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Albucker SJ, Conway J, Lipner SR. Nails in older adults. Ann Med 2024; 56:2336989. [PMID: 38738374 PMCID: PMC11095289 DOI: 10.1080/07853890.2024.2336989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 03/25/2024] [Indexed: 05/14/2024] Open
Abstract
As the world's population of adults greater than 60 years old continues to increase, it is important to manage nail disorders that may impact their daily lives. Nail disorders may have significant impact on quality of life due to decreased functionality, extreme pain, or social embarrassment. In this review, we discuss nail disorders affecting older patients, including physiologic, traumatic, drug-induced, infectious, environmental, inflammatory, and neoplastic conditions. Diagnosis of these conditions involves a detailed history, physical examination of all 20 nails, and depending on the condition, a nail clipping or biopsy and/or diagnostic imaging. Nails grow even more slowly in older adults compared to younger individuals, and therefore it is important for accurate diagnosis, and avoidance of inappropriate management and delay of treatment. Increased awareness of nail pathologies may help recognition and management of nail conditions in older adults.
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Affiliation(s)
- Samantha Jo Albucker
- Department of Dermatology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Jade Conway
- Department of Dermatology, NY Medical College, Valhalla, NY, USA
| | - Shari R. Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
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2
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Affiliation(s)
- Christoph Raschka
- Praxis für Allgemeinmedizin - Sportmedizin, Im Igelstück 31, 36088, Hünfeld, Deutschland
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3
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Rubino K, Ricci C, Zueger M, Kirk J, Terzian T. Exploring the link between UV nail lamps and subungual skin cancer: A call for research. J Cosmet Dermatol 2024; 23:1923-1924. [PMID: 38174603 DOI: 10.1111/jocd.16172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/30/2023] [Accepted: 12/28/2023] [Indexed: 01/05/2024]
Affiliation(s)
- Kendrick Rubino
- Rocky Vista University College of Osteopathic Medicine, Parker, Colorado, USA
| | - Corinne Ricci
- Rocky Vista University College of Osteopathic Medicine, Parker, Colorado, USA
| | - Morgan Zueger
- Rocky Vista University College of Osteopathic Medicine, Parker, Colorado, USA
| | - Jessica Kirk
- Rocky Vista University College of Osteopathic Medicine, Parker, Colorado, USA
| | - Tamara Terzian
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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4
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Tanaka AA, Werner B, Bragatto ACB, Skare TL, Stadler B. Ultrasonographic and power doppler parameters of nails fail to differentiate between onychodystrophy in patients with psoriasis vulgaris or psoriatic arthritis. Adv Rheumatol 2024; 64:25. [PMID: 38605415 DOI: 10.1186/s42358-024-00367-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/30/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Nail involvement is frequent in patients with psoriasis (Pso) and psoriatic arthritis (PsA) and there is a relationship between nail involvement and inflammation of the enthesis. The main objective of the present study is to describe the ultrasound findings and clinical characteristics of nails from patients with psoriasis and psoriatic arthritis with and without nail dystrophy. METHODS A cross-sectional study including consecutive patients with PsO and PsA was carried out. The study patients were divided into 4 groups, totaling 120 participants. Group 1: patients with psoriasis vulgaris and clinically normal nails; Group 2: patients with psoriasis vulgaris and onychodystrophy; Group 3: patients with psoriatic arthritis and clinically normal nails; Group 4: patients with psoriatic arthritis and onychodystrophy; All patients were submitted to dermatological and rheumatological clinical analysis. Ultrasound examinations was performed by a single examiner, blinded to all clinical data, with ultrasound high resolution, in B-mode or gray-scale (GS), Power Doppler (PD) and Spectral Doppler. RESULTS A significant difference was found between the groups regarding the variable Psoriasis Area and Severity Index (PASI) (p = 0.008) and body surface area (BSA) (p = 0.005), with patients with psoriatic arthritis having lower PASI and BSA compared to patients with only cutaneous psoriasis. A positive relationship was found with the average ultrasound thickness of the nail bed and the Nail Psoriasis Severity Index (NAPSI) in correlation analysis (rho = 0.344). When we grouped patients with psoriasis and psoriatic arthritis, there was no significant difference between the cutaneous psoriasis groups and the psoriatic arthritis groups in terms of nail plate GS (p = 0.442), nail bed PD (p = 0.124). CONCLUSION Greater nail bed thickness indicates early psoriatic nail disease, as confirmed in our study correlating NAPSI with nail bed thickness. Ultrasonography is a low-cost exam, promising in the evaluation, showing that the ultrasound grayscale is consistent with those who have dystrophic nails, but it can't distinguish psoriasis from psoriatic arthritis, even in those with nail dystrophy.
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Affiliation(s)
- Anber Ancel Tanaka
- Dermatology Service, Mackenzie Evangelical University Hospital, Avenida Sete de Setembro 4698 Sala 201, CEP: 80730-320, Curitiba, Paraná, Brazil.
| | - Betina Werner
- Post-graduate Program - Internal Medicine and Health Sciences, Federal University of Paraná, Curitiba, Paraná, Brazil
- Department of Pathology, Clinics Hospital of the Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Annelise Correa Bueno Bragatto
- Dermatology Service, Mackenzie Evangelical University Hospital, Avenida Sete de Setembro 4698 Sala 201, CEP: 80730-320, Curitiba, Paraná, Brazil
| | - Thelma Larocca Skare
- Reumathology Service, Mackenzie Evangelical University Hospital, Curitiba, Paraná, Brazil
| | - Bárbara Stadler
- Reumathology Service, Mackenzie Evangelical University Hospital, Curitiba, Paraná, Brazil
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Galarza-Delgado DA, Azpiri-Lopez JR, Flores-Alvarado DE, Guajardo-Jauregui N, Cardenas-de la Garza JA, Arvizu-Rivera RI, Gonzalez-Gonzalez V, Reyes-Soto MA, Colunga-Pedraza IJ. Obesity is associated with higher nail psoriasis disease activity and prevalence in patients with psoriatic arthritis. Int J Dermatol 2024; 63:e1-e2. [PMID: 37994111 DOI: 10.1111/ijd.16933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Dionicio A Galarza-Delgado
- Rheumatology Service, Hospital Universitario "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Jose R Azpiri-Lopez
- Cardiology Service, Hospital Universitario "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Diana E Flores-Alvarado
- Rheumatology Service, Hospital Universitario "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Natalia Guajardo-Jauregui
- Internal Medicine Department, Hospital Universitario "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Jesus A Cardenas-de la Garza
- Rheumatology Service, Hospital Universitario "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Rosa I Arvizu-Rivera
- Rheumatology Service, Hospital Universitario "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Valeria Gonzalez-Gonzalez
- Rheumatology Service, Hospital Universitario "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Mayra A Reyes-Soto
- Rheumatology Service, Hospital Universitario "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Iris J Colunga-Pedraza
- Rheumatology Service, Hospital Universitario "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
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6
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Starkey SY, Mar K, Khaslavsky S, Seeburruth D, Khalid B, Virmani D, Lam JM, Mukovozov I. Atypical cutaneous findings of hand-foot-mouth disease in children: A systematic review. Pediatr Dermatol 2024; 41:23-27. [PMID: 37877202 DOI: 10.1111/pde.15461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/08/2023] [Indexed: 10/26/2023]
Abstract
INTRODUCTION Hand-foot-mouth disease (HFMD) is a common childhood infectious disease. Atypical skin findings of HFMD, often associated with coxsackievirus A6 (CVA6), were first reported in 2008, with increasing reports worldwide since. Atypical lesions of HFMD often involve sites beyond the palms and soles and tend to have unusual, polymorphic morphology. METHODS A systematic review was conducted on clinical features and outcomes of pediatric HFMD with atypical cutaneous manifestations. RESULTS Eighty-five studies were included, representing 1359 cases with mean age 2.4 years and a male predominance of 61%. The most reported morphologies were vesicles (53%), papules (49%), and bullae (36%). Other morphologies included eczema herpeticum-like (19%), purpuric/petechial (7%), and Gianotti Crosti-like (4%). Common atypical sites included the arms and/or legs (47%), face (45%), and trunk (27%). CVA6 was identified in 63% of cases. Symptoms resolved in a mean of 10 days. Overall, 16% of cases received treatment, most commonly with acyclovir, intravenous antibiotics, or topical steroids. The most common complications were nail changes (21%) and desquamation (4%) which occurred a mean of 3 and 2 weeks after symptoms, respectively. CONCLUSION Due to unusual morphologies resembling other conditions, HFMD with atypical cutaneous findings may be misdiagnosed, leading to inappropriate and unnecessary investigations, hospitalization, and treatment. Greater awareness of atypical presentations of HFMD is warranted to improve patient care and counseling on infection control precautions.
