RESUMO
Coxsackievirus A10 (CV-A10) infection, a prominent cause of childhood hand-foot-and-mouth disease (HFMD), frequently manifests with the intriguing phenomenon of onychomadesis, characterized by nail shedding. However, the underlying mechanism is elusive. Here, we found that CV-A10 infection in mice could suppress Wnt/ß-catenin signaling by restraining LDL receptor-related protein 6 (LRP6) phosphorylation and ß-catenin accumulation and lead to onychomadesis. Mechanistically, CV-A10 mimics Dickkopf-related protein 1 (DKK1) to interact with Kringle-containing transmembrane protein 1 (KRM1), the CV-A10 cellular receptor. We further found that Wnt agonist (GSK3ß inhibitor) CHIR99021 can restore nail stem cell differentiation and protect against nail shedding. These findings provide novel insights into the pathogenesis of CV-A10 and related viruses in onychomadesis and guide prognosis assessment and clinical treatment of the disease.
Assuntos
Peptídeos e Proteínas de Sinalização Intercelular , Proteína-6 Relacionada a Receptor de Lipoproteína de Baixa Densidade , Via de Sinalização Wnt , Animais , Via de Sinalização Wnt/efeitos dos fármacos , Proteína-6 Relacionada a Receptor de Lipoproteína de Baixa Densidade/metabolismo , Proteína-6 Relacionada a Receptor de Lipoproteína de Baixa Densidade/genética , Camundongos , Peptídeos e Proteínas de Sinalização Intercelular/metabolismo , Peptídeos e Proteínas de Sinalização Intercelular/genética , Humanos , beta Catenina/metabolismo , Doenças da Unha/metabolismo , Doenças da Unha/virologia , Doenças da Unha/patologia , Unhas/metabolismo , Unhas/patologia , Diferenciação Celular/efeitos dos fármacos , Camundongos Endogâmicos C57BL , Doença de Mão, Pé e Boca/virologia , Doença de Mão, Pé e Boca/metabolismo , Doença de Mão, Pé e Boca/patologia , Doença de Mão, Pé e Boca/complicações , Fosforilação/efeitos dos fármacos , Infecções por Coxsackievirus/complicações , Infecções por Coxsackievirus/metabolismo , Glicogênio Sintase Quinase 3 beta/metabolismo , Piridinas/farmacologia , PirimidinasRESUMO
BACKGROUND: COVID-19 is a pandemic disease worldwide. Although cutaneous manifestations may present in affected patients, there have been limited studies on the cutaneous findings and hair and nail abnormalities after discharge. OBJECTIVE: To establish the cutaneous manifestations, hair and scalp disorders, and nail abnormalities in patients who recovered from COVID-19 infections. METHODS: A retrospective chart review and telephone interviews were conducted to determine the cutaneous manifestations, hair and scalp disorders, and nail abnormalities of patients aged over 18 years who were diagnosed with COVID-19 infections at Siriraj Hospital, Bangkok, Thailand, between January and June 2020. RESULTS: Ninety-three patients with prior COVID-19 infections participated in the study. The COVID-19 severity had been mild for most (71%). Cutaneous manifestations were reported in 8 patients (8.6%), with the common skin conditions being maculopapular rash and urticaria. The onsets of the skin conditions were before admission (1%), during admission (4.3%), and after discharge (3.2%). Increased hair shedding was also reported in 22 patients (23.7%), with a female predominance. Three patients were affected during admission, while the others were affected after discharge. The patients with moderate, severe, and critical COVID-19 infections experienced significantly more hair shedding than those with asymptomatic and mild diseases. Only 2 patients with mild COVID-19 disease reported nail abnormalities (chromonychia and brittle nails). CONCLUSIONS: Cutaneous manifestations, hair disorders, and nail abnormalities can occur in patients with COVID-19 after their discharge from hospital. Patients should therefore be followed up in anticipation of dermatological problems.
