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Lai PT, Chang YW, Lin SH. Onychopapilloma: a single medical center experience in Southern Taiwan. J DERMATOL TREAT 2024; 35:2318353. [PMID: 38417812 DOI: 10.1080/09546634.2024.2318353] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
Background: Onychopapilloma is an uncommon benign tumor of the nail bed and the distal matrix. Objectives: We aimed to investigate the clinical and pathological features of onychopapilloma in Taiwan.Materials and methods: We conducted a retrospective analysis of 12 patients with histopathologically proven onychopapilloma in a medical center in southern Taiwan from 2017 to 2023. Results: This case series consisted of 5 men and 7 women aged 29 to 38, with a mean age of 41.25 years. The clinical features were as follows: distal subungual hyperkeratosis (100%), longitudinal erythronychia (50%), longitudinal leukonychia (50 %), distal onycholysis (41%), and distal nail plate fissuring (41%). The duration of the disease varied greatly, ranging from 1 month to several years. Most patients were asymptomatic (58%), while some presented tenderness (41%). Fingernail involvement was more prevalent than toe involvement, with the thumb being the most commonly affected site. Most of the patients presented with a solitary onychopapilloma. None of the seven patients who underwent surgery and were available for follow-up experienced recurrence.Conclusions: This study highlights that longitudinal erythronychia and leukonychia emerged as the predominant clinical presentations of onychopapilloma. Furthermore, our findings suggest that surgical excision appears to be an effective method for onychopapilloma.
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Affiliation(s)
- Po-Ta Lai
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yung-Wei Chang
- Department of Dermatology, Chiayi Chang Gung Memorial Hospital, Puzi City, Taiwan
| | - Shang-Hung Lin
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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2
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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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3
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Amaral MC, Paula FS, Caetano J, Ames PR, Alves JD. Re-evaluation of nailfold capillaroscopy in discriminating primary from secondary Raynaud's phenomenon and in predicting systemic sclerosis: a randomised observational prospective cohort study. Expert Rev Clin Immunol 2024; 20:665-672. [PMID: 38465507 DOI: 10.1080/1744666x.2024.2313642] [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: 10/28/2023] [Accepted: 01/23/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Primary Raynaud's phenomenon (pRP) is difficult to distinguish from secondary (sRP). Although nailfold capillaroscopy (NFC) may detect early alterations, no universal criteria yet discriminate between pRP from sRP. OBJECTIVES To create and validate two NFC scores that could distinguish pRP from sRP and that could predict systemic sclerosis (SSc), respectively. METHODS We performed NFC on two separate cohorts with isolated RP, and recorded number of capillaries per field, enlarged/giant capillaries, crossed/bizarre patterns, microhemorrhages, neoangiogenesis, rarefaction, edema, blood flow velocity, stasis. By multivariate regression analysis, we evaluated the adjusted prognostic role of these features in a derivation cohort of 656 patients. Results were used to construct algorithm-based prognostic scores (A and B). These scores were then tested on a confirmation cohort of 219 patients. RESULTS Score A was unable to discriminate sRP from pRP (low negative predictive values with high positive predictive values for any cut-point); score B was unable to discriminate progression to SSc or a SSc-spectrum disorder (low positive predictive values with high negative predictive values for lower cut-points). CONCLUSION NFC patterns, believed as specific, showed low discriminatory power and on their own are unable to reliably discriminate sRP from pRP or predict evolution to SSc.
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Affiliation(s)
- Marta C Amaral
- Immune response and vascular disease, iNOVA4Health, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
- UDIMS - Unidade de Doenças Imuno-Mediadas Sistémicas, Departamento de Medicina IV, Hospital Prof. Doutor Fernando Fonseca, E.P.E, Amadora, Portugal
| | - F Seguro Paula
- Immune response and vascular disease, iNOVA4Health, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
- UDIMS - Unidade de Doenças Imuno-Mediadas Sistémicas, Departamento de Medicina IV, Hospital Prof. Doutor Fernando Fonseca, E.P.E, Amadora, Portugal
| | - Joana Caetano
- Immune response and vascular disease, iNOVA4Health, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
- UDIMS - Unidade de Doenças Imuno-Mediadas Sistémicas, Departamento de Medicina IV, Hospital Prof. Doutor Fernando Fonseca, E.P.E, Amadora, Portugal
| | - Paul Rj Ames
- Immune response and vascular disease, iNOVA4Health, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
- Department of Haematology, Dumfries & Galloway Royal Infirmary, Cargenbridge, Scotland, UK
| | - J Delgado Alves
- Immune response and vascular disease, iNOVA4Health, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
- UDIMS - Unidade de Doenças Imuno-Mediadas Sistémicas, Departamento de Medicina IV, Hospital Prof. Doutor Fernando Fonseca, E.P.E, Amadora, Portugal
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4
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Miyamoto J, Kawashima Y, Hayakawa M, Fusumae T, Yoshida T, Saito M. Successful treatment of onychomatricoma with minimally invasive surgical procedures based on its pathogenesis: A case report. J Dermatol 2024; 51:719-721. [PMID: 38212937 DOI: 10.1111/1346-8138.17088] [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: 10/03/2023] [Revised: 12/04/2023] [Accepted: 12/11/2023] [Indexed: 01/13/2024]
Abstract
Onychomatricoma is a rare, fibroepithelial tumor of the nail. Although it is benign, unnecessary and excessive treatment, such as extensive or total removal of the nail matrix, has been reported in the past. Recently, it was speculated that onychomatricoma is derived from onychomatricodermis, the dermal stroma of the nail matrix. Excision of the stromal rather than the epithelial component of the tumor is important. However, since the boundary between the normal and diseased stroma is usually unclear, minimal excision at the base of the tumor projection should be sufficient. We report a case of onychomatricoma and suggest a method of surgical treatment that would minimize postoperative deformity of the nail plate.
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Affiliation(s)
- Julia Miyamoto
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
- Department of Dermatology, Tokyo Women's Medical University, Adachi Medical Center, Tokyo, Japan
| | - Yuhei Kawashima
- Department of Dermatology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Michitaro Hayakawa
- Department of Dermatology, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Takayuki Fusumae
- Division of Dermatology, National Hospital Organization Tokyo Medical Center, Meguro, Japan
| | - Tetsuya Yoshida
- Division of Dermatology, National Hospital Organization Tokyo Medical Center, Meguro, Japan
| | - Masataka Saito
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
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5
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Díaz MS, Boggio P, Calvano R, Scacchi MF, Giachetti A. Retronychia in children: A case series. Pediatr Dermatol 2024; 41:428-432. [PMID: 38128581 DOI: 10.1111/pde.15503] [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: 02/16/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Retronychia is characterized by proximal ingrowing of the nail plate into the proximal nail fold. It is always associated with the presence of two or more overlapping nail plates under the proximal nail fold, clinical signs of chronic proximal paronychia refractory to antimicrobial treatment, and a yellowish nail that does not grow. It mainly affects young female adults, with less than 30 pediatric cases described in the literature so far. METHODS Retrospective and observational study of patients between 0 and 18 years with a clinical and/or ultrasound diagnosis of retronychia attending a pediatric dermatology service between December 2020 and January 2022. RESULTS We identified 9 patients with retronychia, 7 girls and 2 boys. In all cases, the hallux nails were affected with 5 unilateral and 4 bilateral cases. On physical examination we observed the following signs: thickened and opaque nail plate (one patient), yellowish nail plate (7 patients), double nail plate (6 patients), and erythema with edema, pain, and suppuration of the proximal nail fold (7 patients). Ultrasound was performed in 7 patients and specific findings of retronychia were found in 5 of them. All patients received topical treatment and were referred for the appropriate surgical treatment. To date, only one patient underwent nail avulsion, which was followed by complete recovery. CONCLUSIONS Retronychia is underdiagnosed, particularly in the pediatric population. We present a series of 9 cases of retronychia in children, with clinical and ultrasonographic findings consistent with those of adults. We emphasize the importance of recognizing this entity, which will allow early and adequate treatment.
