailfold videocapillarascopy (NVC), and to assess the morphological appearance of the nail bed in patients with psoriatic nail disease (PND) as compared with healthy controls (HCs).

MATERIAL AND METHODS

This study was conducted in patients with PND and HCs. General demographic data were collected and clinical assessments were performed for all subjects. The nail plate thickness (NPT) was measured on gray scale using US. The NVRI was measured using color Doppler (CD) US. The measurements of the apical, arterial, venous limb diameters and morpho-structural changes (tortuous, cross-linked capillaries) were assessed using NVC.

RESULTS

Thirty-four patients with PND and 15 HCs were enrolled in this study. The two groups were matched for age and body mass index (BMI). Patients with PND had higher NPT and NVRI in comparison with HCs [(20 (17-23) vs 14 (14-15), p<0.001), (0.55 (0.51-0.61) vs 0.43 (0.38-0.49), p<0.001), respectively]. A higher proportion of patients with PND had tortuous capillaries than HCs (62% and 20% respectively, p=0.005). The mean NVRI was higher in patients with PND who had tortuous capillaries than patients who did not have tortuous capillaries (0.58 (0.7) and 0.52 (0.09), respectively p=0.033).

CONCLUSION

Microvascular changes can be detected easily using non-invasive methods such as US and NVC. These methods can provide an objective data to better assess PND.

Protection during production: Problems due to prevention? Nail and skin condition after prolonged wearing of occlusive gloves

Wearing of occlusive gloves during the whole working shift is considered a risk factor for developing hand eczema, similar to wet work. Moreover, the increased hydration due to glove occlusion may lead to brittle nails. Two hundred and seventy clean room workers, wearing occlusive gloves for prolonged periods, and 135 administrative employees not using gloves were investigated. This included a dermatological examination of the nails and the hands, using the Hand Eczema ScoRe for Occupational Screening (HEROS), measurement of transepidermal water loss (TEWL), and a standardized interview. Of the clean room workers, 39%, mainly women, reported nail problems, mostly brittle nails with onychoschisis. Skin score values showed no significant differences between HEROS values of both groups. TEWL values of exposed subjects were similar to TEWL values of controls 40 min after taking off the occlusive gloves. In a multiple linear regression analysis, male gender and duration of employment in the clean room were associated with a significant increase in TEWL values. The effect of occlusion on TEWL seems to be predominantly transient and not be indicative of a damaged skin barrier. This study confirmed the results of a previous investigation showing no serious adverse effect of wearing of occlusive gloves on skin condition without exposure to additional hazardous substances. However, occlusion leads to softened nails prone to mechanical injury. Therefore, specific prevention instructions are required to pay attention to this side effect of occlusion.

Dermatologic Manifestations in End-stage Renal Disease

End-stage renal disease (ESRD) is a rapidly growing global health problem within the past decades due to increased life expectancy, diabetes mellitus, hypertension, and vascular diseases. Since ESRD is not curable definitively, patients suffering from ESRD have a very low quality of life; therefore, symptomatic management is the cornerstone of medical treatment. Uremia affects almost all body organs, such as skin, through different mechanisms including biochemical, vascular, neurologic, immunologic, hematologic, endocrine, and electrolyte and volume balance disturbances. Some of these conditions are associated with significant morbidity, and patients with ESRD commonly present with a spectrum of dermatologic disorders. Each one has its own unique presentation and treatment approaches. In this review article, we discuss the clinical presentation, pathophysiology, and treatment of the most common skin disorders associated with ESRD.

Association between morphological changes of nail and nail arsenic level in patients with arsenicosis

This case-control type of analytical study was conducted in the Department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh to find out the association between morphological changes of nail and nail arsenic level in arsenicosis patients. Majority of arsenicosis patients were male (56.67%). The mean age of the cases was 43.07+/-13.73 years. Nail changes were found in 26.67% of cases, most were nail dystrophy (23.33%) and rest were Mee's line (3.34%). There was significant difference between cases with or without nail changes and nail arsenic level. But cases with or with out nail changes had a significant difference between duration of intake of arsenic contaminated water. There was no correlation between nail changes and nail arsenic level for nail dystrophy and Mee's line. The study result failed to establish association between the morphological changes of nail and nail arsenic level.

