Long-pulsed nd: YAG laser treatment of nail psoriasis: clinical and ultrasonographic assessment.

Nail psoriasis is a chronic, inflammatory condition which is difficult to treat, linked with greater psoriasis severity, and may be associated with anxiety and significant functional impairment of the quality of life. The 1064 nm Nd: YAG laser was reported to yield satisfactory results in the treatment of nail psoriasis.The aim of the study was to assess the clinical and ultrasonographic efficacy of long-pulsed 1064 nm Nd: YAG laser in the treatment of fingernail psoriasis and compare its effect to control fingernails.This intra-patient randomized controlled trial analyzed 86 fingernails collected from 13 patients suffering from cutaneous and nail psoriasis. The nails were randomized into two groups. Group A was treated with Nd: YAG laser once monthly for three sessions while group B served as control. Assessment took place at baseline, 1 and 3 months after the last treatment session. For scoring, the 32-points target NAPSI scoring systems was used. Additionally, two blinded dermatologists' score of improvement, patients' pain assessment by visual analogue score and ultrasonographic assessment were all performed.At the end of follow up, the medians of tNAPSI score, plate definition, matrix thickness, bed thickness and bed vascularity decreased significantly in the Nd: YAG laser treated group in comparison to baseline (p = 0.001, 0.006, 0.039, < 0.001 and 0.010, respectively). While, there was a non-significant reduction in median tNAPSI score in the control group at last follow up, however, ultrasonography recorded a significant reduction in the medians of plate definition, bed thickness and vascularity (p = 0.002, 0.011 and 0.033, respectively) from the baseline. Comparison of the Nd: YAG laser and the control groups showed no significant difference from baseline regarding the medians of tNAPSI, tNAPSI percentile improvement, pits count, blinded evaluation of photographs and ultrasonographic assessments.In conclusion, Nd: YAG laser showed clinical and ultrasonographic improvement in fingernail psoriasis. Ultrasonography is a useful noninvasive tool in diagnosing and monitoring the clinical and even the subclinical changes in nail psoriasis. Nail psoriasis although difficult to treat, may show spontaneous improvement.

A systematic review of the risk of cutaneous malignancy associated with ultraviolet nail lamps: what is the price of beauty?

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.

Public health assessment of Kenyan ASGM communities using multi-element biomonitoring, dietary and environmental evaluation.

The Kakamega gold belt's natural geological enrichment and artisanal and small-scale gold mining (ASGM) have resulted in food and environmental pollution, human exposure, and subsequent risks to health. This study aimed to characterise exposure pathways and risks among ASGM communities. Human hair, nails, urine, water, and staple food crops were collected and analysed from 144 ASGM miners and 25 people from the ASGM associated communities. Exposure to PHEs was predominantly via drinking water from mine shafts, springs and shallow-wells (for As>Pb>Cr>Al), with up to 366 µg L-1 arsenic measured in shaft waters consumed by miners. Additional exposure was via consumption of locally grown crops (for As>Ni>Pb>Cr>Cd>Hg>Al) besides inhalation of Hg vapour and dust, and direct dermal contact with Hg. Urinary elemental concentrations for both ASGM workers and wider ASGM communities were in nearly all cases above bioequivalents and reference upper thresholds for As, Cr, Hg, Ni, Pb and Sb, with median concentrations of 12.3, 0.4, 1.6, 5.1, 0.7 and 0.15 µg L-1, respectively. Urinary As concentrations showed a strong positive correlation (0.958) with As in drinking water. This study highlighted the importance of a multidisciplinary approach in integrating environmental, dietary, and public health investigations to better characterise the hazards and risks associated with ASGM and better understand the trade-offs associated with ASGM activities relating to public health and environmental sustainability. Further research is crucial, and study results have been shared with Public Health and Environmental authorities to inform mitigation efforts.