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Affiliation(s)
- María Sol Díaz
- Pediatric Dermatology Section, Pediatric Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Paula Boggio
- Pediatric Dermatology Section, Pediatric Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Roberta Calvano
- Pediatric Dermatology Section, Pediatric Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - María Florencia Scacchi
- Pediatric Dermatology Section, Pediatric Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ana Giachetti
- Pediatric Dermatology Section, Pediatric Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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6
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Affiliation(s)
- Christoph Raschka
- Praxis für Allgemeinmedizin - Sportmedizin, Im Igelstück 31, 36088, Hünfeld, Deutschland
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7
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de Nicolas-Ruanes B, Azcarraga-Llobet C, Jimenez-Cauhe J. Use of bone wax as a nail bed dressing after excision of subungual tumors. J Am Acad Dermatol 2024; 90:e167-e168. [PMID: 38081391 DOI: 10.1016/j.jaad.2023.11.056] [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: 09/30/2023] [Revised: 11/04/2023] [Accepted: 11/11/2023] [Indexed: 01/03/2024]
Affiliation(s)
| | | | - Juan Jimenez-Cauhe
- Dermatology Department, Ramon y Cajal University Hospital, Madrid, Spain
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8
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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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9
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Eijkenboom QL, Daxenberger F, Guertler A, Steckmeier S, French LE, Sattler EC. Line-field confocal optical coherence tomography (LC-OCT) for the in vivo examination of nails: Analysis of typical features for the differentiation of nail disorders. J Eur Acad Dermatol Venereol 2024; 38:e413-e416. [PMID: 38059388 DOI: 10.1111/jdv.19641] [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: 03/06/2023] [Accepted: 11/13/2023] [Indexed: 12/08/2023]
Affiliation(s)
- Q L Eijkenboom
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - F Daxenberger
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - A Guertler
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - S Steckmeier
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - L E French
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - E C Sattler
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
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10
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Alomary SA, Schwartz RA, Lambert WC, Alhatem A. From endometrium to fingernail bed: histological evaluation of a rare cutaneous metastasis. BMJ Case Rep 2024; 17:e259545. [PMID: 38642930 PMCID: PMC11033642 DOI: 10.1136/bcr-2023-259545] [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] [Indexed: 04/22/2024] Open
Abstract
In the dermatological spectrum of oncologic manifestations, cutaneous metastases from endometrial carcinoma stand as a rarity, given the tumour's predilection for neighbouring uterine regions. We present an exceptional case of a patient in her mid-50s, whereby an endometrial carcinoma, defying conventional pathways, manifested on the skin and nail of her distal fourth finger, an unusual site for cutaneous metastases, with a specific histology of the primary cancer.
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Affiliation(s)
- Simona A Alomary
- Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Dermatopathology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Robert A Schwartz
- Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Dermatopathology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - W Clark Lambert
- Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Dermatopathology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Albert Alhatem
- Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Dermatopathology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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11
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Veerabagu SA, Zhang J, Krausz AE, Fix WC, Cheng B, Sobanko JF, Etzkorn JR, Shin TM, Higgins HW, Giordano CN, McMurray SL, Walker JL, Miller CJ. Low local recurrence rates after Mohs micrographic surgery for cutaneous squamous cell carcinoma of the nail unit. J Am Acad Dermatol 2024; 90:832-833. [PMID: 38043591 DOI: 10.1016/j.jaad.2023.11.043] [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: 07/28/2023] [Revised: 11/06/2023] [Accepted: 11/21/2023] [Indexed: 12/05/2023]
Affiliation(s)
- Surya A Veerabagu
- Department of Dermatology, University of New Mexico, Albuquerque, New Mexico
| | - Junqian Zhang
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aimee E Krausz
- Department of Dermatology, Main Line Health, Paoli, Pennsylvania
| | - William C Fix
- Division of Dermatology, Albert Einstein College of Medicine, Bronx, New York
| | - Brian Cheng
- Department of Medicine, Indiana University, Vincennes, Indiana
| | - Joseph F Sobanko
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy R Etzkorn
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thuzar M Shin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - H William Higgins
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cerrene N Giordano
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stacy L McMurray
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joanna L Walker
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher J Miller
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
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12
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Selm LC, Morr C, Badiavas EV, Nichols A, Ioannides T. Cutaneous Squamous Cell Carcinoma In Situ on a Fingernail Treated With HPV Vaccine. J Drugs Dermatol 2024; 23:275-276. [PMID: 38564387 DOI: 10.36849/jdd.7507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
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13
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Messina F, Conrad C, Morren MA. [Treatment of childhood psoriasis: present and future]. Rev Med Suisse 2024; 20:631-635. [PMID: 38563537 DOI: 10.53738/revmed.2024.20.867.631] [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: 04/04/2024]
Abstract
Psoriasis may present in childhood with skin, nail and scalp lesions but sometimes also articular involvement. It has an import impact on the quality of life of young patients. In this article we present an overview of the treatments that may be used in children according to skin area involved and severity of lesions with special interest for the biological treatments, already available and under investigation.
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Affiliation(s)
- Francesco Messina
- Département de dermatologie et vénéréologie, Centre hospitalier universitaire vaudois, Université de Lausanne, 1011 Lausanne
- Département de dermatologie, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, 20097 San Donato Milanese, Milan, Italie
| | - Curdin Conrad
- Département de dermatologie et vénéréologie, Centre hospitalier universitaire vaudois, Université de Lausanne, 1011 Lausanne
| | - Marie-Anne Morren
- Unité de dermatologie pédiatrique, Département de dermatologie et vénéréologie, Centre hospitalier universitaire vaudois, Université de Lausanne, 1011 Lausanne
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14
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Riopelle AM, Rajanala S, Khan S, Kosuru SB, Bryant B, Adigun CG, Kuchnir L. Retronychia: the importance of proper footwear. Dermatol Online J 2024; 30. [PMID: 38762854 DOI: 10.5070/d330163282] [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] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 03/12/2024] [Indexed: 05/20/2024] Open
Abstract
Retronychia is commonly underdiagnosed and exhibits classic features of proximal nail fold elevation and nail plate layering. Herein we summarize the literature and discuss cause, diagnosis, and treatment of this condition.
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15
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Eijkenboom QL, Daxenberger F, Gust C, Hartmann D, Guertler A, Steckmeier S, Deussing M, French LE, Welzel J, Schuh S, Sattler EC. Line-field confocal optical coherence tomography, a novel non-invasive tool for the diagnosis of onychomycosis. J Dtsch Dermatol Ges 2024; 22:367-375. [PMID: 38279541 DOI: 10.1111/ddg.15310] [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: 06/27/2023] [Accepted: 10/24/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND AND OBJECTIVES Onychomycosis is common and important to distinguish from other nail diseases. Rapid and accurate diagnosis is necessary for optimal patient treatment and outcome. Non-invasive diagnostic tools have increasing potential for nail diseases including onychomycosis. This study evaluated line-field confocal optical coherence tomography (LC-OCT) as a rapid non-invasive tool for diagnosing onychomycosis as compared to confocal laser scanning microscopy (CLSM), optical coherence tomography (OCT), and conventional methods. PATIENTS AND METHODS In this prospective study 86 patients with clinically suspected onychomycosis and 14 controls were examined using LC-OCT, OCT, and CLSM. KOH-preparation, fungal culture, PCR, and histopathology were used as comparative conventional methods. RESULTS LC-OCT had the highest sensitivity and negative predictive value of all methods used, closely followed by PCR and OCT. Specificity and positive predictive value of LC-OCT were as high as with CLSM, while OCT scored much lower. The gold standard technique, fungal culture, showed the lowest sensitivity and negative predictive value. Only PCR and culture allowed species differentiation. CONCLUSIONS LC-OCT enables quick and non-invasive detection of onychomycosis, with advantages over CLSM and OCT, and similar diagnostic accuracy to PCR but lacking species differentiation. For accurate nail examination, LC-OCT requires well-trained and experienced operators.