Insights into the pathophysiology and management of dermatologic toxicities to EGFR-targeted therapies in colorectal cancer

Epidermal growth factor receptors (EGFRs) play an important role in the development of the skin and up-regulation of these receptors is associated with many cancer-related processes, such as inhibition of apoptosis and uncontrolled cell proliferation. Accordingly, treatment of metastatic colorectal cancer with EGFR inhibitors may lead to adverse cutaneous effects that can decrease the patient's quality of life and could possibly lead to reduced, interrupted, or discontinued therapy. Effective management of these adverse effects may lessen the chance of suboptimal therapy and requires an understanding of the underlying pathophysiology, as well as knowledge of useful strategies for alleviating these effects.

Multiple triangular lunula unguis: a specific finding for the nail-patella syndrome

In this case presentation recognition of multiple triangular lunula unguis led to the diagnosis of the rare nail-patella syndrome (NPS). A single triangular lunula may be traumatic in origin, but multiple, with apex pointing toward the free edge of the nail, must be considered part of the NPS especially when combined with absence of the distal interphalangeal joint creases.

Clinical presentation and pathophysiology of EGFRI dermatologic toxicities

This review summarizes the pathophysiology and clinical presentation of the cutaneous toxicities associated with EGFR inhibition. Such effects include papulopustular reactions, xerosis, pruritus, fissures, nail changes, hair changes, telangiectasias, hyperpigmentation, and mucositis. Most management strategies for these toxicities have been based on anecdotal experience; clinical trials are needed to provide uniform characterization to allow for evidence-based treatment strategies.

Vitamins and minerals: their role in nail health and disease

Nail health and appearance are global concerns. We investigated the use of biotin vitamin E, alpha-tocopherol, vitamin C (ascorbic acid), vitamin A, retinoids, retinol, retinal, silicon, zinc, iron, copper, selenium, and vitamin B12 (Cyanocobalamin) in nail health and disease. The evidence that we adduce in this paper suggests that: 1) proper nail care seems to help maintain nail health; 2) no evidence supports the use of vitamin supplementation with vitamin E, vitamin C (ascorbic acid), vitamin A, retinoids, retinol, retinal, silicon, zinc, iron, copper, selenium, or vitamin B12 (Cyanocobalamin) for improving the nail health of well-nourished patients or improving the appearance of nails affected by pathologic disease; and 3) brittle nail syndrome appears to abate with supplementation with a 2.5-mg dose of biotin daily or a 10-mg dose of silicon daily, a useful form of which is choline-stabilized orthosilicic acid.

Brittle nail syndrome: a pathogenesis-based approach with a proposed grading system

Brittle nail syndrome is a heterogeneous abnormality, characterized by increased fragility of the nail plate. Brittle nails affect about 20% of the population and women are affected twice as frequently as men. The vast majority of patients experience brittle nails as a significant cosmetic problem and a substantial number indicate that these nail abnormalities are painful, impair daily activities, and may have a negative impact on occupational abilities. Pathogenic factors leading to brittle nails are factors that impair intercellular adhesion of the corneocytes of the nail plate or factors that cause a pathologic nail formation by involving the matrix. Clinical features of brittle nail syndrome are onychoschizia and onychorrhexis: the impairment of intercellular adhesive factors of the nail plate is expressed as onychoschizia, whereas the involvement of the nail matrix is expressed as onychorrhexis. Although impairment of life quality has not been evaluated for patients with brittle nail syndrome, the reduction of life quality in other nail problems has been studied and is evident. A proposed scoring system of key features of brittle nails is presented, and therapeutic approaches focussed on the pathogenic factors are discussed.