Assuntos
COVID-19 , Doenças do Cabelo , Doenças da Unha , Pandemias , SARS-CoV-2/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , COVID-19/metabolismo , Feminino , Seguimentos , Cabelo/metabolismo , Cabelo/virologia , Doenças do Cabelo/epidemiologia , Doenças do Cabelo/metabolismo , Doenças do Cabelo/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças da Unha/epidemiologia , Doenças da Unha/metabolismo , Doenças da Unha/virologia , Unhas/metabolismo , Unhas/virologia , Pele/metabolismo , Pele/virologiaRESUMO
BACKGROUND: Intralesional immunotherapy using different types of antigens is considered an effective and safe treatment option for different types of warts. However, there are few studies that illustrate the use of these antigens in the treatment of periungual warts as a distinct type of warts. OBJECTIVE: To evaluate the efficacy and safety of three antigens: measles, mumps, rubella (MMR) vaccine, Candida antigen, and purified protein derivative (PPD) in the treatment of periungual warts. METHODS: The study included 150 patients who were randomly assigned to 3 groups with 50 patients in each. Each agent was injected intralesionally at a dose of 0.1 mL into the largest wart at 2-week intervals until complete clearance or for a maximum of 5 sessions. RESULTS: Complete clearance of warts was observed in 70%, 80%, and 74% in PPD, Candida antigen, and MMR vaccine groups, respectively. There was no statistically significant difference regarding the therapeutic response between the 3 studied groups. Adverse effects were transient and insignificant in the 3 groups. No recurrence of the lesions was reported in any of the studied groups. CONCLUSIONS: Intralesional antigen immunotherapy seems to be an effective therapeutic option for the treatment of periungual warts.
Assuntos
Antígenos de Fungos/uso terapêutico , Imunoterapia/métodos , Vacina contra Sarampo-Caxumba-Rubéola/uso terapêutico , Doenças da Unha/terapia , Doenças da Unha/virologia , Verrugas/terapia , Adolescente , Antígenos de Fungos/administração & dosagem , Candida/imunologia , Criança , Pré-Escolar , Feminino , Humanos , Injeções Intralesionais , Masculino , Vacina contra Sarampo-Caxumba-Rubéola/administração & dosagem , Adulto JovemAssuntos
Anticorpos Antivirais/sangue , COVID-19/sangue , Pérnio/sangue , Imunoglobulina A/sangue , SARS-CoV-2/imunologia , Adolescente , Infecções Assintomáticas , COVID-19/complicações , COVID-19/diagnóstico , Pérnio/virologia , Criança , Feminino , Humanos , Imunoglobulina G/sangue , Masculino , Doenças da Unha/sangue , Doenças da Unha/virologia , Nasofaringe/virologia , Dedos do PéRESUMO
Squamous cell carcinoma of the nail unit (SCCNU) is a rare neoplastic condition that involves multiple digits (polydactylous SCCNU) in only 3.9% of cases. Here, we report a case of polydactylous SCCNU and perform a comprehensive review of MEDLINE and Embase to collate 44 cases of polydactylous SCCNU reported to date. Polydactylous patients were younger on average (48 to 61-63 years) and had a longer diagnostic delay (44 vs 35.1 months) compared with reported monodactylous cases. Human papillomavirus (HPV) positivity was observed in 49% of cases, and the most common serotypes noted were 16 (25.8%), 73 (16.1%), 58 (9.7%), 18 (6.5%), and 33 (6.5%). Twenty percent of the cases were in immunosuppressed individuals who had a statistically significant lower age at diagnosis (39.33 years vs 51.12 years; P = .01) and diagnostic delay (2.50 months vs 132.46 months, P = .04). Patients with HPV positivity had a lower age at diagnosis (43.74 years vs 53.29 years, P = .04). Environmental exposures noted to be associated with polydactylous disease included X-rays, paint/solvents, soluble oils, and stagnant water. This comprehensive literature review serves to characterize polydactylous SCCNU and distinguish the differences in its characteristics to improve diagnosis and clinical recognition.