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Affiliation(s)
| | - Fabia Daxenberger
- Department of Dermatology and Allergy, LMU University Hospital, LMU, Munich, Germany
| | - Charlotte Gust
- Department of Dermatology and Allergy, LMU University Hospital, LMU, Munich, Germany
| | - Daniela Hartmann
- Department of Dermatology and Allergy, LMU University Hospital, LMU, Munich, Germany
| | - Anne Guertler
- Department of Dermatology and Allergy, LMU University Hospital, LMU, Munich, Germany
| | - Stephanie Steckmeier
- Department of Dermatology and Allergy, LMU University Hospital, LMU, Munich, Germany
| | - Maximilian Deussing
- Department of Dermatology and Allergy, LMU University Hospital, LMU, Munich, Germany
| | - Lars Einar French
- Department of Dermatology and Allergy, LMU University Hospital, LMU, Munich, Germany
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, USA
| | - Julia Welzel
- Department of Dermatology, University Hospital Augsburg, Augsburg, Germany
| | - Sandra Schuh
- Department of Dermatology, University Hospital Augsburg, Augsburg, Germany
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16
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Herzum A, Orsi SM, Ciccarese G, Occella C, Viglizzo G. Induction of psoriatic scalp and nail lesions in a patient treated with Ofatumumab: A potential autoimmune dysregulation induced by anti-CD 20 therapy. Skin Res Technol 2024; 30:e13662. [PMID: 38509841 PMCID: PMC10955219 DOI: 10.1111/srt.13662] [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: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Astrid Herzum
- Dermatology DepartmentIRCCS Istituto Giannina GasliniGenovaItaly
| | - Silvia Maria Orsi
- Department of NeuroscienceRehabilitationOphthalmologyGeneticsMaternal and Child HealthUniversity of GenoaGenoaItaly
| | - Giulia Ciccarese
- Dermatology UnitDepartment of Medical and Surgical SciencesUniversity of Foggia and Ospedali RiunitiFoggiaItaly
| | - Corrado Occella
- Dermatology DepartmentIRCCS Istituto Giannina GasliniGenovaItaly
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17
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Singh R, Kumar P, Kumar D, Aggarwal N, Chopra H, Kumar V. Alopecia areata: review of epidemiology, pathophysiology, current treatments and nanoparticulate delivery system. Ther Deliv 2024; 15:193-210. [PMID: 38449420 DOI: 10.4155/tde-2023-0071] [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] [Indexed: 03/08/2024] Open
Abstract
Alopecia areata (AA) is a kind of alopecia that affects hair follicles and nails. It typically comes with round patches and is a type of nonscarring hair loss. Various therapies are accessible for the management and treatment of AA, including topical, systemic and injectable modalities. It is a very complex type of autoimmune disease and is identified as round patches of hair loss and may occur at any age. This review paper highlights the epidemiology, clinical features, pathogenesis and new treatment options for AA, with a specific emphasis on nanoparticulate drug-delivery systems. By exploring these innovative treatment approaches, researchers aim to enhance the effectiveness and targeted delivery of therapeutic agents, ultimately improving outcomes for individuals living with AA.
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Affiliation(s)
- Robel Singh
- College of Pharmacy, PGIMS, Pt B D Sharma, University of Health Sciences-Rohtak, 124001, India
| | - Pawan Kumar
- Indian Pharmacopoeia Commision, Ministry of Health & Family Welfare, Govt. of India
| | - Davinder Kumar
- College of Pharmacy, PGIMS, Pt B D Sharma, University of Health Sciences-Rohtak, 124001, India
| | - Navidha Aggarwal
- MM College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, 133207, India
| | - Hitesh Chopra
- Department of Biosciences, Saveetha School of Engineering, Saveetha Institute of Medical & Technical Sciences, Chennai, 602105, Tamil Nadu, India
| | - Virender Kumar
- College of Pharmacy, PGIMS, Pt B D Sharma, University of Health Sciences-Rohtak, 124001, India
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18
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Metko D, Mehta S, Mcmullen E, Bednar ED, Abu-Hilal M. A systematic review of the risk of cutaneous malignancy associated with ultraviolet nail lamps: what is the price of beauty? Eur J Dermatol 2024; 34:26-30. [PMID: 38557455 DOI: 10.1684/ejd.2024.4616] [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] [Indexed: 04/04/2024]
Abstract
Gel manicures have become part of a popular personal care service in the last two decades due to increased longevity of the polish and the added strength to the nail plate. Prolonged exposure to nail ultraviolet (UV) lamps is required to cure the gel polish. Despite the increased use of UV nail lamps, there is limited consensus in the literature on the risk of skin malignancy associated with UV nail lamps. The objective of this article was to provide a systematic review of the risk of skin malignancy associated with the use of UV nail lamps and to synthesize evidence-based recommendations on their safe usage. A systematic review of the literature was conducted on the databases, Medline and Embase, in accordance with PRISMA guidelines. The search yielded 2,331 non-duplicate articles. Nine were ultimately included, of which three were case reports, one was a cross-sectional study, and five were experimental studies. The risk of bias per the Joanna Briggs Institute guidelines was high or unclear, likely due to the number of case reports included. Prolonged and repeated exposure to UV nail lamps may pose a low risk of skin cancer. It is important to note that the available evidence is weak, and patients should be informed about the limited data to make their own decisions. Dermatologists and other healthcare providers should be updated with the latest evidence to address patients' concerns about gel manicures and suggest practices which can effectively reduce the risk of cutaneous malignancy associated with gel manicures, such as the use of UV-blocking gloves or properly applied sunscreens.
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Affiliation(s)
- Dea Metko
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Shanti Mehta
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Eric Mcmullen
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - E Dimitra Bednar
- Division of Dermatology, University of Toronto, Toronto, ON, Canada
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19
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Navarro-Pérez D, García-Oreja S, Tardáguila-García A, León-Herce D, Álvaro-Afonso FJ, Lázaro-Martínez JL. Inter-observer reliability of the Onychomycosis Severity Index depending on clinical experience: A review of 50 cases. Mycoses 2024; 67:e13694. [PMID: 38214350 DOI: 10.1111/myc.13694] [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: 11/05/2023] [Accepted: 12/26/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Onychomycosis (ONM) is the most prevalent nail unit pathology, and its severity and monitoring are often based on the visual judgement of clinicians. OBJECTIVE The objective of this study is to assess the reliability of the Onychomycosis Severity Index (OSI) classification when utilized by three clinicians with varying levels of clinical experience: an experienced podiatrist (with 5 years of experience), a moderately experienced podiatrist (with 2 years of experience) and an inexperienced podiatrist (a recent graduate familiar with the OSI classification but lacking clinical experience). Additionally, we compared the severity assessments made through visual inspection with those determined using the OSI by different clinicians. METHODS We evaluated reliability using the intraclass correlation index (ICC), analysing 50 images of ONM. RESULTS The OSI demonstrated a very high level of reliability (ICC: 0.889) across clinicians, irrespective of their experience levels. Conversely, a statistically significant increase in severity was observed when comparing visual assessments with the OSI (p < .001) for ONM severity evaluation. CONCLUSION The OSI proves to be a reproducible classification system, regardless of the clinical experience of the practitioner employing it.