The prevalence of temporomandibular disorders in patients with psoriasis with or without psoriatic arthritis

Psoriasis is a chronic, genetic, non-contagious skin disorder that appears in many different forms and can affect any part of the body, including the nails and scalp. It may affect the quality of life by causing psychosocial stress. Psoriatic arthritis (PA) is considered to be a spondyloarthropathy, and has spinal and peripheral joint involvement associated with psoriasis. The purpose of this study was to evaluate the prevalence of signs and symptoms of temporomandibular disorders (TMD) in patients with psoriasis without PA and in patients with PA and compare with a healthy group. Signs and symptoms of TMD were evaluated by means of Helkimo's Anamnestic (Ai) and Dysfunction indices (Di). In the present study, patients with psoriasis without arthritis did not report TMD signs and symptoms significantly more often than healthy subjects. A statistically significant increase was found in patients with PA when compared with psoriasis patients without arthritis and healthy patients in Di. In patients with PA, muscle tenderness on palpation, temporomandibular joint sounds and stiffness/tiredness in jaws in the morning were the most frequent findings. It is concluded that the signs and symptoms of TMD in PA is caused mainly by related joint involvement that directly affects the masticatory system.

Colour duplex sonography of finger arteries in vasculitis and in systemic sclerosis

CASE REPORTS

Three patients-two with Wegener's granulomatosis and one with an overlap syndrome of rheumatoid vasculitis, systemic lupus erythematosus, and antiphospholipid syndrome-are described. All patients experienced a sudden onset of Raynaud's phenomenon or acrocyanosis when they had a flare of their disease.

DISCUSSION

Ultrasonography (US) showed dark (hypoechoic) arteries without colour signals, resembling the US pattern of embolism. In contrast, US in patients with systemic sclerosis is entirely different, delineating a smaller artery lumen, reduced pulsation, and thickened, slightly hyperechoic artery walls.

Hair and nail relationship

Hair and nails are often stated to have much in common in relation to their origin, anatomical structures, and common involvement in many diseases. Hair and nails are predominantly epithelial structures derived from primitive epidermis and made up of keratinous fibrils embedded in a sulfur-rich matrix. It was first noted early in the 20th century that the nail unit was comparable in several respects to a hair follicle sectioned longitudinally and laid on on its side. The epithelial components of hair follicle and nail apparatus are differentiated epidermal structures that may be involved jointly in several ways as congenital and hereditary anomalies and acquired conditions such as alopecia areata, lichen planus, iatrogenic causes, and fungal infection. Multielemental characterization of human hair and nails shows that even after sample washing, many elements are enriched in the surface of the nails.

Housewife onycholysis

OBJECTIVE

The aim of this study was to evaluate the clinical and microbiological aspects of onycholysis in Iraqi housewives.

METHODS

One hundred housewives with onycholysis of the finger nails were evaluated clinically in the Department of Dermatology and Venereology, Baghdad Teaching Hospital, Baghdad, Iraq between October 2002 to March 2003. Swabs were taken from those patients for microbiological evaluation in the Department of Microbiology, College of Medicine, University of Baghdad, Baghdad, Iraq. All cases with skin disorder related systemic diseases like anemia, hypothyroidism and drug intake like minocycline, oral contraceptives were excluded from the study.

RESULTS

One hundred housewives with onycholysis were enrolled in the study. Their ages ranged between 17-70 years with a mean of 41.96 +/- 12.57 years. Married females were 89 (89%), while unmarried females were 11 (11%). The site of involvement was mainly the thumb (76%) followed by the ring finger (12%), the index (7%), little (6%) and middle (5%) fingers. The pattern of onycholysis was distal in 47 (47%), lateral in 30 (30%) and both distal and lateral in 23 (23%) of the patients.