Assuntos
Carcinoma de Células Escamosas , Doenças da Unha , Neoplasias Cutâneas , Fatores Etários , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/etiologia , Carcinoma de Células Escamosas/imunologia , Carcinoma de Células Escamosas/virologia , Humanos , Doenças da Unha/diagnóstico , Doenças da Unha/etiologia , Doenças da Unha/imunologia , Doenças da Unha/virologia , Fatores de Risco , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/imunologia , Neoplasias Cutâneas/virologiaAssuntos
COVID-19/virologia , Doenças da Unha/virologia , SARS-CoV-2/patogenicidade , Dermatopatias Virais/virologia , Antivirais/uso terapêutico , COVID-19/complicações , COVID-19/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Doenças da Unha/diagnóstico , Fatores de Risco , SARS-CoV-2/efeitos dos fármacos , Dermatopatias Virais/diagnóstico , Tratamento Farmacológico da COVID-19Assuntos
COVID-19/complicações , Doenças da Unha/virologia , Adulto , Feminino , Humanos , SARS-CoV-2Assuntos
COVID-19/complicações , Dedos , Doenças da Unha/virologia , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , SARS-CoV-2RESUMO
BACKGROUND: Nail changes, including onychomadesis (nail shedding) and Beau's line, following hand-foot-mouth disease (HFMD) are a common emergence at the stage of late complications of HFMD. However, the exact mechanism is still unknown. Therefore, we conducted this study to elucidate the mechanism of nail changes following HFMD. METHODS: We collected 11 patients suffering from onychomadesis following HFMD. Nail samples from all of them were collected. Real time reverse transcription polymerase chain reaction (RT-PCR) and sequencing for human enteroviruses (HEV) were performed. Throat swabs for RT-PCR and sequencing for HEV were performed for three cases. RESULTS: RT-PCR demonstrated the presence of Coxackievirus A6 (CVA6) in nail samples from three patients and one with Echovirus. CONCLUSION: In conclusion, we believe that the major cause of onychomadesis following HFMD is that certain novel viruses, mostly CVA6, are virulent and may damage nail matrix. Direct injury caused by cutaneous lesions of HFMD around nail matrix is a minor cause. There are still other virulent HEV which may result in onychomadesis. In addition, the novel strain of CVA6 also causes atypical clinical presentations, such as adult involvement and delayed-onset palmar and plantar desquamation. Physicians should be familiar with atypical presentations caused by novel viruses to avoid misdiagnosis and even inform patients of the possibility of onychomadesis that may take place weeks later to reassure patients.
Assuntos
Infecções por Coxsackievirus/diagnóstico , Enterovirus Humano B , Doença de Mão, Pé e Boca/complicações , Doenças da Unha/virologia , Onicomicose/virologia , Adolescente , Adulto , Idoso , Pré-Escolar , Infecções por Coxsackievirus/virologia , DNA Viral , Enterovirus Humano B/genética , Enterovirus Humano B/isolamento & purificação , Feminino , Doença de Mão, Pé e Boca/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças da Unha/etiologia , FilogeniaRESUMO
Human papillomavirus (HPV) causes cervical cancer, anal cancer, vulvar cancer, vaginal cancer, penile cancer, and oropharyngeal cancer. Squamous cell carcinoma (SCC) in the genital region in particular is recognized to be caused by HPV infection, and intraepithelial lesions of the penis and vulva are termed penile intraepithelial neoplasia and vulvar intraepithelial neoplasia, respectively. Although SCC of the nail apparatus is recognized as being associated with high-risk HPVs, it is not well-known in general medicine, and its analysis has been insufficient. In this article, we reviewed 136 cases of HPV-associated nail SCC and SCC in situ and delineated their clinical characteristics. We found that half of the cases were high-risk HPV-associated. Almost all of the types were high-risk α-HPVs. This disease had a male dominance and left hand digit 3 and right hand digits 1-3 were typically affected. In this review, 24% of the cases of nail SCC had a history of other HPV-associated diseases, suggesting the possibility of genitodigital transmission. We propose that nail SCC is a hidden high-risk HPV-associated reservoir and should be recognized as a sexually transmitted infection.
