Should we biopsy melanonychia striata in Asian children? A retrospective observational study.

BACKGROUND AND OBJECTIVES: Melanonychia striata is common in children of darker-skinned Asian races, while subungual melanoma is extremely rare and it is difficult to make a diagnosis clinically. However, performing nail unit biopsies in children is particularly challenging and can result in permanent nail dystrophy. The aim of this study was to review the clinical and histologic characteristics of melanonychia striata in pediatric patients of Asian descent to aid in the clinical decision regarding nail biopsy. METHODS: Sixty-two pediatric patients presenting with melanonychia striata involving single or multiple nails at two tertiary pediatric dermatology clinics in Singapore between 2005 and 2015 were reviewed. Clinical and histopathological data were analyzed, including age at onset, age at presentation, location, color, width, presence of Hutchinson's sign, pseudo-Hutchinson's sign, nail dystrophy, length of follow-up, and clinical evolution. Histopathological assessment was performed by three senior dermatopathologists independently for cases that underwent a nail biopsy. RESULTS: No cases of subungual melanoma were detected in our series. Solitary melanonychia of the thumbnail with a single uniform color was the most common presentation. Pseudo-Hutchinson's sign was commonly observed. Consensus in histological diagnosis emerged amongst all three dermatopathologists in only half of the cases biopsied. CONCLUSION: The occurrence of melanoma in Asian children presenting with melanonychia is extremely rare. We recommend clinical follow-up and anticipatory guidance for these patients and nail unit biopsy only in the presence of high-risk clinical features.

[Ethnic nail pigmentations and differential diagnoses]. / Ethnische Nagelpigmentierungen und Differenzialdiagnosen.

Pigmentary nail changes may have a variety of causes, e. g., chronic inflammation, and occur more often in patients of African descent compared to Caucasians. Subungual malignant melanoma is the most important differential diagnosis and must be ruled out in any case. Dermatoscopy might be helpful. If no biopsy is taken, clinical follow-ups are necessary at short intervals. In case of chronic paronychia, optimization of occupational skin protection measures may contribute to the healing process.

Reassessing Melanonychia Striata in Phototypes IV, V, and VI Patients.

BACKGROUND: Racial melanonychia striata is a nail plate dyschromia described as a gray coloration of the background in dermatoscopy and hypermelanosis in histology. However, many cases with brown or black coloration of the background in the dermatoscopic examination have been followed. OBJECTIVE: Evaluate racial melanonychia striata dermatoscopical patterns and histological diagnosis in Fitzpatrick skin Types IV, V, or VI population. MATERIALS AND METHODS: 482 Fitzpatrick skin Types IV, V, or VI patients, between 19 and 72 years of age, were clinically evaluated and underwent nail plate dermatoscopic examination. Fifty-eight patients presenting melanonychia striata and dermatoscopic patterns with brown or black coloration of the background were submitted to a nail matrix biopsy. When occurring in more than 1 digit, biopsy was performed in the lesion with the darkest coloration presented in dermatoscopy. RESULTS: All skin Types IV, V, or VI patients who had melanonychia striata, with brown or black coloration of the background in the dermatoscopic examination, revealed histopathological analysis compatible with hypermelanosis. CONCLUSION: Racial melanonychia in skin Types IV, V, or VI patients, resulting from hypermelanosis, may present brown or black coloration of the background in the dermatoscopic examination.

The impact of human immunodeficiency virus-related diseases on pigmented skin types.

Infection with human immunodeficiency virus (HIV) remains a significant problem globally. Early diagnosis and treatment with antiretroviral drugs has considerably improved health outcomes and decreased disease-related morbidity. HIV infection is associated with a wide range of skin disorders enabling dermatologists to diagnose HIV as well as associated opportunistic infections early in the course of disease. Despite concerted efforts by international health organizations to limit disease incidence, the prevalence of HIV infection remains high and is highest in sub-Saharan Africa. The diagnosis of HIV-related skin diseases is challenging as immunosuppression often results in atypical disease presentation. In addition, the clinical presentation will vary in pigmented skin types. The aim of this article is to describe disease variation in pigmented skin types.

Melanonychia striata in Chinese children and adults.