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Affiliation(s)
- David Navarro-Pérez
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IDISSC), Madrid, Spain
| | - Sara García-Oreja
- Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IDISSC), Madrid, Spain
| | - Aroa Tardáguila-García
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IDISSC), Madrid, Spain
| | - Diego León-Herce
- Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IDISSC), Madrid, Spain
| | - Francisco Javier Álvaro-Afonso
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IDISSC), Madrid, Spain
| | - José Luis Lázaro-Martínez
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IDISSC), Madrid, Spain
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20
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Heyer C. Zerschundene Nagelfalze mit Riesenkapillaren. MMW Fortschr Med 2024; 166:27. [PMID: 38261194 DOI: 10.1007/s15006-024-3570-7] [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] [Indexed: 01/24/2024]
Affiliation(s)
- Cornelius Heyer
- Springer Medizin Verlag GmbH, Aschauer Str. 30, 81549, München, Deutschland
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21
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Lee SG, Oh BH, Chung KY, Roh MR. Looking Beyond the Hutchinson Sign: A Retrospective Study of Clinical Factors Indicating the Presence and Invasiveness of Nail Unit Melanoma in Patients With Longitudinal Melanonychia. Dermatol Surg 2024; 50:21-27. [PMID: 38112410 DOI: 10.1097/dss.0000000000003982] [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] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND The data underlying this article are available in the article.Longitudinal melanonychia (LM) presents a challenge because nail unit melanoma (NUM) must be considered as a differential diagnosis. Because nail matrix biopsy may result in nail dystrophy, it is important to distinguish NUM from LM. OBJECTIVE To provide evidence of previously reported clinical factors indicative of NUM in patients with LM. METHODS This was a retrospective study of patients who presented with LM and had biopsy-confirmed NUM from 2005 to 2021. Benign LM was either confirmed by biopsy or considered benign if followed without the need for biopsy. Clinical factors associated with LM and NUM were compared by multivariate regression. RESULTS A total of 177 patients (97 LM and 80 NUM) were included. Multivariate regression showed that high band color intensity (p = .0031), variegation (p = .0005), nail plate splitting (p = .0017), Hutchinson sign (p = .0027), and band change (p = .001) correlated with malignancy. Nail plate splitting was associated with Breslow thickness. CONCLUSION Malignancy should be suspected and biopsy performed in patients with LM and high band color intensity, variegation, nail plate splitting, Hutchinson sign, and band change.
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Affiliation(s)
- Sang Gyun Lee
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Ho Oh
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kee Yang Chung
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Ryung Roh
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
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22
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Li F, Jiang JY, Huang SD, Liu MX, Wang XQ, Wong HS, Wang DG. Comparative efficacy of different reconstruction methods after wide local excision of the nail unit: A retrospective study. J Eur Acad Dermatol Venereol 2023; 37:2583-2588. [PMID: 37591629 DOI: 10.1111/jdv.19423] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/20/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Wide local excision (WLE) of the nail unit is widely used in treating in situ and minimally invasive malignant subungual tumours. After WLE, diverse reconstruction methods have been reported. However, the best repair method has yet to be determined. OBJECTIVE To compare the repair effects and postoperative morbidity of secondary intention healing (SIH), artificial dermis grafting combined with secondary intention healing (ADGSIH) and full-thickness skin grafting (FSG) after WLE of the nail unit. METHODS We retrospectively reviewed 21 patients who underwent WLE of the nail unit. The re-epithelializing time, functional and cosmetic outcomes, postoperative complications and patients' satisfaction were assessed from the follow-up records. RESULTS The FSG group showed more rapid healing and better functional and cosmetic outcomes than the SIH and ADGSIH groups. The ADGSIH and FSG groups showed significant pain relief compared to the SIH group. No serious early and late postoperative complications were reported. The median follow-up period was 26 months, and no recurrence was observed. All patients were satisfied with the treatment. CONCLUSIONS FSG after the WLE of the nail unit is a therapeutic option with convenient application, significant pain relief, rapid recovery and satisfying functional and cosmetic outcomes.
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Affiliation(s)
- Fang Li
- Department of Dermatology and Venereology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Jia-Yi Jiang
- Department of Dermatology and Venereology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Shu-Dai Huang
- Department of Dermatology and Venereology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Meng-Xi Liu
- Department of Dermatology and Venereology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Xiao-Qing Wang
- Department of Dermatology and Venereology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Hoi Shiwn Wong
- Department of Dermatology and Venereology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Da-Guang Wang
- Department of Dermatology and Venereology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
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23
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Gupta MK, Lipner SR. Green Toenail Discoloration due to Tracer Dye. Skinmed 2023; 21:270. [PMID: 37771019] [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)
- Mohit Kumar Gupta
- The State University of New York Downstate College of Medicine, Brooklyn, NY
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, NY;
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24
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Hamad MN, Ravella KC, Lipman MD, Mejia A. Local and Systemic Nail Plate Abnormalities: A Clinical Review. J Hand Surg Am 2023; 48:931-940. [PMID: 37191602 DOI: 10.1016/j.jhsa.2023.04.005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 01/16/2023] [Accepted: 04/09/2023] [Indexed: 05/17/2023]
Abstract
Nail disorders are often difficult to recognize and diagnose because of the subtlety of their presentation and their shared overlapping features that are common to several conditions. Experientially, this is further complicated by the fact that specific training on diagnosis of nail pathologies varies substantially across most residency programs and for a majority of medical and surgical specialties. To distinguish these presentations from true, potentially deleterious nail disorders, clinicians should have familiarity with the most commonly occurring nail pathologies and their associations, and use a systematic approach when examining or evaluating alterations in the nails. In the present study, we review the most common clinical disorders affecting the nail apparatus.
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Affiliation(s)
- Mohammed Nazmy Hamad
- Department of Orthopaedic Surgery, University of Illinois Medical Center at Chicago, Chicago, IL
| | - Krishna C Ravella
- Department of Orthopaedic Surgery, University of Illinois Medical Center at Chicago, Chicago, IL.
| | - Marc D Lipman
- Department of Orthopaedic Surgery, University of Illinois Medical Center at Chicago, Chicago, IL
| | - Alfonso Mejia
- Department of Orthopaedic Surgery, University of Illinois Medical Center at Chicago, Chicago, IL
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25
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Abstract
INTRODUCTION Nail psoriasis is an inflammatory disorder without a potential scarring outcome, but the nail signs, even the milder ones, can cause discomfort to patients and severely affect their quality of life. Nail psoriasis may be associated with psoriatic arthritis and when it starts during infancy, it may be a predictor of a more severe disease course in adulthood. All these issues contribute to the high economic burden of psoriasis. AREAS COVERED Nail psoriasis is notoriously difficult to treat, even though new treatments are in continuous development. This paper provides an update on new treatments and address the current gaps in care of nail psoriasis. EXPERT OPINION A better understanding of the disease pathogenesis and more 'real-life' studies will definitely be helpful to improve treatment results. A lower level of heterogeneity should be advisable among trials when evaluating nail psoriasis. Moreover, the relationship between nail psoriasis and psoriatic arthritis should be the focus of unbiased studies in order to better define the real risk that nail psoriasis patients have to develop arthritis.
