Nail involvement in epidermolysis bullosa.

Nail abnormalities are a common feature in most subtypes of epidermolysis bullosa (EB), and they recently have been included among the criteria for scoring EB severity. Trauma undoubtedly contributes to the development of nail dystrophy, and for this reason the great toenails often are affected more severely. The nail abnormalities may be the first or the only symptom of EB. Nail abnormalities observed in EB are not specific or pathognomonic, as they result from nail bed and matrix scarring. The spectrum of clinical severity is large, and nail abnormalities may cause severe disability or just be a mild cosmetic problem. This article reviews the nail abnormalities observed in EB.

Dealing with melanonychia.

Melanonychia describes a brown or black pigmentation of the nail plate caused by the presence of melanin. In this article, we review possible causes of melanonychia and discuss the main problems of management of patients with this condition. The goal in the management of melanonychia is early diagnosis of melanoma of the nail matrix and bed. Melanoma of the nail bed is also known as subungual melanoma. We discuss clinical, dermoscopic features that may help the clinician in selecting lesions that should have excisional biopsy and evaluate different options for the excision. Addressing melanonychia is still a difficult task, and the correct management of pigmented bands in children is far from established. Dermoscopy is possibly a useful tool but the real benefit of this technique, screening lesions to determine which ones need to be removed, remains to be proven.

Frequency and main sites of allergic contact dermatitis caused by nail varnish.

BACKGROUND: Liquid nail varnish has been used since 1919, and allergic contact dermatitis (ACD) has been recognized for at least 80 years, but it is difficult for nonspecialists to identify this condition. OBJECTIVES: (1) To verify the frequency of ACD from nail varnish in patients with a presumptive diagnosis of contact dermatitis seen at an outpatient clinic, (2) to characterize the groups studied according to site of skin disorder, and (3) to determine the main sensitizer related to varnish. METHODS: Patients with a final diagnosis of ACD caused by nail varnish were assessed by means of retrospective analysis of medical charts and protocols used in the clinic from January 1996 to December 2006. Patch tests with the Brazilian standard series and a complementary series were applied to all patients. RESULTS: Diagnosis of ACD from nail varnish was made in 8% of cases (157 of 1,971). The most affected sites were the face and neck; however, involvement of some uncommon areas, such as periungual and perianal regions, was also observed. CONCLUSIONS: ACD from nail polishes is a common event and recognition of the condition must be improved. Toluenesulfonamide formaldehyde resin (TSFR) was the most common allergen in the group studied.

[Ileocecal valve reconstruction in dogs]. / Reconstituição da válvula ileocecal em cães.

PURPOSE: The importance of keeping the ileocecal valve in the intestinal ressections has been reported by several authors. When preserved, the ileocecal valve was related to a longer survival and prevention of the short bowel syndrome, due to its ability to block the colonic content reflux into the ileum and to avoid the rapid empting of the ileal content into the cecum. It was assessed a tecnique of ileocecal valve reconstitution, based on vesicoureteral anti-reflux tecniques. METHODS: Fourteen beagles were operated. Seven underwent ileocecal valve reconstitution following the tecnique proposed and in the other seven a simple end-to-end anastomosis was performed. To assess the new valve, it was done the clinical follow up, the microbiologic analysis and the manometric study. RESULTS: Clinically, during 45 days of follow up, there was no difference between the dogs with and without ileocecal reconstitution. In the aerobic bacteria analysis, the predominant bacterium was Escherichia coli. Quantitatively, the cultures grew in an irregular way, so that it was not able to compare the bacterial growth between the groups with or without ileocecal valve. The new valve had a colo-ileal reflux pressure similar to that of the physiological valve (P > 0.05). However, when compared to the non valve group, the reflux pressures of the physiological valve and new valve were significantly higher, with P < 0.05 and P < 0.001, respectively. CONCLUSION: In this study, the reconstituted ileocecal valve served as a barrier to the colo-ileal reflux just as the physiological valve does.