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Affiliation(s)
- Samantha Y Starkey
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Nemours Children's Hospital Delaware, Wilmington, Delaware, USA
| | - Kristie Mar
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Bushra Khalid
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Divya Virmani
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Island Infectious Disease Consultants, Victoria, British Columbia, Canada
| | - Joseph M Lam
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Ilya Mukovozov
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
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7
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Arun Babu T, Nagendran P. Idiopathic onychomadesis. BMJ Case Rep 2023; 16:e257235. [PMID: 38056926 PMCID: PMC10711881 DOI: 10.1136/bcr-2023-257235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Affiliation(s)
- Thirunavukkarasu Arun Babu
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Andhra Pradesh, India
| | - Prabhakaran Nagendran
- Department of Dermatology, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Andhra Pradesh, India
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8
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Schneider C, Williams NM, Morrison BW, Tosti A. Nail disorders in skin of color: A retrospective chart review over a 5-year period. J Am Acad Dermatol 2023; 89:1315-1317. [PMID: 37659456 DOI: 10.1016/j.jaad.2023.08.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 08/20/2023] [Accepted: 08/25/2023] [Indexed: 09/04/2023]
Affiliation(s)
- Caralin Schneider
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida.
| | - Natalie M Williams
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Brian W Morrison
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Antonella Tosti
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
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9
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Starace M, Cedirian S, Alessandrini A, Bruni F, Piraccini BM, Iorizzo M. Self-induced nail disorders (SINDs): What do we know so far? Ann Dermatol Venereol 2023; 150:253-259. [PMID: 37813711 DOI: 10.1016/j.annder.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/17/2023] [Accepted: 05/09/2023] [Indexed: 10/11/2023]
Abstract
Self-induced nail disorders are a broad group of different clinical manifestations that share the common trait of being caused more or less voluntarily by the patient. These are distinct conditions within the clinical spectrum of onychotillomania. Most patients diagnosed with these disorders have psychiatric co-morbidities, and a multidisciplinary approach is thus highly recommended. The purpose of this review is to describe the most common clinical features encountered during daily nail consultations and to provide useful diagnostic tools and therapeutic tips for the best approach to these conditions.
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Affiliation(s)
- M Starace
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Bologna, Italy
| | - S Cedirian
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Bologna, Italy.
| | - A Alessandrini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Bologna, Italy
| | - F Bruni
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Bologna, Italy
| | - B M Piraccini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Bologna, Italy
| | - M Iorizzo
- Private Dermatology Practice, Lugano/Bellinzona, Switzerland
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10
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Follows AM, Follows GA. Transverse Leukonychia (Mees' Lines). N Engl J Med 2023; 389:e48. [PMID: 38009615 DOI: 10.1056/nejmicm2304533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Affiliation(s)
- Annabel M Follows
- University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
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11
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Paudyal A, Yang Y, Zheng M, Zhang X, Wang H, Gong S, Regmi P, Lyu X. Assessment of nail fold capillary changes by hand-held dermoscopy in adult dermatomyositis: A single-centre prospective study. Australas J Dermatol 2023; 64:514-521. [PMID: 37723903 DOI: 10.1111/ajd.14157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 08/13/2023] [Accepted: 08/31/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Hand-held dermoscopy is a valuable tool for dermatologists, but it has been rarely used to assess the nail fold capillary (NFC) in patients with dermatomyositis (DM). METHODS Patients were collected from the Department of Dermatology and Venereology from July 2020 to July 2021, and the follow-up was conducted until January 2022. Demographic features, disease activity and NFC changes were analysed using a hand-held dermoscopy. RESULTS The most common NFC finding in our study was bushy capillary (87.0%). There was no significant improvement in scleroderma-dermatomyositis (SD)-like nail fold changes or enlarged capillaries from baseline to 12 weeks of treatment (p > 0.05) or from 12 weeks to 24 weeks of treatment (p > 0.05), but there was a significant improvement from baseline to 24 weeks of treatment (p < 0.05). The avascular area did not improve from baseline to 12 weeks of follow-up, but the changes were significant from 12 weeks to 24 weeks of treatment (p < 0.05) and baseline to 24 weeks of treatment (p < 0.05). Periungual erythema improved significantly from baseline to 12 weeks of treatment (p < 0.05) and baseline to 24 weeks of treatment (p < 0.05), but it did not improve significantly from 12 weeks to 24 weeks of treatment (p > 0.05). There was no significant difference in disease activity between patients with or without specific NFC changes. However, some NFC features improved as disease activity decreased. CONCLUSION Dermoscopy of NFC is a cost-effective option for the preliminary diagnosis of DM. Further, long-term follow-up is necessary to study the relationship between disease activity and NFC changes.