CONCLUSION

Onycholysis is a major problem among Iraqi housewives, most probably caused by repetitive mechanical, chemical and physical trauma; therefore, special preventive measures should be undertaken to minimize the incidence of the disease. Housewives should be encouraged to use preventive measures like using gloves and washing machines.

Nail discoloration induced by doxycycline

All tetracyclines are deposited in calcifying areas of the bones and teeth and may cause discoloration. Although hyperpigmentation of the skin, teeth and nails have been reported and well documented due to other tetracycline intake, it has been rarely reported that discolored nails induced by doxycycline in pediatric patients. Here we report an 11-year-old-boy with nail discoloration caused by doxycycline intake.

Common and uncommon hair and nail problems in sports

We report an exhaustive review of the hair and nail conditions related to participation in sports. It is important that medical professionals who care for athletes recognize the unique dermatologic conditions that may affect those athletes.

Nail changes and disorders among the elderly

Nail disorders are frequent among the geriatric population. This is due in part to the impaired circulation and in particular, susceptibility of the senile nail to fungal infections, faulty biomechanics, neoplasms, concurrent dermatological or systemic diseases, and related treatments. With aging, the rate of growth, color, contour, surface, thickness, chemical composition and histology of the nail unit change. Age associated disorders include brittle nails, trachyonychia, onychauxis, pachyonychia, onychogryphosis, onychophosis, onychoclavus, onychocryptosis, onycholysis, infections, infestations, splinter hemorrhages, subungual hematoma, subungual exostosis and malignancies. Awareness of the symptoms, signs and treatment options for these changes and disorders will enable us to assess and manage the conditions involving the nails of this large and growing segment of the population in a better way.

Spontaneous regression of subungual keratoacanthoma with reossification of underlying distal lytic phalynx

A 45-year-old man presented with a rapidly enlarging keratotic lesion of the distal subungual right middle finger. An X-ray of the digit revealed a well-defined cup-shaped lytic lesion of the phalynx underlying the subungual nodule. The lesion resolved spontaneously with reossification of the underlying bony defect. The clinical history and X-ray is consistent with a diagnosis of spontaneously resolving subungual keratoacanthoma.

H�ufige Ver�nderungen und Krankheiten des Nagelapparates

Disorders of anatomical variants of the nails are often seen in clinical practice. Their correction identification and interpretation are essential dermatological skills. The increasing emphasis on aesthetic considerations in dermatology means that even the slightest nail changes may assume significance for their patients. In order to skillfully evaluate nails, one must be familiar with the terminology and classification of nail disorders. The nail plate, nail bed and periungual tissue may also be affected. Longitudinal melanonychia is especially important as a possible clue to subungual melanoma.

Physical demands and injuries to the upper extremity associated with the space program

Hand and upper-extremity overuse and repetitive injuries in astronauts have been and continue to be a common problem in the space program. The demands on upper-extremity use in the astronaut training program, the zero-gravity environment, the extreme temperature conditions of space, the effects of space travel on human physiology/anatomy, and the constraints and pressures of space suits and gloves all can negatively impact upper-extremity function in ways that can result in overuse/repetitive injuries. Future plans for space exploration include endeavors that will continue and even increase the demands on the hand and upper extremity.

[Physiological skin changes during pregnancy]

A NATURAL PHENOMENON: Pregnancy is a period of hormone, immunological, metabolic and vascular changes. Modifications of the skin, mucosa and integuments are therefore physiological. The modifications are in pigmentation, but also affect nevi, the connective tissue, vessels and appendices. Modifications in pigmentation exist in more than 9 pregnancies out of 10 in the form of local melanosis. Melasma, also know as the 'pregnancy mask' or chloasma, is fairly rare. These disorders in pigmentation are also observed in black-skinned women. Changes in nevi (darker brown colour, increase in size) occur in around 15% of pregnancies. MODIFICATIONS IN CONNECTIVE TISSUE: Characterised by vergetures, affecting 60 to 90% of women, appear between the 6th and 8th month of pregnancy and for which there is no satisfactory treatment. Vascular modifications are generally proliferative and due to estrogen impregnation that affects the arteriolar and venous systems. Stellar angiomas are present in 50 to 70% of Caucasian women. Bilateral palmar erythema may also be associated with these angiomas. Varicose veins and varicosities of the lower limbs induced by excessive venous pressure are frequent, as well as oedema (salt-water retention, increased capillary permeability). MODIFICATIONS IN THE APPENDICES: These concern the activity of the sweat glands, the size of the sebaceous glands (Montgomery tubercles), the nails and hair growth.

