Transungual Excision of Glomus Tumors: A Treatment and Quality of Life Study.

BACKGROUND: Glomus tumors are rare benign painful tumors, frequently found in the subungual region. Complete surgical excision is essential for relief of symptoms. The main postoperative complications are tumor recurrence and nail dystrophy. OBJECTIVE: To evaluate the long-term outcome and the impact on quality of life (QoL) of glomus tumors after a transungual approach. MATERIALS AND METHODS: A retrospective cohort study was conducted. Twenty-six patients underwent transungual excision of subungual glomus tumors. A self-administered questionnaire was sent to evaluate the postoperative outcome. Glomus tumor-related QoL was investigated using modified nail psoriasis (NPQ10) and onychomycosis questionnaires. RESULTS: A response rate of 85% was achieved. After a mean follow-up of 63 months after transungual excision of the tumor, the mean Numeric Pain Rating Score had improved from 7.9 (±SD 1.8) preoperatively, to 0.8 (±SD 1.9) (p < .000). Quality of life improved significantly: the mean NPQ10-score improved from 5.5 (±SD 3.4) to 0.64 (±SD 2.1) (p < .000). Nail-related sequelae were not reported in any of the patients. CONCLUSION: Our study showed that glomus tumors cause impairment on QoL, mostly due to severe pain. Surgical excision with the transungual approach is an effective treatment, without permanent damage to the nail unit that gives relief of pain and improves QoL.

Fingernail psoriasis reconsidered: a case-control study.

BACKGROUND: Literature concerning clinical signs and frequency of nail psoriasis is incomplete. Recent studies focus only on signs included in the Nail Psoriasis Severity Index (NAPSI). OBJECTIVE: We sought to describe clinical characteristics of fingernail psoriasis in comparison with healthy controls. METHODS: We collected data on 49 patients with fingernail psoriasis who visited our outpatient department and 49 control subjects, through questionnaires and clinical examination. The disease severity was measured by the NAPSI. RESULTS: Mean NAPSI score in patients and control subjects was 26.6 and 3.6, respectively. Most items included in the NAPSI were specific for nail psoriasis. Onycholysis and splinter hemorrhages were most frequently observed. Leukonychia was more frequent in control subjects. Longitudinal ridges and Beau lines are not included in the NAPSI but are significantly more frequently seen in patients than in control subjects. LIMITATIONS: Limited sample size was a limitation. CONCLUSION: The NAPSI was able to discriminate patients with fingernail psoriasis from healthy control subjects. Onycholysis and splinter hemorrhages were the most prevalent fingernail changes in psoriatic patients. Leukonychia was more frequently observed in control subjects, which raises the question of whether leukonychia should remain in the NAPSI. On the other hand, longitudinal ridges and Beau lines occurred more frequently in psoriasis but are not included in the NAPSI.