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Affiliation(s)
- Aliza Paudyal
- Department of Dermatology and Venereology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Department of Dermatology and Venereology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Yao Yang
- Department of Dermatology and Venereology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Zheng
- Department of Dermatology and Venereology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Xingwei Zhang
- Department of Dermatology and Venereology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Han Wang
- Department of Dermatology and Venereology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Shirui Gong
- Department of Dermatology and Venereology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Parbatraj Regmi
- Department of Dermatology and Venereology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoyan Lyu
- Department of Dermatology and Venereology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
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12
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Chen TL, Chen CC. Multiple Beau Lines and Onychomadesis. Mayo Clin Proc 2023; 98:1727-1728. [PMID: 37923530 DOI: 10.1016/j.mayocp.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/07/2023] [Accepted: 06/20/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Tai-Li Chen
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Chiang Chen
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, Department of Dermatology, and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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13
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Yang L, Wang T, Liu Y. Onycholysis and purpuric nail striae in a child. Pediatr Dermatol 2023; 40:1124-1126. [PMID: 37970690 DOI: 10.1111/pde.15317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 03/25/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Lu Yang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Wang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuehua Liu
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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14
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Wu PC, Wu J, Hung YT. Nail Changes in a Patient With Cancer. Mayo Clin Proc 2023; 98:1442-1443. [PMID: 37793722 DOI: 10.1016/j.mayocp.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/12/2023] [Accepted: 05/05/2023] [Indexed: 10/06/2023]
Affiliation(s)
- Po-Chien Wu
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Jennifer Wu
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.
| | - Yi-Teng Hung
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
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15
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Bnaya A, Tvito A, Ben-Chetrit E, Shavit L, Breuer GS. An unusual case of AL amyloidosis presenting as alopecia and nail changes. Intern Emerg Med 2023; 18:2133-2134. [PMID: 37086347 DOI: 10.1007/s11739-023-03284-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/14/2023] [Indexed: 04/23/2023]
Affiliation(s)
- Alon Bnaya
- Institute of Nephrology, Shaare Zedek Medical Center, Affiliated With the Hebrew University, P.O Box 3235, 91031, Jerusalem, Israel.
| | - Ariella Tvito
- Department of Hematology, Shaare Zedek Medical Center,, Affiliated With the Hebrew University, Jerusalem, Israel
| | - Eli Ben-Chetrit
- Infectious Diseases Unit, Shaare Zedek Medical Center, Affiliated With the Hebrew University, Jerusalem, Israel
| | - Linda Shavit
- Institute of Nephrology, Shaare Zedek Medical Center, Affiliated With the Hebrew University, P.O Box 3235, 91031, Jerusalem, Israel
| | - Gabriel Simon Breuer
- Rheumatology Unit, Shaare Zedek Medical Center, Affiliated With the Hebrew University, Jerusalem, Israel
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16
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Sangwan P, Dhiman A, Hazarika N. Idiopathic Acquired True Total Leukonychia. Skinmed 2023; 21:293-294. [PMID: 37771027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Affiliation(s)
- Priyanka Sangwan
- The Department of Dermatology, Venereology, and Leprology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Avita Dhiman
- The Department of Dermatology, Venereology, and Leprology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Neirita Hazarika
- The Department of Dermatology, Venereology, and Leprology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India;
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17
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Oska C, Morrison B, Tosti A. Postinflammatory pigmentation and friction melanonychia. Int J Dermatol 2023; 62:e474-e476. [PMID: 36683209 DOI: 10.1111/ijd.16601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/23/2022] [Accepted: 01/07/2023] [Indexed: 01/24/2023]
Affiliation(s)
- Caroline Oska
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Brian Morrison
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Antonella Tosti
- University of Miami Miller School of Medicine, Miami, FL, USA
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18
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Lafreniere AS, Misati G, Knox A. Approach to nail trauma for primary care physicians. Can Fam Physician 2023; 69:609-613. [PMID: 37704235 PMCID: PMC10498896 DOI: 10.46747/cfp.6909609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
OBJECTIVE To provide an overview and approach to common nail bed injuries seen by primary care practitioners. SOURCES OF INFORMATION An Ovid MEDLINE literature search was performed using search terms and studies were graded based on level of evidence. MAIN MESSAGE Nail trauma is common in primary care practice and requires proper and prompt treatment to avoid lasting effects on finger function and cosmesis. When presented with a fingernail injury, primary care physicians should perform a thorough physical examination to determine extent of injury; take a history to rule out notable risk factors; perform a comprehensive neurovascular examination to assess pulp capillary refill, to do a 2-point discrimination, and to compare with an uninjured digit; and evaluate range of motion. Clinical evaluation may require local anesthesia and a tourniquet. Nail bed trauma can present in different ways and includes subungual hematomas, distal phalanx fractures, Seymour fractures, and-in more severe cases-fragmentation or avulsion of the nail bed. Treatment for subungual hematomas where the nail plate is intact does not require nail plate removal and nail bed exploration; however, exploration and repair are indicated for a nail plate injury, a proximal fracture involving the germinal matrix, and a distal phalanx fracture requiring stabilization. CONCLUSION Fingertips are essential to normal hand function. Nail trauma is common and can be managed by primary care physicians. Shared decision making concerning management is based on the mechanism and extent of the injury and aims to prevent secondary deformities.
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Affiliation(s)
| | | | - Aaron Knox
- Plastic surgeon at the Peter Lougheed Centre in Calgary
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19
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Jiang J, Kern JS, Tam M. A simple solution for habit-tic nail deformity. Australas J Dermatol 2023; 64:e295-e296. [PMID: 37195687 DOI: 10.1111/ajd.14077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/05/2023] [Accepted: 04/29/2023] [Indexed: 05/18/2023]
Affiliation(s)
| | - Johannes S Kern
- Department of Dermatology, Alfred Hospital, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Mei Tam
- Department of Dermatology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
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20
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Maximov I, Kochergin N, Ditmarova Z, Borzova E. A rare subungual eumycetoma in a cancer survivor: A case report. J Eur Acad Dermatol Venereol 2023; 37:e330-e333. [PMID: 36310340 DOI: 10.1111/jdv.18713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/25/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Ivan Maximov
- Department of Dermatology and Venereology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Nikolay Kochergin
- Department of Dermatology and Venereology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Zhanna Ditmarova
- Bacteriological Laboratory, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Elena Borzova
- Department of Dermatology and Venereology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
- Department of Clinical Genetics, Veltischev Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University, Moscow, Russian Federation
- Dermatology Division, Niigata University, Niigata, Japan
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21
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Abstract
INTRODUCTION Cronkhite-Canada syndrome (CCS) is currently considered to be a non-hereditary disease, which is relatively rare clinically. It is also known as polyposis hyperpigmentation alopecia nail dystrophy syndrome, it is a syndrome characterized by gastrointestinal polyposis and ectodermal changes, the main manifestations are gastrointestinal symptoms, skin pigmentation, alopecia, and hypothyroidism. CASE PRESENTATION In this paper, the clinical characteristics, diagnosis and treatment of a case of CCS admitted to Huanghe Sanmenxia Hospital were analyzed. In the course of treatment, traditional Chinese medicine was used, but no hormone, and the patient's clinical symptoms were greatly relieved. CONCLUSIONS CCS is rare, there is no specific treatment, and traditional Chinese medicine may can greatly relieve the clinical symptoms of patients. However, it's still having to be verified by a large sample, multi-center, long-term treatment follow-up studies.