Dermatological and ophthalmological sequels in toxic epidermal necrolysis

BACKGROUND

Toxic epidermal necrolysis (TEN) is a rare, drug-induced disease characterized by epidermal detachment and mucosal involvement. After an acute period, potentially disabling cutaneous and ocular sequels may appear. Although long-term complications are not rare, only few outcome studies are published.

OBJECTIVE

To evaluate the incidence of dermatological and ophthalmological sequels following TEN, to describe its clinical aspects and correlation with acute involvement.

PATIENTS AND METHODS

Eight patients surviving to TEN were submitted to dermatological and ophthalmological observation ranging from 0.5 to 8 years after hospitalization. Cutaneous and ocular involvement, during the acute phase, was retrospectively analysed.

RESULTS

Dermatological sequels were observed in 6 patients (75%) corresponding to those with more extensive skin involvement in the acute phase. The most frequent complications were cutaneous dyschromia (62.5%) and nail dystrophies (37.5%). Six patients (75%) had ocular complications with tarsal conjunctiva keratinization in 5 (62.5%) and keratoconjunctivitis sicca in 4 of them (50%). Trichiasis, corneal neovascularization and symblepharon were observed in 1 case. There was no correlation between the severity of acute ocular involvement and long-term complications.

CONCLUSION

Following TEN, most patients have dermatological and ophthalmological sequels that persist for several years.

Psoriatic nails: a prospective clinical study

BACKGROUND

Psoriasis is a widespread skin disorder in which nail involvement is a common symptom. Many psoriatic patients have nail changes morphologically resembling onychomycosis.

OBJECTIVE

The present study was undertaken (1) to evaluate the frequency of nail involvement in psoriatic patients, (2) to assess the types of nail changes in psoriasis, (3) to find eventual relationships between nail involvement and some clinical parameters, and finally (4) to determine the prevalence of fungal nail infections in psoriatic individuals.

MATERIAL AND METHODS

One hundred six patients hospitalized in our department due to exacerbation of psoriasis participated in the study. Each patient underwent dermatologic examination with special attention paid to the nail changes. In any case of abnormalities clinically suspected of fungal infection, further mycological investigations were performed.

RESULTS

Nail changes were present in 83 patients (78.3%) with psoriasis. The most common nail abnormality observed on both fingernails and toenails was subungual hyperkeratosis. Hyperkeratosis, onychorrexis, and discoloration of nail plates were observed significantly more often on toenails. Pitting and longitudinal ridges were significantly more frequent on fingernails. Patients with psoriatic nail dystrophy were significantly older than psoriatic patients without nail abnormalities. Nails were involved statistically more often in patients with arthropathic psoriasis. Positive mycological cultures were obtained from 18% of patients with nail changes. The most commonly isolated fungi were molds.

CONCLUSIONS

Dystrophic nails are frequently found in psoriatic individuals, especially those suffering from arthropathic psoriasis. Subungual hyperkeratosis and pitting are the most typical lesions. It is difficult to assess definitively whether psoriasis is a predisposing factor to the development of fungal infections of the nails.