Ultrasound Assessment of Psoriatic Arthritis Patients With Clinically Normal Nails and Evaluation of its Correlation With the Disease Activity: A Case-Control Study.

OBJECTIVES: Nail unit is one of the targets of ultrasound (US) assessment. We aimed to compare ultrasound parameters of clinically normal nail unit in psoriatic arthritis (PsA) patients with healthy controls (HC) and evaluate their correlations with disease activity. METHODS: This was a cross-sectional study including patients with PsA and matched HC. Tender (TJC) and swollen joint count (SJC), Psoriasis Area and Severity Index (PASI), and Disease Activity in Psoriatic Arthritis (DAPSA) were collected in PsA patients. Patients underwent US assessment of fingernails with a study of morphological changes and measurement of the thickness of nail bed (NBT), nail plate (NPT), and adjacent skin (ST). Correlation between nail unit parameters and disease activity was studied. RESULTS: We evaluated 22 PsA patients (219 nails) and 21 HC (210 nails). Mean DAPSA was 21.56 ± 14.36 and mean PASI was 2.19 ± 3.8. PsA patients had more US morphological changes than HC (16.89 vs 3.33%, P = .03). NPT comparison between identical fingernails of PsA and HC did not reveal significant difference. However, NBT was significantly higher in HC (1.77 vs 2.07 mm, P = .027) as well as ST (2.26 vs 2.59 mm, P = .003). TJC and ST were positively correlated (r = .46, P = .03). No correlation was noted between disease activity scores and NPT, NBT, or ST in PsA patients. In biologic parameters, ESR was negatively correlated with ST (r = -.41, P = .05). CONCLUSIONS: Nail bed and adjacent skin US morphological changes were contributive to distinguish psoriatic from healthy nails. Adjacent skin thickness measurement was positively correlated with TJC and ESR, suggesting that it could be used as an indicator of disease activity in PsA.

Assessment of Ingrown Toenails Treated with Nail Fold Cryotherapy in Adolescent Patients: An Observational Pilot Study.

BACKGROUND: Cryotherapy reduces pain by making some reversible functional changes in peripheral nerves. It has also been reported to have a positive effect on the regression of inflammation and granulation tissue. Few studies have evaluated the efficacy and safety of nail fold cryotherapy in ingrown toenails (IGTN) in adults, and there are no studies in the pediatric population. We aimed to evaluate the clinical efficacy of cryotherapy applied to the nail fold in juvenile IGTN. METHODS: This study was conducted in adolescent patients aged 12 to 16 years with unilateral juvenile IGTN. Liquid nitrogen was sprayed into the nail fold for 10 to 15 seconds with a double freeze-thaw cycle. The effectiveness of cryotherapy was interpreted by the clinician's decision, the improvement in visual analogue scale score, Children's Dermatology Life Quality Index score, and granulation tissue. RESULTS: According to the physician, good efficacy was achieved in 91.7% of patients (n = 22 of 24). We found that 54.5% of them (n = 12 of 22) were still in remission after 6 months. Rates of complete regression in granulation tissue were pronouncedly less in sizes larger than 5 mm (≤5 mm, 55.6%; >5 mm, 16.7%). However, adequate symptomatic relief was observed in 83.3% of stage 3 patients, even if complete granulation tissue response was not achieved yet. Significant improvements in visual analogue scale and the Children's Dermatology Life Quality Index scores were observed after cryotherapy (P < .05). CONCLUSIONS: Nail fold cryotherapy is a useful alternative among conservative methods because of its rapid and high efficiency (91.7%), especially in mild to moderate cases, despite the high recurrence rates (45.5%) in juvenile IGTN.

Semi-quantitative health risk assessment of heavy metal dust exposure among nail technicians using the SQRA technique and Monte Carlo simulation.