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Affiliation(s)
- Hailong Hu
- Department of General Surgery, Huanghe Sanmenxia Hospital, Sanmenxia, China
| | - Yating Wu
- Department of General Surgery, Huanghe Sanmenxia Hospital, Sanmenxia, China
| | - Yaqin Zhang
- First Clinical Medical College, Nanjing Medical University, Nanjing, China
| | - Li Zhang
- Department of General Surgery, Huanghe Sanmenxia Hospital, Sanmenxia, China
| | - Jianfa Zhang
- Department of General Surgery, Huanghe Sanmenxia Hospital, Sanmenxia, China
| | - Rui Zhang
- Department of General Surgery, Huanghe Sanmenxia Hospital, Sanmenxia, China
- *Correspondence: Rui Zhang, Department of General Surgery, Huanghe Sanmenxia Hospital, Sanmenxia, China (e-mail: )
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22
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Sil A, Ghosh S, Das A, Chandra A. Transverse erythronychia: A unique nail manifestation of COVID-19 infection and brief review of COVID-19 associated nail changes. J R Coll Physicians Edinb 2022; 52:320-323. [PMID: 36476144 PMCID: PMC9742509 DOI: 10.1177/14782715221142559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Over the past 2 years, a plethora of mucocutaneous manifestations have been described to be associated with coronavirus 2019 (COVID-19) infection. Nail changes attributed to COVID-19 have rarely been documented in the literature. We describe here a unique nail finding 'transverse erythronychia' due to COVID-19 and review the literature on the diverse nail pathology attributed to the disease.
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Affiliation(s)
- Abheek Sil
- Department of Dermatology, Venereology,
and Leprosy, RG Kar Medical College and Hospital, Kolkata, India
| | - Shouvik Ghosh
- Department of Dermatology, Venereology,
and Leprosy, KPC Medical College and Hospital, Kolkata, India
| | - Anupam Das
- Department of Dermatology, Venereology,
and Leprosy, KPC Medical College and Hospital, Kolkata, India
| | - Atanu Chandra
- Department of Internal Medicine, RG Kar
Medical College and Hospital, Kolkata, India
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23
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Gallo G, Mastorino L, Barilà D, Cattel F, Panzone M, Quaglino P, Ribero S, Dapavo P. Topical cyclosporine hydrogel preparation: A new therapeutic option in the treatment of nail psoriasis. Dermatol Ther 2022; 35:e15917. [PMID: 36214268 DOI: 10.1111/dth.15917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/19/2022] [Accepted: 10/05/2022] [Indexed: 11/29/2022]
Abstract
Nail psoriasis is a chronic nail disorder that commonly affects psoriatic patients causing severe distress despite the limited body surface area. Treatments for nail psoriasis are limited, as nails are often difficult to treat with topical therapies, and among different systemic agents responses are unpredictable. We carried out a prospective study in order to analyze the effectiveness and tolerability of topical cyclosporine hydrogel ointment in nail psoriasis. Three patients, for a total of 44 nails, were treated with topical cyclosporine hydrogel ointment. All nails were evaluated, before starting the treatment, every 28 days and after 12 weeks of therapy, by the same dermatologists, through clinical and onychoscopic evaluations. The patients were also asked to assess on the compliance with product use. Complete response (CR) was observed in 2 of 3 patients; a partial response (PR) was observed in the other patient. Overall, 24 of 44 nails had CR and 20 had a PR. Cyclosporine hydrogel ointment has shown efficacy and safety in the treatment of nail psoriasis. The product has also been shown to be stable in composition, easy to apply and not discomfortable for the patient.
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Affiliation(s)
- Giuseppe Gallo
- Dermatology Clinic, Department of medical sciences, University of Turin, Turin, Italy
| | - Luca Mastorino
- Dermatology Clinic, Department of medical sciences, University of Turin, Turin, Italy
| | - Diego Barilà
- Department of Pharmaceutical Science and Technology, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Francesco Cattel
- Department of Pharmaceutical Science and Technology, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Michele Panzone
- Dermatology Clinic, Department of medical sciences, University of Turin, Turin, Italy
| | - Pietro Quaglino
- Dermatology Clinic, Department of medical sciences, University of Turin, Turin, Italy
| | - Simone Ribero
- Dermatology Clinic, Department of medical sciences, University of Turin, Turin, Italy
| | - Paolo Dapavo
- Dermatology Clinic, Department of medical sciences, University of Turin, Turin, Italy
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24
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Wang Z, Man X. An 18-Year-Old Woman With Recurrent Skin, Nail, and Oral Mucosal Abnormalities. JAMA 2022; 328:1100-1101. [PMID: 35980713 DOI: 10.1001/jama.2022.14460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
An 18-year-old woman had a 14-year history of recurrent skin, nail, and oral mucosal abnormalities, treated with 3- to 6-month courses of itraconazole; the abnormalities typically recurred within 6 to 12 months of discontinuing itraconazole. Skin scrapings from the lower extremities demonstrated fungal elements; fungal culture of the skin scrapings grew Candida albicans. What is the diagnosis and what would you do next?
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Affiliation(s)
- Zhaoyuan Wang
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoyong Man
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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25
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Hetterschijt CRM, Pasch MC. [Nail disorders in daily practice]. Ned Tijdschr Geneeskd 2022; 166:D6766. [PMID: 36300431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Familiarity with common nail disorders enables the clinician to diagnose and treat nail disorders and to recognize red-flag conditions. Knowledge of the anatomy of the nail unit is essential to understand the origin of nail disorders. This article focuses on neoplasms, abnormalities of nail color and shape, infections, and inflammatory conditions of the nail unit. There are various neoplasms of and around the nail unit, like squamous cell carcinoma (in situ), melanoma, and benign neoplasms such as mucous cyst, subungual exostosis, glomus tumor, onychopapilloma and fibro(kerato)ma. The most common deviating colors of the nail are red, white and brown-black. Abnormalities of nail color and shape may indicate an underlying systemic disease. Infections of the nail unit include onychomycosis, acute paronychia, pseudomonas nail infection and verruca vulgaris. The inflammatory conditions we discuss in this article are chronic paronychia, psoriasis, alopecia areata and lichen planus.
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26
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Mervak JE. Hair and Nail Conditions: Nail Conditions. FP Essent 2022; 517:27-34. [PMID: 35679470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
A thorough understanding of nail anatomy can help physicians identify the causes of nail conditions. Observation of changes to the nail can help establish a diagnosis. Patient evaluation should include a physical examination, dermoscopy, and, in some cases, nail biopsy. Onychomycosis is the most common nail condition worldwide, and should be distinguished from other nail conditions with similar manifestations. Empiric onychomycosis treatment without confirmatory tests has been proposed, but studies have shown the cost-effectiveness of testing to prevent inappropriate therapy. Systemic drugs for management include terbinafine and itraconazole. Longitudinal melanonychia is a brown band through the length of the nail. Nail melanoma should be suspected if the band is dark brown-black, is located on a single digit, and occupies 40% or more of the nail plate width. Biopsy with local anesthesia should be performed in patients with suspected nail melanoma or other neoplastic nail conditions. Identification of warning signs of nail melanoma can result in earlier diagnosis and limit potential morbidity and mortality. Nail psoriasis often is overlooked but can affect up to 50% of patients with psoriasis. Nail lichen planus can cause permanent scarring with loss of normal nail anatomy. Other common nail conditions include acute and chronic paronychia, onychocryptosis, onycholysis, Pseudomonas infection (ie, green nails), onychogryphosis, subungual hematoma, and onychomadesis.