Onycholysis and subungual haemorrhages secondary to systemic chemotherapy (paclitaxel)

Paclitaxel is a chemotherapic agent of the taxane family used in treatment of malignant solid tumory. We report here the case of a 40-year old woman referred to our clinic for nail changes involving all 20 digits and developed after 5 months of paclitaxel intake, due to a breast carcinoma. Clinical examination revealed red-brown discoloration of the nails associated with hematomas and onycholysis. The nail changes were very painful and the patient complained of discharge of bad-smelling yellow brown opaque fluid from underneath the nail plate. Hemorrhagic onycholysis and subungual abscesses are a possible side effect of taxane treatment that should be early recognized to prevent serious complications.

[Upper respiratory tract manifestations in yellow nail syndrome]

Yellow Nail Syndrome (YNS) is characterized by a triad of ankle edema, pleural effusion and yellow nails. A close association was also found between YNS and rhinitis and sinusitis ranging from 25% to 83%. Although usually other symptoms precede rhinosinusitis, we describe three cases in which the onset of the upper respiratory tract manifestations predated nail changes and other characteristics of YNS. Our aim is to emphasize the importance of upper respiratory tract diseases in this uncommon syndrome.

Yellow nail syndrome: does protein leakage play a role?

Yellow nail syndrome is characterized by primary lymphoedema, recurrent pleural effusion and yellow discoloration of the nails. Although mechanical lymphatic obstruction is assumed to be the underlying pathology, it cannot explain the common finding of high albumin concentration in the pleural space. This paper describes a case of yellow nail syndrome presenting with the classical triad of lymphoedema, recurrent pleural effusion and yellow discoloration of the nails, associated with persistent hypoalbuminaemia and increased enteric loss of albumin. Based on the findings in this case and those in the literature, it is speculated that increased microvascular permeability may contribute to the pathogenesis of this syndrome.

[Pigmented lesions of the nail apparatus]

Linear pigmentation of the nail apparatus most reflects longitudinal melanonychia. It results either from simple activation of matrical melanocytes induced by various factors or from benign (lentigo or naevus) or malignant (melanoma) melanocyte hyperplasia. Hematomas and some fungal infections can falsely resemble linear pigmentation. Non-linear pigmented lesions of the nail bed are most often subungual hematoma or infections (fungal, or pyocyanic superfection of a loosened or separated nail). Opening the nail bed directs the diagnosis. A possible tumoral cause should be kept in mind, especially melanoma, or carcinoma.

[Keratin diseases]

The rapid development in human genome research has resulted in a tremendous increase in our understanding of the molecular basis of many genetic skin diseases. One outstanding example of this is diseases caused by mutations in keratin genes, which comprise several disorders of the epidermis, as for example the different types of epidermolysis bullosa simplex. In this respect, the most important questions have been to 1. Define the molecular defect. 2. Unravel the pathophysiological mechanisms that lead to the characteristic phenotype and 3. Design of new therapeutic strategies. Molecular research has contributed significantly to the first two issues whereas a therapeutic break-through has yet to appear.

Yellow nail syndrome: the nail that grows half as fast grows twice as thick

We report a case of a 51-year-old man with yellow nail syndrome (YNS).1 During a 23-week period of study, the dynamics of thumbnail growth were compared between one affected thumb and the normal contralateral thumb. Longitudinal nail growth was normal (0.46 mm/week) in the normal thumb and double that of the affected thumb (0.23 mm/week). Thickness of nail at the free edge in the affected thumb (0.97 mm) was twice that of the normal thumb (0.57 mm). Within the nail plate in the dorso-ventral axis there were 50% more cells in the affected thumb (358) in comparison with the contralateral control (242). This case illustrates that rate of longitudinal growth does not necessarily reflect nail plate production.

Yellow nail syndrome and bilateral cystic lung disease

In patients with yellow nail syndrome (YNS), highly characteristic nail changes are often associated with lymphedema and respiratory disorders due to pleural effusions or bronchiectasis. We describe a 4-year-old girl with the YNS who also had cystic lesions of the lung, affecting first the left lower lobe and, after surgical resection of the involved segments, also the right lower lobe. We discuss the etiology of the pulmonary cysts and hypothesize that abnormalities in pulmonary lymphatic flow, characteristic of YNS, may have decreased lung tissue compliance and determined the unusual progression of the cystic lesions in this patient.