Nail technology, including the application of artificial nails and nail care, is a developing sector of the global beauty industry. Nail technicians are exposed to a variety of chemical substances through inhalation, as they spend extended periods of time in close proximity to these materials. This study aimed to evaluate the semi-quantitative health risk of dust-containing heavy metals among nail technicians. This analytical descriptive study employed the risk assessment method provided by the Singapore Occupational Health Department to evaluate the health hazards of lead, cadmium, nickel, chromium, and manganese. Dust samples from nail filing were collected from the respiratory zone of 20 nail technicians following the NIOSH 7300 method. The samples were analyzed using ICP-OES instrumentation. Monte Carlo simulation was utilized to characterize the risk and its uncertainties. Manganese and cadmium had the highest and lowest mean concentrations, respectively. The risk scores of the metals ranked from highest to lowest were as follows: Ni>Cr>Cd>Mn>Pb. All five metals had risk rankings below 2.8, signifying a minimal risk level. Sensitivity analysis using Spearman's correlation coefficient demonstrated a positive relationship between concentration, daily hours of exposure, and the number of workdays per week with the risk score (RR) and exposure level (ER). Conversely, the variable of weekly working hours (W) showed a negative correlation with these parameters. Despite the low-risk level of the examined metals, continuous exposure and potential long-term effects on nail technicians warrant preventive measures. Recommendations include implementing local exhaust ventilation systems, using table fans, establishing work-rest cycles, wearing N95 dust masks, and using reputable and high-quality nail polishes.

Safety assessment for nail cosmetics: Framework for the estimation of systemic exposure through the nail plate.

All cosmetics products, including nail care products, must be evaluated for their safety. The assessment of systemic exposure is a key component of the safety assessment. However, data on the exposure, especially via ungual route (nail plate) are limited. Based on the physicochemical properties of human nails and permeability data of topical onychomycosis drugs, the nail plate is considered a good barrier to chemicals. We examine factors impacting penetration of nail care ingredients through the nail plate, including properties of the nails of the ingredients and formulations. The molecular weight, vapor pressure, logP, water solubility, and keratin binding, as well as formulations properties e.g., polymerization of acrylate monomers are considered important factors affecting penetration. To estimate systemic exposure of nail care ingredients through the nail plate, a standardized framework is applied that quantifies the impacts of these properties on penetration with an adjustment factor for each of these influencing properties. All the adjustment factors are then consolidated to derive an integrated adjustment factor which can be used for calculation of the systemic exposure dose for the ingredient. Several case studies are presented to reflect how this framework can be used in the exposure assessment for nail cosmetic products.

Inhalation exposure to toxic heavy metals in nail salon technicians and health risk assessment using Monte Carlo simulation.

OBJECTIVE: Nail salons offer a developing and diverse occupation for many women, especially the new generation. Due to the increasing apprehension surrounding heavy metals in dust caused by filing nails containing dried nail polish, the present study was designed aimed to health risk assessment of heavy metals in breathing zone of nail salon technicians (NSTs). METHODS: This is a cross-sectional study that was conducted in NSTs. The concentration of Cadmium (Cd), Lead (Pb), Nickel (Ni), Chromium (Cr) and Manganese (Mn)in breathing zone of 20 NSTs was determined using ICP-OES. RESULTS: The metal concentrations were in the following order: Mn > Pb > Ni > Cr > Cd with corresponding arithmetic mean values of0.008, 0.0023, 0.0021, 0.001 and 0.0006 mg m-3, respectively, which are exceeded the recommended levels stated in the indoor air guidelines. The average lifetime carcinogenic risk (LCR) for Cr, Cd, Ni and Pb was calculated 0.0084, 0.00054, 0.00026 and 1.44 E - 05, respectively. The LCR values of all metals (except Pb) exceeded the acceptable level set by the USEPA. The mean of Hazard quotients (HQ) for Mn, Cd, Cr, Ni and Pb were calculated to be23.7, 4.74, 2.19, 0.51 and 0.0.24, respectively. The sensitivity analysis showed that, the exposure frequency (EF) for Cr and Ni had the strong effects on generation of both LCR and HQ. Furthermore, the concentrations of Mn, Cd and Pb had strong impacts on the HQ generation and the concentration of Cd and Pb had main effects on LCR generation. CONCLUSION: To effectively reduce pollutant concentration, it is recommended to install a ventilation system near nail salon work tables and conduct continuous monitoring and quality control of nail products.