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Affiliation(s)
- Matilde Iorizzo
- Private Dermatology Practice, Bellinzona/Lugano, Switzerland
| | - Antonella Tosti
- Miller School of Medicine, Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, FL, USA
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26
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Bellinato F, Gisondi P, Filippucci E, Tozzi F, Fassio A, Adami G, Idolazzi L. Systematic study on nail plate assessment: differences in nail plate shape, thickness, power Doppler signal and scanning approach. Arch Dermatol Res 2023; 315:593-600. [PMID: 36271200 PMCID: PMC10020276 DOI: 10.1007/s00403-022-02404-5] [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: 05/25/2022] [Revised: 09/27/2022] [Accepted: 10/11/2022] [Indexed: 11/02/2022]
Abstract
Ultrasonography (US) of the nail is raising interest in the last years and its feasibility, quickness and amount of descriptive data may provide valuable information. Different authors presented several scanning approaches to nail complex in different pathological conditions, such as psoriasis, but no scanning protocol was ever proposed using healthy subjects as population of reference. The aim of the study was to establish a protocol for the US of nail plate and to assess whether the measurement of the nail plate is influenced by longitudinal vs transverse scan, sex, digit and hand dominance. Using high frequency probe and a Canon Aplio i800 machine, ultrasonographers took scans of nail plates of the hands from healthy subjects. Nail plate shape, thickness and power Doppler signal (PDUS) were evaluated and scans were taken both on longitudinal and transverse axis, at distal, middle and proximal portion of the nail plate or at a fixed angles of - 45°, 0° or + 45°. All the images were then revised and scored using a DICOM software, in order to allow good standards of accuracy and reproducibility. A total of 27 subjects (14 females and 13 males) were assessed. The measures did not result to differ in different portions or angles. Furthermore, no difference appears in sex or dominant vs not dominant hand. A decreasing and significant trend for nail plate thickness was found from the first to the fifth finger. Doppler signal was found in all but one subjects, with a range from almost absent to very evident. No difference was found between groups regarding PDUS. The data provided suggest that a proper scan protocol should include all the nails and evaluation should be done both on longitudinal and transverse axis. Since Doppler signal is highly variable in healthy subjects, its presence should be carefully considered as pathological finding. Observations provided by this study clarify important points of the scanning technique and solve doubts related to which nails should be scanned and where to evaluate quantitative parameters.
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Affiliation(s)
- Francesco Bellinato
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy.
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Emilio Filippucci
- Clinica Reumatologica, Università Politecnica Delle Marche, Ospedale "Carlo Urbani", Jesi, Ancona, Italy
| | - Francesca Tozzi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Angelo Fassio
- Section of Rheumatology, Department of Medicine, University of Verona, Verona, Italy
| | - Giovanni Adami
- Section of Rheumatology, Department of Medicine, University of Verona, Verona, Italy
| | - Luca Idolazzi
- Section of Rheumatology, Department of Medicine, University of Verona, Verona, Italy
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27
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Curtis KL, Lipner SR. Metastases to the nail unit and distal phalanx: a systematic review. Arch Dermatol Res 2023; 315:347-358. [PMID: 36260150 DOI: 10.1007/s00403-022-02411-6] [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: 04/17/2022] [Revised: 10/02/2022] [Accepted: 10/13/2022] [Indexed: 11/02/2022]
Abstract
Metastases to the nail unit/distal phalanx (NU/DP), although rare, carry a poor prognosis and are frequently misdiagnosed due to variable clinical presentation. Metastases to the NU/DP may be the initial presenting sign of a new or recurrent malignancy. Since the most recent systematic review of case reports (133 patients total) was conducted in 2001, we conducted a systematic review from 1900 to 2021 (244 patients total) to assess any changes in trends in demographics, clinical presentation, and morphology and to report on more updated differential diagnoses. We also examined cases for age, sex, race, ethnicity, Fitzpatrick skin type, laterality, distribution, and diagnostic methods. The PubMed database (1900-2021) was used to detect case-level data per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We found that the most common primary tumors were lung, kidney, and esophagus. A NU/DP metastasis was the presenting sign of malignancy in 31.00% of patients without a former cancer diagnosis. Male to female ratio was 2:1, with average age at diagnosis 58 years. Metastases most often affected a single digit (79.91%), particularly the thumb, followed by the fourth digit. This systematic review corroborates that metastases to the NU/DP may be the initial presenting sign of a new or recurrent malignancy and provides updated diagnostic guidelines. NU/DP metastasis should be considered in both healthy patients and patients with a former malignancy diagnosis presenting with nail changes involving a single digit. Prompt diagnosis and treatment may improve prognosis.
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Affiliation(s)
- Kaya L Curtis
- Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10021, USA
| | - Shari R Lipner
- Weill Cornell Dermatology, 1305 York Avenue, New York, NY, 10021, USA.
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28
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Folle L, Fenzl P, Fagni F, Thies M, Christlein V, Meder C, Simon D, Minopoulou I, Sticherling M, Schett G, Maier A, Kleyer A. DeepNAPSI multi-reader nail psoriasis prediction using deep learning. Sci Rep 2023; 13:5329. [PMID: 37005487 PMCID: PMC10067940 DOI: 10.1038/s41598-023-32440-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 01/04/2023] [Accepted: 03/28/2023] [Indexed: 04/04/2023] Open
Abstract
Nail psoriasis occurs in about every second psoriasis patient. Both, finger and toe nails can be affected and also severely destroyed. Furthermore, nail psoriasis is associated with a more severe course of the disease and the development of psoriatic arthritis. User independent quantification of nail psoriasis, however, is challenging due to the heterogeneous involvement of matrix and nail bed. For this purpose, the nail psoriasis severity index (NAPSI) has been developed. Experts grade pathological changes of each nail of the patient leading to a maximum score of 80 for all nails of the hands. Application in clinical practice, however, is not feasible due to the time-intensive manual grading process especially if more nails are involved. In this work we aimed to automatically quantify the modified NAPSI (mNAPSI) of patients using neuronal networks retrospectively. First, we performed photographs of the hands of patients with psoriasis, psoriatic arthritis, and rheumatoid arthritis. In a second step, we collected and annotated the mNAPSI scores of 1154 nail photos. Followingly, we extracted each nail automatically using an automatic key-point-detection system. The agreement among the three readers with a Cronbach's alpha of 94% was very high. With the nail images individually available, we trained a transformer-based neural network (BEiT) to predict the mNAPSI score. The network reached a good performance with an area-under-receiver-operator-curve of 88% and an area-under precision-recall-curve (PR-AUC) of 63%. We could compare the results with the human annotations and achieved a very high positive Pearson correlation of 90% by aggregating the predictions of the network on the test set to the patient-level. Lastly, we provided open access to the whole system enabling the use of the mNAPSI in clinical practice.
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Affiliation(s)
- Lukas Folle
- Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander-Universität Erlangen-Nürnberg, Martensstraße 3, 91058, Erlangen, Germany.
| | - Pauline Fenzl
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Filippo Fagni
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Mareike Thies
- Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander-Universität Erlangen-Nürnberg, Martensstraße 3, 91058, Erlangen, Germany
| | - Vincent Christlein
- Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander-Universität Erlangen-Nürnberg, Martensstraße 3, 91058, Erlangen, Germany
| | - Christine Meder
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Department of Dermatology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Ioanna Minopoulou
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Michael Sticherling
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Department of Dermatology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Andreas Maier
- Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander-Universität Erlangen-Nürnberg, Martensstraße 3, 91058, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
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29
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Peck GM, Wang Y, Fleischer AB, Lipner SR. Practice region and density, male sex, and specialty predict frequent performers of nail biopsies. J Am Acad Dermatol 2023; 88:688-690. [PMID: 35817331 DOI: 10.1016/j.jaad.2022.07.004] [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: 03/01/2022] [Revised: 06/22/2022] [Accepted: 07/03/2022] [Indexed: 11/17/2022]
Affiliation(s)
| | - Yu Wang
- Department of Dermatology, Wake Forest University, Winston-Salem, North Carolina
| | - Alan B Fleischer
- Department of Dermatology, University of Cincinnati, Cincinnati, Ohio
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, New York.