Assuntos
Carcinoma de Células Escamosas/virologia , Reservatórios de Doenças/virologia , Doenças da Unha/virologia , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/complicações , Infecções Sexualmente Transmissíveis/virologia , Neoplasias Cutâneas/virologia , Feminino , Humanos , Masculino , Fatores de RiscoAssuntos
Ciclopropanos/administração & dosagem , Dermatoses Faciais/tratamento farmacológico , Fatores Imunológicos/administração & dosagem , Imunoterapia/métodos , Doenças da Unha/tratamento farmacológico , Pele/efeitos dos fármacos , Verrugas/tratamento farmacológico , Adolescente , Adulto , Criança , Ciclopropanos/efeitos adversos , Esquema de Medicação , Dermatoses Faciais/diagnóstico , Dermatoses Faciais/imunologia , Dermatoses Faciais/virologia , Feminino , Humanos , Fatores Imunológicos/efeitos adversos , Imunoterapia/efeitos adversos , Masculino , Doenças da Unha/diagnóstico , Doenças da Unha/imunologia , Doenças da Unha/virologia , Indução de Remissão , Estudos Retrospectivos , Pele/imunologia , Pele/patologia , Pele/virologia , Fatores de Tempo , Resultado do Tratamento , Verrugas/diagnóstico , Verrugas/imunologia , Verrugas/virologia , Adulto JovemAssuntos
Carcinoma de Células Escamosas/virologia , Exantema/virologia , Papillomavirus Humano 16/isolamento & purificação , Papillomavirus Humano 6/isolamento & purificação , Doenças da Unha/virologia , Infecções por Papillomavirus/virologia , Prurido/virologia , Neoplasias Cutâneas/virologia , Idoso , Biópsia , Carcinoma de Células Escamosas/secundário , Carcinoma de Células Escamosas/terapia , Exantema/patologia , Exantema/terapia , Humanos , Imuno-Histoquímica , Masculino , Doenças da Unha/patologia , Doenças da Unha/terapia , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/patologia , Infecções por Papillomavirus/terapia , Prurido/patologia , Prurido/terapia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/terapiaAssuntos
Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/virologia , Papillomavirus Humano 16 , Doenças da Unha/virologia , Infecções por Papillomavirus/complicações , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/virologia , Verrugas/virologia , Falanges dos Dedos da Mão/patologia , Dedos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças da Unha/patologia , Invasividade Neoplásica , Verrugas/patologiaRESUMO
BACKGROUND: Bowen disease is the most frequent nail malignancy, usually seen as a verrucous plaque of the nail in men. OBJECTIVE: To characterize the affected patient population, the clinical manifestations, the diagnostic delay and diagnostic steps, and presence of human papilloma virus (HPV) infection. METHODS: We retrospectively evaluated all cases of Bowen disease of the nail unit over a period of 9 years. Data were obtained from our electronic database. Human papilloma virus genotype was assessed in biopsy specimens by polymerase chain reaction (PCR) sequencing. RESULTS: We identified 12 cases of Bowen disease of the nail unit in 10 patients. Mean age at onset was 52 years, with a male predominance of 90%. The thumb and middle finger were the most frequently affected (66%). Fifty percent of the lesions presented as periungual and subungual verrucous tumours. Patients sought medical evaluation after a mean delay of 5.7 years; histopathological diagnosis was made after a mean delay of 3.2 years. HPV infection was identified in 75% of the cases. CONCLUSIONS: Any recently appeared verrucous lesion of the nail unit in men above the age of 40 years should raise the suspicion of Bowen disease and lead to further histopathological diagnostic procedures.