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Affiliation(s)
- Julie E Mervak
- Department of Dermatology - University of Michigan School of Medicine, 1910 Taubman Center 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5314
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27
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Inthasot S, André J, Richert B. Causes of longitudinal nail splitting: a retrospective 56-case series with clinical pathological correlation. J Eur Acad Dermatol Venereol 2022; 36:744-753. [PMID: 35088456 DOI: 10.1111/jdv.17967] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 12/07/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Split nail (SN) is a rare type of nail fragility syndrome, characterized by a longitudinal fissure involving the entire thickness of the nail plate. Longitudinal nail splitting may be caused by direct injury to the nail plate or matrix insult. Few articles have been published on the topic, most were related to the traumatic aetiology. Some case reports mention tumours and inflammatory disorders as other causes. OBJECTIVES AND METHODS The aim of this retrospective study was to analyse the clinical and histopathological features of 56 SN collected at the nail consultation of the dermatology department at Saint Pierre University Hospital in Brussels, between 1997 and 2019. RESULTS Fifty-six patients were included (34 women and 22 men) with median age of 44.2 years. The fingernails were 3.2 times more frequently affected than toenails, especially the thumb. The most frequent aetiologies were tumours (45.6%), inflammatory diseases (26.3%) and traumas (19.3%). Congenital (5.3%) and systemic disorders (3.5%) were rarer causes. Histopathological slide review confirmed that alteration of the nail matrix integrity causes split nail, resulting either from matrix stretching by an underlying tumour or from impairment of the keratinization process by inflammatory diseases, melanocytic tumours and Bowen's disease. CONCLUSIONS This study is the largest case series of longitudinal nail splitting to date. It is the first to gather nail disorders causing SN with their clinical pathological correlation. The most common causes are traumatisms, tumours and inflammatory disorders. Congenital and systemic disorders are rarer. Tumours are responsible for half of the cases from which one third are malignant, mainly melanoma. When facing a monodactylic SN, benign as well as malignant tumours should be ruled out before concluding to traumatic aetiology.
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Affiliation(s)
- S Inthasot
- Dermatology Department, St-Pierre, Brugmann and Queen Fabiola Children University Hospitals, Université Libre de Bruxelles, Bruxelles, Belgium
| | - J André
- Dermatology Department, St-Pierre, Brugmann and Queen Fabiola Children University Hospitals, Université Libre de Bruxelles, Bruxelles, Belgium
| | - B Richert
- Dermatology Department, St-Pierre, Brugmann and Queen Fabiola Children University Hospitals, Université Libre de Bruxelles, Bruxelles, Belgium
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28
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Yamaguchi T, Shimizu K. Subungual hemorrhage as a sign of infective endocarditis. QJM 2022; 115:179-180. [PMID: 35137211 DOI: 10.1093/qjmed/hcac034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Yamaguchi
- Primary Care and Advanced Triage Section, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Japan
| | - K Shimizu
- Primary Care and Advanced Triage Section, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Japan
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29
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Chen J, Wang X, Zhu Y, He J, Rao Y, Liu K. Nail matrix scars that result in nail dystrophy resemble cutaneous scars: A new nail trauma model. Burns 2022; 48:396-403. [PMID: 34670717 DOI: 10.1016/j.burns.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 05/05/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Few studies have described how the injury affects the nail soft tissue under the nail plate. Nail matrix scar is poorly known. OBJECTIVE To establish a stable rat nail loss model in a simple way, and to discuss the comparability of this model. METHODS A sterile cotton swab dipped in a 10% NaOH solution was used to burn the entire nail matrix and bed plane region, and the specimens were examined on day 3, 7, 14, and 28. RESULTS After avulsion of the nail plate, the eponychia and matrix stuck together without any tissue destruction. On day 28, all claws of the experimental group were observed to be permanently damaged, except for one claw malformed regeneration. All impaired nail regeneration had deficiency or functional loss of NMSCs and shared similar characteristics with the cutaneous scars. CONCLUSIONS The scar formation of nail matrix was a fundamental reason to nail deficiency of rat or human, providing a research basis for further mechanism or treatment study of nail defect diseases.
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Affiliation(s)
- Jun Chen
- Department of Dermatology, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Center for Specialty Strategy Research of Shanghai JiaoTong University China Hospital Development Institute, Shanghai 200011, PR China
| | - Xue Wang
- Department of Dermatology, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Center for Specialty Strategy Research of Shanghai JiaoTong University China Hospital Development Institute, Shanghai 200011, PR China
| | - Yueqian Zhu
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou 215000, PR China
| | - Jing He
- Department of Anatomy and Neurobiology, Tongji University School of Medicine, Shanghai, PR China
| | - Yamin Rao
- Department of Pathology, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Center for Specialty Strategy Research of Shanghai JiaoTong University China Hospital Development Institute, Shanghai 200011, PR China.
| | - Ke Liu
- Department of Dermatology, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Center for Specialty Strategy Research of Shanghai JiaoTong University China Hospital Development Institute, Shanghai 200011, PR China.
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30
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Fernandez-Somoza JM, Ginarte M, Otero E, Tomé S, Soutullo C, Martínez-Ulloa A, Gonzalez-Quintela A. Clinical and capillaroscopic findings in patients with liver disease and proximal apparent leukonychia (Terry nails and its variants). Medicine (Baltimore) 2021; 100:e26207. [PMID: 34087892 PMCID: PMC8183706 DOI: 10.1097/md.0000000000026207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 05/10/2021] [Indexed: 01/04/2023] Open
Abstract
Terry nails and Lindsay nails are similar forms of proximal apparent leukonychia (PAL). A change in nail bed vascularity is thought to be responsible for PAL. The study was aimed at investigating the frequency of PAL in patients attending a liver disease clinic, the factors associated with its presence, its value for detecting cirrhosis, its prognostic value for mortality, and associated capillaroscopic findings.A total of 521 patients were included (age range, 18-94 years; 69% men). Systematic nail photographs were evaluated by 2 independent investigators. Disease-related data were obtained from the medical records. Mortality was evaluated after 7 years of follow-up. Nailfold capillaroscopy was performed on a subset of 80 patients.PAL was present in 228 patients (43.8%; Terry nails in 205, Lindsay nails in 20, and both in 3). The kappa-coefficient of interobserver agreement was 0.82. The presence of PAL was associated with cirrhosis and, accordingly, with portal hypertension and hepatocellular dysfunction. The positive likelihood ratio of PAL for the diagnosis of cirrhosis was 1.6 (95% CI 1.3-1.92). PAL was independently associated with chronic alcohol abuse and was not a significant predictor of mortality. Venous loop dilatation and prominence of the venous plexus were observed on capillaroscopy in patients with cirrhosis but were not significantly associated with PAL.In summary, PAL is a common finding in patients from a liver clinic; it is associated with liver cirrhosis and with alcohol abuse. PAL is not associated with specific capillaroscopic findings. We propose the generic term proximal apparent leukonychia instead of classic eponymous titles to avoid confusion in the literature.