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30
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Perrin C. Preferentially Expressed Nuclear Antigen in Melanoma Expression in Melanocytic Activation (Melanotic Macule) of the Nail Unit. A Potential Diagnostic Pitfall? A Study of 3 Cases. Am J Dermatopathol 2022; 44:499-502. [PMID: 35220324 DOI: 10.1097/dad.0000000000002156] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Recent studies have argued that melanocyte preferentially expressed nuclear antigen in melanoma (PRAME) is a sensitive and specific immunohistochemical marker of melanoma, including acral melanoma. In addition, loss of p16 expression has recently been suggested to have diagnostic utility in acral melanocytic tumors. The purpose of this study was to report PRAME expression in 3 cases of melanocytic activation (MAN). There were 2 men and 1 woman ranging in age at diagnosis from 46 years to 78 years (mean 61, 6 years). All cases involved a single digit. One lesion was in the fingernail (fifth finger), whereas the remaining 2 lesions were in the toenails (hallux). All the patient presented with a longitudinal melanonychia. The width of the lesions varied from 3 mm (2 cases) to 4 mm (1 case). The duration of the lesions before diagnosis varied from 12 to 24 months. Distinction of MAN from melanoma in situ is not always easy. Some morphological misleading features are illustrated in this study: (1) the suprabasal location of matrix melanocytes with long and thick dendrites within the 2-4 germinative cell layers; (2) the microconfluence of 2 melanocytes and rare melanocytes with a relatively large nucleus, however in a general context of melanocyte scarcity; and (3) the occasional nonspecific nuclear microphtalmia-associated transcription factor (MITF) staining of keratogeneous cells. Such staining could suggest a pagetoid spread of melanocytes in the keratogenous zone. PRAME antibody revealed a strong and diffuse staining in all cases. In addition, all cases were p16 negative. In this study, the melanocyte count inferior to 9 melanocytes/mm and the lack of nuclear atypia or confluence of melanocytes permitted a confident diagnosis of MAN. Limitations of our study lie largely in the small number of cases. Despite this, the expression of PRAME in some MAN seems to hamper its diagnostic value in differentiating benign from malignant lesion.
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Affiliation(s)
- Christophe Perrin
- Laboratoire Central D'Anatomie Pathologique, Hôpital L. Pasteur, University of Nice, Nail's Dermatology Consultations, Nice, Cannes, France
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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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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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van Zijverden LM, Marees CH. [Persistently crumbling nails in a patient with limited Dutch proficiency]. Ned Tijdschr Geneeskd 2022; 166:D6461. [PMID: 35499542] [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
BACKGROUND Nail psoriasis, also called psoriasis unguium, is a variant of psoriasis in which nail changes appear due to inflammation of nail bed or nail matrix. 15% to 50% of patients with cutaneous psoriasis have nail psoriasis, the condition also occurs without or before the appearance of skin lesions. CASE DESCRIPTION A 54-year-old male visits his general practitioner because of crumbling of his fingernails. Upon clinical examination, this was interpreted as onychomycosis and treated with oral antimycotics. Due to the lack of improvement and a negative PCR-test on dermatophytes, the condition was later diagnosed as nail psoriasis. CONCLUSION Nail psoriasis is often diagnosed as fungal infection of the nails. To make the right diagnosis, a complete medical history should be obtained, and physical examination of skin and joints need to be conducted. Furthermore, we advise to rule out onychomycosis in patients with known skin psoriasis to prevent overtreatment with antimycotics.
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Affiliation(s)
- L M van Zijverden
- Amsterdam UMC, locatie VUmc, afd. Huisartsgeneeskunde, Amsterdam
- Contact: L. M. van Zijverden
| | - C H Marees
- Amsterdam UMC, locatie VUmc, afd. Huisartsgeneeskunde, Amsterdam
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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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Abstract
BACKGROUND Amputation has been the standard treatment for subungual melanoma. Although there is growing attention toward a more conservative functional surgery, specific operative techniques are not yet available. OBJECTIVE We aimed to provide objective measurements for use in functional surgery by analyzing the anatomy of the nail apparatus obtained from 21 cadavers. MATERIALS AND METHODS Nailbed thickness was histologically measured in each subunit, and skin surface anatomy was evaluated to determine the proximal resection margin. Immunohistochemical staining was performed to analyze microvessel distribution according to the nail subunit. RESULTS The nailbed thickness was the thinnest at the most proximal point of the nail matrix (thumbs, 1.10 ± 0.42 mm; big toes, 1.15 ± 0.37 mm) and the thickest at the hyponychium (thumbs, 2.86 ± 0.82 mm; big toes, 2.72 ± 0.84 mm). The distance from the eponychium to the skin surface closest to the bony cortex of extensor tendon insertion was 6.92 ± 5.13 mm in thumbs and 5.14 ± 1.59 mm in big toes. The median microvessel density was the highest at the hyponychium (25.74 vessels/mm2) and lowest at the germinal matrix (16.26 vessels/mm2) (p < .05). CONCLUSION This histological study offers practical tips, including those to help decide the proximal and deep resection margins, in functional surgery.
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Affiliation(s)
- Byung Jun Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jinhyun Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Julong Hu
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yoonjin Kwak
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sung Tack Kwon
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul, Republic of Korea
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Xue S, Chen Y, Haneke E. Soft Tissue Chondroma: A Possible Diagnosis of Single-Digit Nail Clubbing. Dermatol Surg 2022; 48:143-144. [PMID: 34904580 PMCID: PMC8667792 DOI: 10.1097/dss.0000000000003295] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Supplemental Digital Content is Available in the Text.
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Affiliation(s)
- Siliang Xue
- Department of Dermatovenereology, Sichuan University West China Hospital, Chengdu, China
| | - Yusha Chen
- Department of Dermatovenereology, Sichuan University West China Hospital, Chengdu, China
| | - Eckart Haneke
- Department of Dermatology, Inselspital, Bern University Hospital, Bern, Switzerland
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Oh SJ, Lee J, Park S, Park JH, Lee D. Hutchinson Sign: Biopsy May Assist in Diagnosis of Subungual Melanoma in Situ. Dermatol Surg 2022; 48:28-31. [PMID: 34608084 DOI: 10.1097/dss.0000000000003233] [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] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Early and accurate diagnosis of subungual melanoma (SUM) through histopathologic examination is critical, but lack of clinical suspicion leads to delays in diagnosis. Hutchinson sign (HS) can be one of the important clinical indicators for diagnosing SUM. OBJECTIVE To evaluate the diagnostic value of small biopsies of HS for detecting SUM in situ. METHODS We retrospectively evaluated 12 patients who were diagnosed as SUM in situ and underwent punch biopsy at HS areas. Clinical features, dermoscopic findings, and histopathologic findings in HS regions were analyzed. RESULTS In most cases, HS was seen in hyponychium (11/12, 91.7%) with 1 case found in proximal nail fold, and 1 case in both the hyponychium and proximal nail fold. Dermoscopic features of HS showed irregular diffuse pigmentation (12/12, 100%) and parallel ridge pattern (7/12, 58.3%). Histopathologically, all cases showed irregularly scattered atypical melanocytes with hyperchromatic nuclei. Two cases showed subtle changes in melanocytes with little nuclear atypia, but additional section specimen showed more definitive findings of SUM in situ. CONCLUSION We present a supplementary biopsy technique for diagnosing SUM. Biopsy of HS may help in the diagnosis of SUM.