Perceived Benefits and Barriers to Implementing Occupational Health Recommendations Among Immigrant-Owned Nail Salons in the Greater Philadelphia Region.

Introduction. Immigrant nail salon owners and employees face multiple barriers to accessing occupational health training and services. We formed an academic-community-based organization-business owner partnership-unique in that all partners were culturally congruent-to develop a pilot intervention program for the nail salon community. Methods. Eighteen individuals (nine salon owners and nine employees) from the Greater Philadelphia region received the training in their native language and provided feedback through in-depth qualitative interviews. Interview guide was developed using the Consolidated Framework for Implementation Research (CFIR). Themes of perceived benefits and barriers were identified and aligned with relevant CFIR constructs to gain better understanding of the implementation challenges. Results. Reported benefits of program were improved knowledge of the workplace hazards and safety practices, and the potential to attract more customers and retain employees. Perceived barriers to implementing recommended practices were limited availability of safer products and high cost, challenges communicating with customers, lack of engagement from some owners, organizational management practices affecting employees' motivation, and limited partnership with local government to assist small immigrant-owned businesses. Conclusions. Our study revealed multiple factors that pit long-term health protection of nail salon workers against the economic viability of the businesses that employ them. Our research highlights the need to (1) advocate for federal policies making safer products to be more accessible to the masses, (2) establish local policy and culturally appropriate technical support programs that engage community-based organizations, and (3) develop economic opportunities and mentorship for immigrant entrepreneurs to operate profitable healthy salons.

Nd:YAG 1064 nm laser treatment for onychomycosis - is it really effective? A prospective assessment for efficiency and factors contributing to response.

Onychomycosis is a highly prevalent and persistent nail disorder primarily caused by dermatophytes. The effectiveness of current topical and systemic antifungals is limited by the extent and severity of the infection, patient demographics and health status, hepatic toxicity, drug interactions and low compliance. Laser therapy is a promising modality for safe and cost-effective removal of mycotic nail. This prospective study assessed the performance of a multi-series long-pulsed Nd:YAG 1064 nm regimen (30-40 J/cm2 , 1 Hz) in the treatment of 213 mycotic nails in 31 patients. Pain and discomfort were scored at each treatment session and mycological and clinical cure rates were determined 3 months after the last treatment session. Patients presented with mostly severe (mean SCIO score: 21.9 ± 8.9), T. rubrum-positive (87.1%) infections. Most (61%) had a family history of onychomycosis and a significant proportion had comorbidities, including hypertension (38.7%), hyperlipidemia (35.5%) and/or diabetes (12.9%). Treatment was well tolerated and there were no reports of nail deformity or burns. By 3 months post-treatment, mycological cure was achieved by 4 (12.9%) and visual improvements were noted for 10 (32.3%) patients, including 3 (9.7%) with moderate to significant improvements. Clinical response correlated with baseline SCIO ≤ 20 (OR: 0.9 [0.13-6.52]), family history of onychomycosis (OR: 0.27 [0.04-1.50]) and comorbidities (OR: 0.44 [0.05-3.74]). In conclusion, Nd:YAG 1064 nm laser is safe and effective for the management of mild-to-moderate onychomycosis in diverse populations. Further studies will be necessary to adjust treatment parameters to patient and nail profiles and to determine the impact of combined laser and topical therapies.

Assessment of substance exposures in nail clipping samples: A systematic review.