Topical anthralin therapy for refractory nail psoriasis

The nail is commonly involved in psoriasis; however, very few therapies are satisfactory. In this study, we treated for 20 cases of psoriasis vulgaris with nail involvement with topical anthralin therapy. An ointment of 0.4-2.0% anthralin in petrolatum was applied to the affected nail bed once a day and washed away with water after 30 minutes. Then, 10% triethanolamine cream was applied to prevent undesired pigmentation. Within five months of therapy, twelve out of twenty psoriatic patients (60%) showed moderate and obvious improvement, four patients (20%) showed no response to this regimen. Onycholysis and pachyonychia both responded clinically, and the number of pitting was markedly decreased in some cases. The main side effect of anthralin therapy was reversible pigmentation of the nail plate. Topical anthralin therapy is effective for nail psoriasis and considered to be a useful treatment for refractory nail psoriasis.

Treatment of subungual myxoma preserving the nail matrix: a case report

Subungual myxomas are uncommon, benign, expansile lesions that club the fingertip. Traditionally the nail matrix is incised, which results in permanent nail deformity. This report describes a midlateral approach that not only spares the nail apparatus but demonstrates that the nail can remodel even if a void is left under the nail matrix after excision of the tumor. The histologic examination of the tumor is described.

The relation between nailfold bleeding and capillary microscopic abnormality in patients with connective tissue diseases

BACKGROUND

Patients with connective tissue diseases, mainly scleroderma, show nailfold bleeding and nailfold capillary abnormality. An attempt was made to determine the possible relation between nailfold bleeding and nailfold capillary abnormality.

METHODS

The correlation between nailfold bleeding and nailfold capillary abnormality was studied using quantitative nailfold capillary microscopy.

RESULTS

The frequencies of nailfold bleeding in scleroderma, mixed connective tissue disease, dermatomyositis/polymyositis, and secondary Raynaud's phenomenon were significantly higher than those of normal controls. The distributions of abnormal values of capillary parameters in scleroderma, mixed connective tissue disease, dermatomyositis/polymyositis, systemic lupus erythematosus, primary Sjögren's syndrome, secondary Raynaud's phenomenon, primary Raynaud's phenomenon, and diabetes mellitus were significantly higher than those of normal controls. In normal controls, scleroderma, mixed connective tissue diseases, dermatomyositis/polymyositis, systemic lupus erythematosus, primary Sjögren's syndrome, primary Raynaud's phenomenon, and diabetes mellitus, all nailfold bleeding was observed in subjects with nailfold capillary abnormality. The distribution of nailfold bleeding in secondary Raynaud's phenomenon with abnormal values of capillary parameters was significantly higher than that with normal values.

CONCLUSIONS

There is a close relationship between nailfold bleeding and nailfold capillary abnormality.

Colloidal silicic acid for the treatment of psoriatic skin lesions, arthropathy and onychopathy. A pilot study

In a randomized, double-blind study, patients with chronic plaque-type psoriasis were either treated with 30 ml colloidal silicic acid gel, orally, daily, and topically with the same gel (n = 15), or were treated identically with placebo gel (n = 15) for 3 months. One stable psoriatic lesion on the knee or elbow was treated topically and followed throughout the study. Five patients in the treated group and seven controls had psoriatic arthropathy and 11 treated patients and 12 controls had psoriatic onychopathy. Three treated patients and six controls withdrew because of skin irritation or lack of efficacy. In the treated group there were clear improvements in scaling, induration and erythema after treatment. The nail changes were cured in five of 10 evaluable patients in the treated group and joint pain was reduced by almost half in the four evaluable patients with arthropathy. There were no such improvements in the placebo group.