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Affiliation(s)
- Se Jin Oh
- All authors are affiliated with the Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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38
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Meershoek AJA, Roks DJGH, Somford MP. [A boy with an abnormal hallux]. Ned Tijdschr Geneeskd 2021; 165:D6452. [PMID: 35138764] [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
An eleven-year-old boy was seen by the general practioner due to a painfull hallux. The diagnosis unguis incarnatus was made. Therefore, a partial nail extraction was performed. Unfortunately, the patient still had complaints of a painful hallux and was forwarded to the surgical outpatient clinic. We saw a round, hard and benign tumor on the lateral side of the nail (picture 1). We performed a partial nail extraction as well. Due to persistence complaints and the abnormal course and X-ray was performed. On the X-ray an exostosis was seen (picture 2). This confirmed the diagnosis: subungual exostosis. It is a rare clinical manifestation and has a long delay up until diagnosis. It is a benign bone tumor and often seen on the hallux. A radical excision must be performed.
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Bernardes SS, Ferreira I, Elder DE, Nobre AB, Martínez‐Said H, Adams DJ, Robles‐Espinoza CD, Possik PA. More than just acral melanoma: the controversies of defining the disease. J Pathol Clin Res 2021; 7:531-541. [PMID: 34213090 PMCID: PMC8503895 DOI: 10.1002/cjp2.233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/13/2021] [Accepted: 06/09/2021] [Indexed: 01/17/2023]
Abstract
Acral melanoma (AM) is a malignant cutaneous melanocytic tumour specifically located on the palms, soles, and nail apparatus, which are areas of glabrous (hairless) skin. Acral lentiginous melanoma, a subtype of AM, represents a histopathological subtype diagnosis of cutaneous melanoma with unique morphological and structural features. Despite clear definitions, the misuse of these terms and the inconsistency in reporting the histopathological features of AM cases have become a major obstacle to the study of the disease. In this review, we discuss the epidemiology, histopathological features, prognosis, and genetic profile of AM, highlighting the differences observed when histopathological subtypes are considered. The increasing global effort to characterise AM cases from ethnically diverse populations would benefit greatly from a more consistent classification of the disease.
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Affiliation(s)
- Sara S Bernardes
- Program of Immunology and Tumour BiologyBrazilian National Cancer InstituteRio de JaneiroBrazil
- Tissue Microenvironment Laboratory, Department of General PathologyFederal University of Minas GeraisBelo HorizonteBrazil
| | - Ingrid Ferreira
- Experimental Cancer GeneticsWellcome Sanger InstituteHinxtonUK
- Université Libre de BruxellesBrusselsBelgium
| | - David E Elder
- Division of Anatomic PathologyHospital of the University of PennsylvaniaPhiladelphiaPAUSA
| | - Aretha B Nobre
- Division of PathologyBrazilian National Cancer InstituteRio de JaneiroBrazil
- Serviço de Patologia, Maternidade EscolaUniversidade Federal do Rio de JaneiroRio de JaneiroBrazil
| | - Héctor Martínez‐Said
- Servicio de Piel y Partes BlandasInstituto Nacional de CancerologíaCiudad de MéxicoMexico
| | - David J Adams
- Experimental Cancer GeneticsWellcome Sanger InstituteHinxtonUK
| | - Carla Daniela Robles‐Espinoza
- Experimental Cancer GeneticsWellcome Sanger InstituteHinxtonUK
- Laboratorio Internacional de Investigación sobre el Genoma HumanoUniversidad Nacional Autónoma de MéxicoSantiago de QuerétaroMexico
| | - Patricia A Possik
- Program of Immunology and Tumour BiologyBrazilian National Cancer InstituteRio de JaneiroBrazil
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Pei S, Szczykutowicz TP, Hinshaw JL, Hinshaw MA. Consistency of histologic fungal burden in onychomycotic nails regardless of clinical severity: A retrospective case series of 79 patients. J Am Acad Dermatol 2021; 87:845-847. [PMID: 34425176 DOI: 10.1016/j.jaad.2021.08.026] [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: 01/31/2021] [Revised: 07/28/2021] [Accepted: 08/10/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Susan Pei
- Department of Pathology and Laboratory Medicine and Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Timothy P Szczykutowicz
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - James Louis Hinshaw
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Molly A Hinshaw
- Department of Dermatology and Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
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Yoo H, Kim H, Kwon ST, Jo SJ, Mun JH, Lee C, Kwak Y, Kim BJ. Tumor invasion in the hyponychium is associated with distant metastasis and poor prognosis in subungual melanoma: A histologic landscape of 44 cases. J Am Acad Dermatol 2021; 86:1027-1034. [PMID: 34153394 DOI: 10.1016/j.jaad.2021.06.847] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 09/04/2020] [Revised: 06/06/2021] [Accepted: 06/14/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Subungual melanoma (SUM) has a poor prognosis because of delayed diagnosis. Its progression, consensus on surgical treatment, and correlation with clinical outcomes remain unclear. OBJECTIVE We aimed to identify the pattern of dermal invasion in different locations of the nail apparatus and its relationship with prognosis. METHODS In this retrospective review of surgically treated SUM patients between January 2011 and April 2019, the nail apparatus was divided into 5 anatomic subunits: the dorsal roof of proximal nail fold, ventral floor of proximal nail fold, germinal matrix, nail bed, and hyponychium. Invasions in the subunits were categorized using 3 criteria: no tumor, in situ tumor, or invasion. RESULTS Among 44 cases of SUM, dermal invasion occurred mostly in the distal areas, with 11, 30, 18, 7, and 4 in the hyponychium, nail bed, germinal matrix, ventral floor of proximal nail fold, and dorsal roof of proximal nail fold, respectively. The patients with hyponychial invasion showed a significantly greater Breslow depth (P = .009), a higher rate of lymph node metastasis (P = .019), distant metastasis (P = .036), and shorter disease-free survival (P = .001). CONCLUSION Hyponychial invasion is an important prognostic predictor of SUM, given its strong association with invasion depth, metastatic progression, and disease-free survival. Patients with invasion in the hyponychium should undergo more strict workup, treatment, and surveillance.
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Affiliation(s)
- Hyokyung Yoo
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | - Sung Tack Kwon
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seong Jin Jo
- Department of Dermatology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Je-Ho Mun
- Department of Dermatology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Cheol Lee
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yoonjin Kwak
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Byung Jun Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Rich P, Goldblum O, Disch D, Lin CY, Merola JF, Elewski B. Nail Psoriasis Does Not Affect Skin Response to Ixekizumab in Patients With Moderate-To-Severe Psoriasis. J Drugs Dermatol 2021; 19:741-746. [PMID: 32845588 DOI: 10.36849/jdd.2020.5116] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background: Presence of nail psoriasis in patients with plaque psoriasis may be an indicator of greater disease severity. Previously, patients with nail psoriasis have had delayed skin clearance after treatment compared to patients without nail psoriasis. Objective: This post-hoc analysis evaluated the efficacy of ixekizumab in clearance of plaque psoriasis in patients with and without nail psoriasis. Methods: Data were integrated from two phase 3 clinical trials (UNCOVER-2 and UNCOVER-3; N=2570) to assess skin response over 12 weeks of treatment with subcutaneous placebo, etanercept, or ixekizumab in patients with and without nail psoriasis. Nail response was assessed using Nail Psoriasis Severity Index (NAPSI) and skin response was assessed as the percentage of patients achieving 75%, 90%, or 100% improvement in Psoriasis Area and Severity Index (PASI 75, PASI 90, PASI 100) or a score of 0 or 1 on the static Physician Global Assessment (sPGA 0 or 0,1). Results: From baseline to week 12, progressive improvement in psoriasis occurred with ixekizumab and etanercept treatment; however, significantly more patients with nail psoriasis than without mild PASI 75 at weeks 8 and 12 and sPGA (0,1) at week 12 with ixekizumab. Significantly more patients with severe nail psoriasis than mild achieved PASI 75 at weeks 8 and 12 with ixekizumab. Conclusion: Patients with and without nail psoriasis responded well to ixekizumab. The presence of nail psoriasis did not negatively affect skin clearance in patients treated with ixekizumab. ClinicalTrials.gov: NCT01597245, NCT01646177 J Drugs Dermatol. 2020;19(8):741-746. doi:10.36849/JDD.2020.5116.