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Affiliation(s)
| | - Manuel Ginarte
- Department of Dermatology, Hospital Clínico Universitario, Santiago de Compostela, Spain
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31
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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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32
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Affiliation(s)
- Uddalak Chakraborty
- Department of Internal Medicine, College of Medicine and Sagore Dutta Hospital, Kolkata, India.
| | - Atanu Chandra
- Department of Internal Medicine, R G Kar Medical College and Hospital, Kolkata, India
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33
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Affiliation(s)
- Myron Zhang
- Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, New York
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34
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Talaga-Ćwiertnia K, Salamon D, Krzyściak P. Unexpected subungual Sarcoptes infestation of toenail - a case report and literature review. Ann Parasitol 2021; 67:779-787. [PMID: 35294148 DOI: 10.17420/ap6704.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Scabies is the skin infestation caused by Sarcoptes scabiei var hominis. It is one of the commonest dermatological infection which can affect people around the world. However, nails are relatively rarely involved, and the fingernails are mostly infected. The report a case of a 77-year-old woman, long-term pensioner of a nursing home, who had isolated toe subungual Sarcoptes infestation. In addition, the results of systematic review of toenails scabies was presented. Analysis of 21 subungual Sarcoptes infestation cases, revealed that patients in any age (median age 45+/-31.7-year-old) and sex can be affected. Most of the patients had concomitant diseases. Seventy-five percent of cases of nail involvement were treated with combined or sequential therapy. The most used drugs were ivermectin (IVR) and permethrin (PER) (each used in 47.6% cases), following γ-BHC (38.1%) and crotamiton (CRO) (23.8%). It seems that the crucial for adequate diagnosis in scabies affected nails is a precise anamnesis, early and accurate diagnosis that consists of examining not only skin lesions, but including assessing toenails, and differentiation of Sarcoptes infestation from other nail diseases as onychomycosis or psoriasis. Important to achieving a cure is at least frequent nail trimming, softening the nail plate with urea or in the difficult cases the mechanical removal of subungual plaque with using of a scabicide in the location allowing to penatrate it under the nail plate.
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Affiliation(s)
- Katarzyna Talaga-Ćwiertnia
- Chair of Microbiology, Department of Molecular Medical Microbiology, Faculty of Medicine, Jagiellonian University Medical College, ul. Czysta 18, 31-121 Cracow, Poland
- Chair of Microbiology, Department of Infection Control and Mycology, Faculty of Medicine, Jagiellonian University Medical College, ul. Czysta 18, 31-121 Cracow, Poland
| | - Dominika Salamon
- Chair of Microbiology, Department of Infection Control and Mycology, Faculty of Medicine, Jagiellonian University Medical College, ul. Czysta 18, 31-121 Cracow, Poland
| | - Paweł Krzyściak
- Chair of Microbiology, Department of Molecular Medical Microbiology, Faculty of Medicine, Jagiellonian University Medical College, ul. Czysta 18, 31-121 Cracow, Poland
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35
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Tokuyama M, Ota M, Saitoh R, Sawamura M, Okitsu N, Shimizu T, Kondoh A, Yamaoka H, Mabuchi T. Biological Retention Rates, the Reasons of Switching, and Prognostic Factors in Patients with Psoriasis Treated Biologics. Tokai J Exp Clin Med 2020; 45:230-235. [PMID: 33300595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/09/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To review patients who were treated at Tokai University Hospital with biologic agents for psoriasis vulgaris and psoriatic arthritis and analyze the biological retention rate, reasons for switching biologics, and investigate possible clinical prognostic factor which may affect whether a patient preferred one biologic to another. METHODS Clinical courses of 63 patients who received biologic agents between Sep of 2010 to June of 2019 were investigated. Biological retention rate of each biologic agents, reasons of switching to another biologic agent, and prognostic factors, if any, between switched and non-switched patients were examined. RESULTS The biological retention rate of ustekinumab (UST) was significantly longer than that of infliximab (IFX) or adalimumab (ADA). The major reason of switching was due to secondary loss of efficacy. Patients being treated with UST were more likely to switch to another biologic when they exhibited nail lesions. CONCLUSION These results suggested that biological retention rate of UST was superior than that of IFX or ADA. Furthermore, with patients administered UST, nail symptom suggested possible clinical prognostic factor for switching to other biologic agents.
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Affiliation(s)
- Michio Tokuyama
- Department of Dermatology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan.
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Affiliation(s)
- Satoshi Ide
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
- Emerging and Reemerging Infectious Diseases, Graduate School of Medicine, Tohoku University, Japan
| | - Shinichiro Morioka
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
- Emerging and Reemerging Infectious Diseases, Graduate School of Medicine, Tohoku University, Japan
| | - Makoto Inada
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
- Emerging and Reemerging Infectious Diseases, Graduate School of Medicine, Tohoku University, Japan
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Tosun S, Tosun B. Onychogryphosis. J Am Podiatr Med Assoc 2020; 110:445581. [PMID: 33021642 DOI: 10.7547/18-155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Onychogryphosis is a nail disorder that can damage nail plates, usually caused by repeated minor trauma to the foot. Onychogryphosis of the toe is commonly seen in clinical practice; however, optimal treatment of the condition is still the subject of debate. The purpose of this study was to evaluate clinical outcomes of patients with toe onychogryphosis treated by subcutaneous flap coverage after total matricectomy. METHODS In this article, we describe 12 patients who had onychogryphosis on the great toe treated by subcutaneous flap coverage after total matricectomy. There were eight men and four women, with a mean age of 63.8 years (range, 56-74 years). RESULTS The follow-up period ranged from 4 to 108 months, with an average of 25.2 months. All of the flap reconstructions ultimately survived. CONCLUSIONS The advantage of the described technique is the avoidance of tight closure of the skin and preservation of toe length. The possible limitation of the technique is poor blood circulation to the feet.
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Kang R, Lipner S. Social media and dissemination: impressions of fish pedicures following a case of onychomadesis. Dermatol Online J 2020; 26:13030/qt0b66f6t3. [PMID: 32815700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 07/29/2020] [Indexed: 06/11/2023] Open
Abstract
Although the popularity of fish pedicures as cosmetic or routine services and/or tourist attractions has peaked in the past decade, the practice is still trending today and accompanying risks are less well-known by the public. More recently, a case of onychomadesis following fish pedicure has gained interest in both public and dermatologic populations, highlighting the importance of patient education. In this study, we aimed to demonstrate the wide reach of the manuscript through social media and news outlets. The majority of social media correspondences have come from Thai accounts whereas news outlets were mostly from the United States and various European or Asian countries. Analyzed by Altmetric score, the report was within the top 5% of all research outputs ever scored by Altmetric. Finally, Google Trend data indicates that fish pedicure interest decreased thereafter to the lowest levels in the past decade after the case report was published, signifying its likely effect on diminishing public interest. This case report and analysis of its news/social media reach emphasize the importance of literature/media outlets in informing patients and the public of adverse effects. As fish pedicures continue to be popular both in the US and overseas, appropriate education of the public remains important in preventing complications.
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Abstract
The majority of patients with Sézary syndrome (SS) present with classic symptoms of erythroderma, lymphadenopathy, and pruritus. However, there have been numerous reports of patients with SS who have non-classic signs. In this review, we report the less common clinical presentations of SS and discuss their relevant treatments. Our search included all literature on SS since 2008, the year the World Health Organization (WHO) incorporated the diagnostic criteria for SS into the WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. We reviewed 896 articles and identified 505 patients with non-classic presentations of SS. Of these 505 patients, the most common non-classic signs of SS were keratoderma, onychodystrophy, alopecia, leonine facies, and ectropion. Given the aggressive and highly symptomatic nature of SS, it is imperative that clinicians recognize the less common signs of the disease to prevent delays in diagnosis and treatment. To our knowledge, this is the first review of the clinical variations of SS with a focus on non-classic signs and symptoms.