BACKGROUND: Studies of prenatal substance exposure often rely on self-report, urine drug screens, and/or analyses of blood or meconium biomarkers. Accuracy of these measures is limited when assessing exposure over many weeks or months of gestation. Nails are increasingly being considered as a matrix from which to assess substance exposure. This systematic review synthesizes data on the validity of detecting alcohol, nicotine, cannabis, and opioid from nail clippings, with an emphasis on prenatal exposure assessment. METHODS: The systematic review was conducted using PRISMA 2020 guidelines. Seven databases were searched with keywords relevant to the four substances of interest. Results were summarized grouping manuscripts by the exposure of interest with focus on accuracy and feasibility. RESULTS: Of 2384 papers initially identified, 35 manuscripts were included in our qualitative synthesis. Only a few studies specifically looked at pregnant individuals or mother-child dyads. Across the four substances, many studies demonstrated a dose-response relationship between exposure and concentration of analytes in nails. Nail assays appear to detect lower level of exposure compared to hair; however, sample insufficiency, especially for multi-substance assays, remains a limitation. CONCLUSIONS: Based on the reviewed studies, nail clippings are an acceptable and potentially preferable matrix for the evaluation of these four prenatal substances when sampling frequency and/or study design necessitates assessment of past exposures over an extended period. Nails have the advantage of infrequent sampling and minimal invasiveness to assess a broad exposure period. Future studies should examine validity of analytes in toenail versus fingernail clippings.

Assessment of nail fold capillary changes by hand-held dermoscopy in adult dermatomyositis: A single-centre prospective study.

BACKGROUND: Hand-held dermoscopy is a valuable tool for dermatologists, but it has been rarely used to assess the nail fold capillary (NFC) in patients with dermatomyositis (DM). METHODS: Patients were collected from the Department of Dermatology and Venereology from July 2020 to July 2021, and the follow-up was conducted until January 2022. Demographic features, disease activity and NFC changes were analysed using a hand-held dermoscopy. RESULTS: The most common NFC finding in our study was bushy capillary (87.0%). There was no significant improvement in scleroderma-dermatomyositis (SD)-like nail fold changes or enlarged capillaries from baseline to 12 weeks of treatment (p > 0.05) or from 12 weeks to 24 weeks of treatment (p > 0.05), but there was a significant improvement from baseline to 24 weeks of treatment (p < 0.05). The avascular area did not improve from baseline to 12 weeks of follow-up, but the changes were significant from 12 weeks to 24 weeks of treatment (p < 0.05) and baseline to 24 weeks of treatment (p < 0.05). Periungual erythema improved significantly from baseline to 12 weeks of treatment (p < 0.05) and baseline to 24 weeks of treatment (p < 0.05), but it did not improve significantly from 12 weeks to 24 weeks of treatment (p > 0.05). There was no significant difference in disease activity between patients with or without specific NFC changes. However, some NFC features improved as disease activity decreased. CONCLUSION: Dermoscopy of NFC is a cost-effective option for the preliminary diagnosis of DM. Further, long-term follow-up is necessary to study the relationship between disease activity and NFC changes.

Nail analysis for the assessment of caffeine abuse in Northwest China: A population-based study.

Caffeine is the most widely consumed psychoactive agent worldwide and has the potential for abuse, but studies monitoring caffeine abuse in China are scarce. This study aims to estimate the prevalence of caffeine abuse in northwest China and investigate the correlation between caffeine and other drugs in hair and nails using an ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Fingernail clippings were collected from 376 participants in northwest China to detect caffeine and 13 other illicit psychoactive drugs and their metabolites. Paired hair and nail samples were collected from 39 participants to investigate the correlation between caffeine and other drugs in hair and nails. The samples were decontaminated, pulverized, and extracted by a high-throughput nail sample preparation method and analyzed by UPLC-MS/MS. The results showed a risk of caffeine abuse in northwest China, with concentrations ranging from 0.43 to 10.6 ng/mg for healthy volunteers, 0.49-246 ng/mg for caffeine abusers, and 0.25-363 ng/mg for drug addicts in community rehabilitation centers. Caffeine was detected together with other illicit psychoactive drugs and their metabolites. Furthermore, positive detection correlations were found between hair and nail samples. This study provides a current perspective on caffeine abuse in northwest China and demonstrates the practical use of UPLC-MS/MS for the simultaneous detection of caffeine and 13 illicit psychoactive drugs and their metabolites in hair and nails. The results highlight the potential of nails as a supplementary matrix when hair samples are unavailable and emphasize the need for handling caffeine carefully given its potential for abuse.