BACKGROUND: There is considerable racial variation in the occurrence of melanonychia striata. The prevalence of melanonychia striata in the Chinese population is not known. The purpose of this study was to investigate the prevalence and characteristics of melanonychia striata in a Chinese population of patients. METHODS: Two thousand, four hundred and fifty-seven Chinese patients attending an Asian medical clinic were examined for the presence of melanonychia striata in a cross-sectional prevalence survey. The examinations were carried out as part of the routine medical care provided to these patients. Patients of mixed racial background were excluded. The fingernails and toenails of each patient were examined, and the presence or absence of melanonychia striata, the anatomic distribution of the lesion, and the age and sex of the patient were recorded. RESULTS: Melanonychia striata was not detected in patients aged less than 20 years. The condition was present in 0.6% of patients aged between 20 and 29 years. Thereafter, the prevalence increased gradually to 1.7% in patients aged 50 years and over. There was a significant relationship between age and the presence of melanonychia striata (chi(2) = 141, P < 0.01). There was no significant sex-related difference in the age-specific prevalence (P > 0.05). The thumbs were most frequently affected, followed by the index fingers (P < 0.001). The condition was bilateral in 40% of cases. None of the patients had involvement of more than two digits. CONCLUSION: Melanonychia striata is uncommon in Chinese individuals, especially in those aged under 20 years. The male to female ratio is approximately equal. The thumbs are most frequently affected and the condition is often bilateral.

Childhood longitudinal melanonychia: case reports and review of the literature.

"Longitudinal melanonychia" refers to a brown or brown-black longitudinal band on a fingernail or toenail. A number of conditions can cause longitudinal melanonychia, but its main importance is that, in some patients, it may indicate the presence of a subungual malignant melanoma. Hyperpigmented nail bands are not uncommon in African-American, Latino and Asian patients, especially those over sixty years of age, and are often multiple in these groups. Longitudinal melanonychia is most worrisome when there is a solitary, dark, broad longitudinal band with pigment extending over the proximal nail fold (Hutchinson's sign). Such findings are considered to be a strong indication for biopsy of the nail matrix to rule out melanoma. Since nail matrix biopsy sometimes results in permanent nail deformity, and since the incidence of malignant melanoma is quite small in the pediatric age group, there is some controversy as to whether this procedure should routinely be performed in children. We report two cases of dramatic longitudinal melanonychia in toddlers and review the current literature on the management of this striking condition in the pediatric age group.

Multisystem disorder of Punjabi children exhibiting spontaneous dermal and submucosal granulation tissue formation: LOGIC syndrome.

We describe a multisystem disease that affects children of Muslim families originating in the Punjab region of Pakistan and India. An altered cry due to vocal cord thickening, skin ulceration, nail abnormalities, and conjunctival scarring appear in the first few months of life. Progression and spread of the disease in these sites may be accompanied by involvement of other epithelial surfaces. The teeth may exhibit defective enamel formation. Histology reveals the formation of simple granulation tissue arising in the dermis and submucosa which become massively thickened and ulcerated. There is good evidence for an autosomal recessive gene defect, but the actual mechanism of the disease is not known. Medical and surgical therapy have been ineffective in altering the course of this devastating and usually fatal condition. We suggest the term LOGIC (laryngeal and ocular granulation tissue in children from the Indian subcontinent) for this newly established disease.

Cosmetics in blacks.

Blacks comprise a phenotypically heterogeneous group with respect to skin and hair. They are uniquely multihued with at least 35 different possible shades of pigmentation, and there is considerable variability in hair texture. This accounts for many of the unique skin and hair cosmetic requirements and customs in the black race. These grooming practices may present perplexing problems for the dermatologist when viewed in the context of resultant skin disease; therefore, an awareness and understanding of skin and hair products used by blacks, grooming techniques, and their consequences are essential for clinicians caring for black patients.

Diffuse nail dyschromia in black patients with systemic lupus erythematosus.

Diffuse dark blue-black chromonychia was observed in 17 of 33 (52%) black patients with systemic lupus erythematosus (SLE), but not in 47 non-SLE black patients. About half of these patients had active disease. A comparison was made between patients with SLE with chromonychia and those without but no distinctive clinical or laboratory variable differentiated the 2 groups. This pattern of nail hyperpigmentation has not previously been associated with SLE.

Clinical observations on nail changes in psoriasis.

410 cases of psoriasis [282 males (68%) and 127 females (31%)] were interviewed and examined to study the nail changes. The prevalence of nail changes was 78.0% (males = females). Common changes were pitting (67.5%) and onycholysis (67.2%). Dystrophy of varying degrees occurred in 35.0%, subungual hyperkeratosis in 24.7%, discoloration in 18.4%, loss of nails in 2.8% and pustulation in 1.3%. Pitting and onycholysis was the most common combination (45.6%). Nail changes were significantly more common in patients who have moderate to severe psoriasis as compared with patients with mild psoriasis; in patients who have psoriasis for greater than 5 years as compared with patients who have psoriasis for less than 5 years; and in patients older than age 50 as compared with those aged less than 50. A definite correlation was found between the prevalence of nail changes and the presence of scalp and periungual psoriasis, and the presence of joint involvement.