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Affiliation(s)
- Lisa Morris
- University of Missouri-Columbia School of Medicine, Columbia, MO, USA
| | - Jessica Tran
- Baylor College of Medicine, Houston, TX, USA.
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1452, Houston, TX, 77030, USA.
| | - Madeleine Duvic
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1452, Houston, TX, 77030, USA
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LOPEZ-CASTILLO D, CURTO-BARREDO L, SÁNCHEZ-SCHMIDT JM, PUJOL RM. Multiple Eruptive Pyogenic Granulomas on the Proximal Nail Folds Following Cast Immobilization: A Case Report with Nail Unit Ultrasound Findings. Acta Derm Venereol 2020; 100:adv00071. [PMID: 31821515 PMCID: PMC9128891 DOI: 10.2340/00015555-3389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2019] [Indexed: 11/16/2022] Open
Affiliation(s)
- Daniel LOPEZ-CASTILLO
- Department of Dermatology, Hospital del Mar-Parc de Salut Mar, Passeig Marítim, 25-29, ES-08003 Barcelona, Spain. E-mail:
| | - Laia CURTO-BARREDO
- Department of Dermatology, Hospital del Mar-Parc de Salut Mar, Passeig Marítim, 25-29, ES-08003 Barcelona, Spain. E-mail:
| | - Júlia M. SÁNCHEZ-SCHMIDT
- Department of Dermatology, Hospital del Mar-Parc de Salut Mar, Passeig Marítim, 25-29, ES-08003 Barcelona, Spain. E-mail:
| | - Ramon M. PUJOL
- Department of Dermatology, Hospital del Mar-Parc de Salut Mar, Passeig Marítim, 25-29, ES-08003 Barcelona, Spain. E-mail:
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Ko D, Lipner SR. Concurrent beau lines, onychomadesis, and retronychia following scurvy. Cutis 2020; 105:146-149. [PMID: 32352431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Beau lines, onychomadesis, and retronychia are nail conditions with their own characteristic clinical findings. It has been hypothesized that these 3 disorders may share a common pathophysiologic mechanism of slowing and/or halting nail plate production at the nail matrix. We report the case of a 41-year-old woman who presented with concurrent Beau lines, onychomadesis, and retronychia 6 months following a diagnosis of scurvy. Simultaneous presentation of these 3 nail conditions is not commonly reported, and our case supports a shared pathophysiologic basis.
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Affiliation(s)
- Dayoung Ko
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, New York, USA
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Abstract
Gray diseases are a group of skin disorders characterized mainly by gray discoloration with or without involving the mucous membranes and nails. These diseases may be hereditary or acquired. Some of the better-known hereditary entities are dermal melanocytosis, incontinentia pigmenti, hypomelanosis of Ito, hemochromatosis, ochronosis, and silvery hair syndrome. Acquired diseases with gray coloring include late-stage organ failure, lichen planus pigmentosus, erythema dyschromicum perstans, and drug reactions. The discoloration is due to either increased epidermal and or dermal melanin or dermal deposition of a chromogen or a combination of both. Investigations are directed to determining the underlying medical condition and a skin biopsy is usually unnecessary. Likewise, treatment is directed mainly toward the underlying medical disease. Although bleaching (lightening) agents may diminish the discoloration, better results may be obtained from using a Q-switched laser and intense pulsed light, either alone or in combination with topical agents.
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Affiliation(s)
- M Badawy Abdel-Naser
- Department of Dermatology, Andrology and STIs, Ain Shams University Hospital, Cairo, Egypt.
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Abstract
OBJECTIVE Psoriasis is a chronic inflammatory disease that affects the skin, joints, and nails. To investigate the efficacy of sonoelastographic evaluation for assessing nail involvement and severity in psoriasis. MATERIALS AND METHODS Thirty-one psoriasis patients and 31 healthy control subjects were included in the study. The nail thickness and nail bed thickness of the thumbs of all cases were measured by gray scale ultrasonography. In addition, the values of strain elastography were measured by sonoelastography. RESULTS Of the participants, 38 were male and 24 were female; the ratio of males and females was equal in both groups. There was no significant difference between the patient and control group in terms of gender and age. In the patient group, the mean duration of illness was 13.87 ± 9.8 years, mean PASI score was 5.53 ± 2.38, and mean NAPSI score was 33.97 ± 37.99. The nail plate thickness and elastography strain ratios were found to be statistically higher in the psoriasis group compared to the control group. There was also significant correlation between elastography strain ratios and nail thickness (P = .014), nail bed thickness (P < .001) and NAPSI scores (P = .01). CONCLUSION Due to the superiority of ultrasound in real-time imaging of the nail structure and the compatibility of sonographic elastography with clinical scores in the assessment of the nail bed, we believe that it can be used as a complementary method.
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Affiliation(s)
| | - Mahizer Yaldiz
- Departmant of Dermatology, Sakarya University Training and Research Hospital, Sakarya, Turkey
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Metzgar MM, Zhongyu Zhang K. Nail Changes Following a Viral Infection. Am Fam Physician 2019; 100:497-498. [PMID: 31613574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Gonzalez-Martin C, Pertega-Diaz S, Seoane-Pillado T, Balboa-Barreiro V, Soto-Gonzalez A, Veiga-Seijo R. Structural, Dermal and Ungual Characteristics of the Foot in Patients with Type II Diabetes. ACTA ACUST UNITED AC 2019; 55:medicina55100639. [PMID: 31557980 PMCID: PMC6843386 DOI: 10.3390/medicina55100639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/12/2019] [Accepted: 09/20/2019] [Indexed: 01/13/2023]
Abstract
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.
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Affiliation(s)
- Cristina Gonzalez-Martin
- Research Group of Clinical Epidemiology and Biostatistics, Biomedical Research Institute of A Coruña (INIBIC), University Hospital Complex of A Coruña (CHUAC), SERGAS, University of A Coruña,15006 A Coruña, Spain.
| | - Sonia Pertega-Diaz
- Research Group of Clinical Epidemiology and Biostatistics, Biomedical Research Institute of A Coruña (INIBIC), University Hospital Complex of A Coruña (CHUAC), SERGAS, University of A Coruña,15006 A Coruña, Spain.
| | - Teresa Seoane-Pillado
- Research Group of Clinical Epidemiology and Biostatistics, Biomedical Research Institute of A Coruña (INIBIC), University Hospital Complex of A Coruña (CHUAC), SERGAS, University of A Coruña,15006 A Coruña, Spain.
| | - Vanesa Balboa-Barreiro
- Research Group of Clinical Epidemiology and Biostatistics, Biomedical Research Institute of A Coruña (INIBIC), University Hospital Complex of A Coruña (CHUAC), SERGAS, University of A Coruña,15006 A Coruña, Spain.
| | - Alfonso Soto-Gonzalez
- Endocrinology Service of the University Hospital Complex of A Coruña (CHUAC), SERGAS, University of A Coruña, 15006 A Coruña, Spain.
| | - Raquel Veiga-Seijo
- Research Group of Clinical Epidemiology and Biostatistics, Biomedical Research Institute of A Coruña (INIBIC), University Hospital Complex of A Coruña (CHUAC), SERGAS, University of A Coruña,15006 A Coruña, Spain.