Cost-effectiveness of replacing versus discarding the nail in children with nail bed injury.

Every year in the UK, around 10 000 children need to have operations to mend injuries to the bed of their fingernails. Currently, most children have their fingernail placed back on the injured nail bed after the operation. The NINJA trial found that children were slightly less likely to have an infection if the nail was thrown away rather than being put back, but the difference between groups was small and could have be due to chance. This study looked at whether replacing the nail is cost-effective compared with throwing it away. Using data from the NINJA trial, we compared costs, healthcare use, and quality of life and assessed the cost-effectiveness of replacing the nail. It was found that throwing the nail away after surgery would save the National Health Service (NHS) £75 (€85) per operation compared with placing the nail back on the nail bed. Changing clinical practice could save the NHS in England £720 000 (€819 000) per year.

Effectiveness of nail bed repair in children with or without replacing the fingernail: NINJA multicentre randomized clinical trial.

BACKGROUND: Surgery for nail bed injuries in children is common. One of the key surgical decisions is whether to replace the nail plate following nail bed repair. The aim of this RCT was to assess the clinical effectiveness and cost-effectiveness of nail bed repair with fingernail replacement/substitution compared with repair without fingernail replacement. METHODS: A two-arm 1 : 1 parallel-group open multicentre superiority RCT was performed across 20 secondary-care hospitals in the UK. The co-primary outcomes were surgical-site infection at around 7 days after surgery and cosmetic appearance summary score at a minimum of 4 months. RESULTS: Some 451 children presenting with a suspected nail bed injury were recruited between July 2018 and July 2019; 224 were allocated to the nail-discarded arm, and 227 to the nail-replaced arm. There was no difference in the number of surgical-site infections at around 7 days between the two interventions or in cosmetic appearance. The mean total healthcare cost over the 4 months after surgery was €84 (95 per cent c.i. 34 to 140) lower for the nail-discarded arm than the nail-replaced arm (P < 0.001). CONCLUSION: After nail bed repair, discarding the fingernail was associated with similar rates of infection and cosmesis ratings as replacement of the finger nail, but was cost saving. Registration number: ISRCTN44551796 (http://www.controlled-trials.com).

A deep learning system for quantitative assessment of microvascular abnormalities in nailfold capillary images.

OBJECTIVES: Nailfold capillaroscopy is key to timely diagnosis of SSc, but is often not used in rheumatology clinics because the images are difficult to interpret. We aimed to develop and validate a fully automated image analysis system to fill this gap. METHODS: We mimicked the image interpretation strategies of SSc experts, using deep learning networks to detect each capillary in the distal row of vessels and make morphological measurements. We combined measurements from multiple fingers to give a subject-level probability of SSc.We trained the system using high-resolution images from 111 subjects (group A) and tested on images from subjects not in the training set: 132 imaged at high-resolution (group B); 66 imaged with a low-cost digital microscope (group C). Roughly half of each group had confirmed SSc, and half were healthy controls or had primary RP ('normal'). We also estimated the performance of SSc experts. RESULTS: We compared automated SSc probabilities with the known clinical status of patients (SSc versus 'normal'), generating receiver operating characteristic curves (ROCs). For group B, the area under the ROC (AUC) was 97% (94-99%) [median (90% CI)], with equal sensitivity/specificity 91% (86-95%). For group C, the AUC was 95% (88-99%), with equal sensitivity/specificity 89% (82-95%). SSc expert consensus achieved sensitivity 82% and specificity 73%. CONCLUSION: Fully automated analysis using deep learning can achieve diagnostic performance at least as good as SSc experts, and is sufficiently robust to work with low-cost digital microscope images.