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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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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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Oliveira MH, Pinto FCM, Ferraz-Carvalho RS, Albuquerque AV, Aguiar JL. BIO-NAIL: a bacterial cellulose dressing as a new alternative to preserve the nail bed after avulsion. J Mater Sci Mater Med 2020; 31:121. [PMID: 33247774 DOI: 10.1007/s10856-020-06456-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 10/27/2020] [Indexed: 06/12/2023]
Abstract
Avulsion of the nail plate is the most accomplished surgical procedure among the nail apparatus surgeries. Since it is not possible to use the removed nail to cover the nail bed, some materials have been suggested, however, they are generally not available for use and often at a high cost. To evaluate the use of Bacterial Cellulose (BC) dressing as a biological nail (Bio-Nail) after partial or total avulsion of the nail plate. Twenty-six candidates for nail avulsion, were randomized into two groups: Control, using Vaseline with gauze (11 patients) and Experimental group, BC group, using the Bio-Nail (15 patients). The patients were followed up during the 180-day period. The distribution of the patients in the groups was homogeneous for both sociodemographic and clinical data. The occurrence of infection (1 case in the control group) was not statistically relevant. The BC group had lower pain intensity (p = 0.011) with earlier temporal resolution when compared to the control group (p = 0.003). The BC group presented earlier reepithelization (p = 0.022) and better quantitative (p = 0.021) and qualitative conditions (p = 0.011) for the exudate. Regarding satisfaction, all the patients were satisfied. Good preservation of the nail plate area was observed in the BC group at the end of the 180-day period (p = 0.024). Average time of BC dressing permanence was 16.4 ± 7.1 days. BC showed to be appropriate as a dressing after partial or total avulsion of the nail plate. BC is a Bio-Nail promising for nail bed healing.
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Affiliation(s)
- M H Oliveira
- Department of Dermatology, Hospital das Clínicas, Department of Surgery, Health Sciences Center, Federal University of Pernambuco, UFPE, Pernambuco, Brazil
| | - F C M Pinto
- Post-Graduation Program in Surgery, Department of Surgery, Health Sciences Center, Federal University of Pernambuco, UFPE, Pernambuco, Brazil.
| | - R S Ferraz-Carvalho
- Post-Graduation Program in Surgery, Department of Surgery, Health Sciences Center, Federal University of Pernambuco, UFPE, Pernambuco, Brazil
| | - A V Albuquerque
- Post-Graduation Program in Surgery, Department of Surgery, Health Sciences Center, Federal University of Pernambuco, UFPE, Pernambuco, Brazil
| | - J L Aguiar
- Post-Graduation Program in Surgery, Department of Surgery, Health Sciences Center, Federal University of Pernambuco, UFPE, Pernambuco, Brazil
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Affiliation(s)
- Soumya Chatterjee
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
- Orthopaedic and Rheumatologic Institute, Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Elliott Chandler Dasenbrook
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
- Cleveland Clinic Adult Cystic Fibrosis Program and Bronchiectasis Center, Cleveland, Ohio
- Respiratory Institute, Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, Ohio
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Djuardi I, Ilyas F, Djawad K, Helina I, Wibisono O. Nail Fold Dermatoscopic Findings in Scleroderma Patients. Skinmed 2020; 18:308-310. [PMID: 33160442] [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
A 28-year-old woman with previously excellent health presented with pain, swelling, and stiffness on the face and hands, which had persisted for over 18 months. She had initially experienced intermittent pain in both knees. Skin hardening spread to both hands until the fingers could no longer be straightened. There were intermittent pain and skin hardening on the cheeks extending to the neck. These were accompanied by breathing difficulty, especially during high-intensity activity.
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Affiliation(s)
- Irene Djuardi
- Department of Dermatology and Venereology, Hasanuddin University Faculty of Medicine, Makassar 90245, South Sulawesi, Indonesia
- Hasanuddin University Hospital, Makassar 90245, South Sulawesi, Indonesia
- Dr. Wahidin Sudirohusodo Hospital, Makassar 90245, South Sulawesi, Indonesia;
| | - Faridha Ilyas
- Department of Dermatology and Venereology, Hasanuddin University Faculty of Medicine, Makassar 90245, South Sulawesi, Indonesia
- Dr. Wahidin Sudirohusodo Hospital, Makassar 90245, South Sulawesi, Indonesia
| | - Khairuddin Djawad
- Department of Dermatology and Venereology, Hasanuddin University Faculty of Medicine, Makassar 90245, South Sulawesi, Indonesia
- Dr. Wahidin Sudirohusodo Hospital, Makassar 90245, South Sulawesi, Indonesia
| | - Irma Helina
- Department of Dermatology and Venereology, Hasanuddin University Faculty of Medicine, Makassar 90245, South Sulawesi, Indonesia
| | - Olivia Wibisono
- Department of Dermatology and Venereology, Hasanuddin University Faculty of Medicine, Makassar 90245, South Sulawesi, Indonesia
- Hasanuddin University Hospital, Makassar 90245, South Sulawesi, Indonesia
- Dr. Wahidin Sudirohusodo Hospital, Makassar 90245, South Sulawesi, Indonesia
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Parodi M, Errichetti E. Eruptive Mucosal and Ungual Melanoma Metastases. N Engl J Med 2020; 383:169. [PMID: 32640135 DOI: 10.1056/nejmicm1915587] [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: 11/19/2022]
Affiliation(s)
- Maria Parodi
- University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Enzo Errichetti
- University Hospital Santa Maria della Misericordia, Udine, Italy
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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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Endringer Pinto F, Bagger C, Kunze G, Joly-Tonetti N, Thénot JP, Osman-Ponchet H, Janfelt C. Visualisation of penetration of topical antifungal drug substances through mycosis-infected nails by matrix-assisted laser desorption ionisation mass spectrometry imaging. Mycoses 2020; 63:869-875. [PMID: 32406142 DOI: 10.1111/myc.13103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 03/05/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Matrix-assisted laser desorption ionisation mass spectrometry imaging (MALDI-MSI) is a mass spectrometry-based technique, which can be applied for compound-specific imaging of pharmaceuticals in tissues samples. MALDI-MSI technology is widely used to visualise penetration and distribution profile through different tissues but has never been used with nail tissue. OBJECTIVES This study used MALDI-MSI technology to visualise distribution profile and penetration into ex vivo human mycosis-infected toenails of three antifungal active ingredients amorolfine, ciclopirox and naftifine contained in topical onychomycosis nail treatment preparations, marketed as Loceryl® , Ciclopoli® and Exoderil® . METHODS Three mycosis-infected toenails were used for each treatment condition. Six and twenty-four hours after one single topical application of antifungal drugs, excess of formulation was removed, nails were cryo-sectioned at a thickness of 20 μm, and MALDI matrix was deposited on each nail slice. Penetration and distribution profile of amorolfine, ciclopirox and naftifine in the nails were analysed by MALDI-MSI. RESULTS All antifungal actives have been visualised in the nail by MALDI-MSI. Ciclopirox and naftifine molecules showed a highly localised distribution in the uppermost layer of the nail plate. In comparison, amorolfine diffuses through the nail plate to the deep layers already 6 hours after application and keeps diffusing towards the lowest nail layers within 24 hours. CONCLUSIONS This study shows for the first-time distribution and penetration of certain antifungal actives into human nails using MALDI-MSI analysis. The results showed a more homogeneous distribution of amorolfine to nail and a better penetration through the infected nails than ciclopirox and naftifine.
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Affiliation(s)
- Fernanda Endringer Pinto
- Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Bagger
- Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | - Christian Janfelt
- Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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