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Geizhals S, Lipner SR. Clinical pearl: benzethonium chloride for habit-tic nail deformity. Cutis 2019; 104:81-82. [PMID: 31487340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Treatment of habit-tic nail deformity is challenging, as it often requires both patient awareness and behavioral changes that may be long-standing. Many treatment options have been suggested, but limitations include inadequate supporting evidence and potential adverse effects. Herein, we describe the use of benzethonium chloride as a safe and effective treatment of habit-tic nail deformity.
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Affiliation(s)
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, New York, USA
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Affiliation(s)
- Avinash Aujayeb
- Acute Medicine and Respiratory Department, Northumbria Healthcare NHS Foundation Trust, North Shields, Newcastle, UK
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Kuo ME, Theil AF, Kievit A, Malicdan MC, Introne WJ, Christian T, Verheijen FW, Smith DEC, Mendes MI, Hussaarts-Odijk L, van der Meijden E, van Slegtenhorst M, Wilke M, Vermeulen W, Raams A, Groden C, Shimada S, Meyer-Schuman R, Hou YM, Gahl WA, Antonellis A, Salomons GS, Mancini GMS. Cysteinyl-tRNA Synthetase Mutations Cause a Multi-System, Recessive Disease That Includes Microcephaly, Developmental Delay, and Brittle Hair and Nails. Am J Hum Genet 2019; 104:520-529. [PMID: 30824121 DOI: 10.1016/j.ajhg.2019.01.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 01/15/2019] [Indexed: 02/06/2023] Open
Abstract
Aminoacyl-tRNA synthetases (ARSs) are essential enzymes responsible for charging tRNA molecules with cognate amino acids. Consistent with the essential function and ubiquitous expression of ARSs, mutations in 32 of the 37 ARS-encoding loci cause severe, early-onset recessive phenotypes. Previous genetic and functional data suggest a loss-of-function mechanism; however, our understanding of the allelic and locus heterogeneity of ARS-related disease is incomplete. Cysteinyl-tRNA synthetase (CARS) encodes the enzyme that charges tRNACys with cysteine in the cytoplasm. To date, CARS variants have not been implicated in any human disease phenotype. Here, we report on four subjects from three families with complex syndromes that include microcephaly, developmental delay, and brittle hair and nails. Each affected person carries bi-allelic CARS variants: one individual is compound heterozygous for c.1138C>T (p.Gln380∗) and c.1022G>A (p.Arg341His), two related individuals are compound heterozygous for c.1076C>T (p.Ser359Leu) and c.1199T>A (p.Leu400Gln), and one individual is homozygous for c.2061dup (p.Ser688Glnfs∗2). Measurement of protein abundance, yeast complementation assays, and assessments of tRNA charging indicate that each CARS variant causes a loss-of-function effect. Compared to subjects with previously reported ARS-related diseases, individuals with bi-allelic CARS variants are unique in presenting with a brittle-hair-and-nail phenotype, which most likely reflects the high cysteine content in human keratins. In sum, our efforts implicate CARS variants in human inherited disease, expand the locus and clinical heterogeneity of ARS-related clinical phenotypes, and further support impaired tRNA charging as the primary mechanism of recessive ARS-related disease.
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Affiliation(s)
- Molly E Kuo
- Cellular and Molecular Biology Program, University of Michigan Medical School, Ann Arbor, MI 48109, USA; Medical Scientist Training Program, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Arjan F Theil
- Department of Molecular Genetics, Oncode Institute, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 CN Rotterdam, the Netherlands
| | - Anneke Kievit
- Department of Clinical Genetics, Erasmus Medical Center, University Medical Center, 3015 GD Rotterdam, the Netherlands
| | - May Christine Malicdan
- Undiagnosed Diseases Program and Office of the Clinical Director, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Wendy J Introne
- Undiagnosed Diseases Program and Office of the Clinical Director, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Thomas Christian
- Department of Biochemistry and Molecular Biochemistry, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Frans W Verheijen
- Department of Clinical Genetics, Erasmus Medical Center, University Medical Center, 3015 GD Rotterdam, the Netherlands
| | - Desiree E C Smith
- Metabolic Unit, Department of Clinical Chemistry, Amsterdam University Medical Center and Amsterdam Gastroenterology and Metabolism, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, 1081 HZ Amsterdam, the Netherlands
| | - Marisa I Mendes
- Metabolic Unit, Department of Clinical Chemistry, Amsterdam University Medical Center and Amsterdam Gastroenterology and Metabolism, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, 1081 HZ Amsterdam, the Netherlands
| | - Lidia Hussaarts-Odijk
- Department of Clinical Genetics, Erasmus Medical Center, University Medical Center, 3015 GD Rotterdam, the Netherlands
| | - Eric van der Meijden
- Department of Clinical Genetics, Erasmus Medical Center, University Medical Center, 3015 GD Rotterdam, the Netherlands
| | - Marjon van Slegtenhorst
- Department of Clinical Genetics, Erasmus Medical Center, University Medical Center, 3015 GD Rotterdam, the Netherlands
| | - Martina Wilke
- Department of Clinical Genetics, Erasmus Medical Center, University Medical Center, 3015 GD Rotterdam, the Netherlands
| | - Wim Vermeulen
- Department of Molecular Genetics, Oncode Institute, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 CN Rotterdam, the Netherlands
| | - Anja Raams
- Department of Molecular Genetics, Oncode Institute, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 CN Rotterdam, the Netherlands
| | - Catherine Groden
- Undiagnosed Diseases Program and Office of the Clinical Director, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Shino Shimada
- Undiagnosed Diseases Program and Office of the Clinical Director, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Rebecca Meyer-Schuman
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Ya Ming Hou
- Department of Biochemistry and Molecular Biochemistry, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - William A Gahl
- Undiagnosed Diseases Program and Office of the Clinical Director, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Anthony Antonellis
- Cellular and Molecular Biology Program, University of Michigan Medical School, Ann Arbor, MI 48109, USA; Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI 48109, USA; Department of Neurology, University of Michigan Medical School, Ann Arbor, MI 48109, USA.
| | - Gajja S Salomons
- Metabolic Unit, Department of Clinical Chemistry, Amsterdam University Medical Center and Amsterdam Gastroenterology and Metabolism, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, 1081 HZ Amsterdam, the Netherlands; Genetic Metabolic Diseases, Amsterdam University Medical Center, University of Amsterdam, 1081 HZ Amsterdam, the Netherlands.
| | - Grazia M S Mancini
- Department of Clinical Genetics, Erasmus Medical Center, University Medical Center, 3015 GD Rotterdam, the Netherlands
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Affiliation(s)
- S H Lee
- Division of Cardiology, Department of Internal Medicine, Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - W H Kim
- Division of Cardiology, Department of Internal Medicine, Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
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