Utility of nailfold capillary assessment for predicting psoriatic arthritis based on a prospective observational cohort study.

OBJECTIVES: PsA is one of the most serious comorbidities associated with psoriasis. While the early intervention in PsA is demanded, risk factors of PsA development are not well-known. This is the first prospective study to evaluate the clinical significance of nailfold capillary (NFC) changes in patients with psoriasis. METHODS: We conducted a prospective cohort study in a population of 449 psoriasis patients who had not been treated with systemic therapy or topical finger therapy. NFCs were observed by dermoscopy and capillaroscopy, and the correlation of NFC abnormalities, including nailfold bleeding (NFB) and enlarged capillaries, with the prevalence of PsA, incidence of new PsA, and serum levels of TNF-a, IL-17A and IL-23 were analysed. RESULTS: Detailed examination at the time of inclusion revealed that of 449 patients, 236 had Psoriasis vulgaris (PsV) and 213 had PsA. Both NFB and enlarged capillaries were significantly more frequent in patients with PsA (34.7% vs 84.5%, P < 0.0001; 25.4% vs 100%, P < 0.0001). In addition, PsV patients were prospectively observed before they developed PsA (mean 21 months, 95% CI 2, 77 months). Multivariate analysis suggested that the appearance of NFB and enlarged capillaries was a predictor of PsA development (HR 2.75, 95% CI 1.38, 5.47 and HR 4.49, 95% CI 2.25, 8.96, respectively). The degree of NFC abnormalities also correlated with the severity of PsA and serum cytokine levels. CONCLUSIONS: NFC abnormalities were suggested to be a predictor of PsA in psoriasis patients, and at the same time, its degree could be an indicator of disease severity.

Trace Element Levels in Nails of Residents of Addis Ababa Are Shaped by Social Factors and Geography.

The Akaki catchment in Ethiopia is home to Addis Ababa and about five million people. Its watercourses receive a variety of wastes released by the residents and industries. River water is being used for irrigation, livestock watering, and other domestic purposes. This study tested the hypothesis that the river pollution would be reflected in higher levels of trace elements in the nails of residents living in Akaki-Kality Sub-City in the downstream, as compared to those living in Gullele Sub-City in the upstream of the Akaki catchment. Samples were taken and subsequently analysed for metals using inductively coupled plasma optical emission spectrometry (ICP-OES). The mean concentrations of Fe, Zn, Cu, Mn, Ni, Cr, Pb, and As in nails from Akaki-Kality were 488 ± 49, 106 ± 10, 5.2 ± 0.3, 13 ± 1.5, 11 ± 8, 2.2 ± 0.3, 0.09 ± 0.01, and 0.16 ± 0.01 µg/g, respectively. Likewise, the concentrations of Fe, Zn, Cu, Mn, Ni, Cr, Pb, and As in nails from Gullele were 1035 ± 135, 251 ± 10, 6.6 ± 0.4, 31 ± 3.7, 7.4 ± 1.7, 2.0 ± 0.3, 0.63 ± 0.01, and 0.25 ± 0.01 µg/g, respectively. Co and Cd were not detected. Contrary to the initial hypothesis, higher metal levels were found in nails of residents living in the upstream rather than the downstream area of the catchment. In particular, the concentrations of Fe (p = 0.000), Zn (p = 0.01), and Mn (p = 0.000) were significantly elevated in nails from Gullele and also high in comparison with internationally reported values. Besides, geography and social factors, especially education level, correlated to trace metals in nails. Most of the elements were significantly lower in the nails of individuals with a university degree compared to those who were illiterate or only completed primary school.