Onychomatricoma on the fourth toenail: A rare tumor in a rare localization.

Onychomatricoma is a rare benign tumor of the nail matrix, characterized by finger-like projections that invade the nail plate. The fingernails of Caucasian women are most commonly affected. Because this tumor can easily mimic other more prevalent ungual diseases, it is crucial to be acquainted with its characteristic clinical and histopathologic features. The authors present a case of a 40-year-old man with an onychomatrichoma in the fourth left toenail, which was initially misdiagnosed and treated as onychomycosis.

The nail flag sign in heart transplant recipients: case reports and review of the patients with the flag sign of the nail.

The nail plate flag sign is a distinctive nail plate change that appears as white, red, white, and red sequential transverse bands beginning at the proximal nail fold. This distinctive nail change was initially described in patients with diabetes mellitus and leprosy; indeed, it was considered to be characteristic, but not diagnostic of leprosy. Subsequently, the flag sign was observed in patients with vitiligo. The flag sign has recently been noted in two men following heart transplantation. In summary, the flag sign is a unique nail change that has occurred in patients with autoimmune disorders, infection, and post transplantation surgery associated with immunosuppressive therapy to prevent organ rejection.

Role of nail biopsy as a diagnostic tool.

Nail biopsy (NB) is an investigation that is not routinely resorted to by most of the dermatologists. The commonly cited reasons are the complexity of the procedure, risk of scarring and the reluctance of the patient. However, in cases with isolated nail psoriasis, isolated nail lichen planus, onychomycosis not confirmed on direct microscopy and culture, or longitudinal melanonychia, the treating dermatologist is left with no choice but to resort to this procedure. Nail as a unit, is capable of projecting only a limited number of clinical manifestations. This is responsible for the more or less similar clinical presentation of many different nail disorders. Hence, a practical knowledge of the indications, appropriate patient selection, procedural details and histopathological interpretation of a NB is a must-have for any practicing dermatologist. The risk of scarring is none to minimal if appropriate type of biopsy is performed, not to mention the wealth of histopathological data that can be retrieved from the nail unit. This article aims to explore the various practical do's and don'ts for the NB and tells us what to expect from of the procedure.

Nail cosmetics.

The nail as an anatomic structure protects the terminal phalanx of the digit from injury. Historically, it has served as a tool for protection and for survival. As civilizations developed, it attained the additional function of adornment. Nail beautification is a big industry today, with various nail cosmetics available, ranging from nail hardeners, polishes, extensions, artificial/sculpted nails, and nail decorations. Adverse events may occur either during the nail-grooming procedure or as a reaction to the individual components of the nail cosmetics. This holds true for both the client and the nail technician. Typically, any of the procedures involves several steps and a series of products. Separate "nail-bars" have been set up dedicated to serve women and men interested in nail beautification. This article attempts to comprehensively inform and educate the dermatologist on the services offered, the products used, and the possible/potential adverse effects related to nail-grooming and nail cosmetics.

Trachyonychia: a comprehensive review.

Trachyonychia or rough nails, may present as an idiopathic disorder of the nails or it can be associated with other dermatological conditions. The dystrophic nail findings seen in trachyonychia are characterized by brittle, thin nails, with excessive longitudinal ridging. The most common histopathologic features associated with trachyonychia are spongiosis and exocytosis of inflammatory cells into the nail epithelia; typical features of lichen planus or psoriasis can also be detected. Determining the cause of trachyonychia is challenging. Treatment is often unsatisfactory, although in general it should be aimed at the underlying cause, if found. In most cases, the nail abnormalities improve spontaneously.

Clinical study of nail changes in leprosy and comparison with nail changes in diabetic patients.

BACKGROUND: Nail changes in leprotic patients are not specific to leprosy, and may be observed in other peripheral neuropathies. Diabetes is one of the diseases that present with nail dystrophy secondary to peripheral neuropathy, vasculopathy, trauma and infections. Therefore, nail changes in diabetic neuropathy are expected to be very similar to that of leprosy. OBJECTIVES: To evaluate the frequency and pattern of nail changes in Egyptian leprotic patients with the different spectrums of the disease, and to compare nail changes in leprosy with those seen in patients with diabetic neuropathy. METHODS: The study included 115 leprosy patients and 60 patients with diabetic peripheral neuropathy. Nail examination was thoroughly carried out and various nail changes were recorded including the location of the involved nails (fingers, toes). RESULTS: Our study detected similar incidence of nail changes in both multibacillary (MB) (86%) and paucibacillary (PB) patients (86%). Flag sign (alternating horizontal bands of whitish and pinkish discoloration of the nail) observed in our study was not reported before. It was more commonly seen in MB patients (21%) than in PB patients (14%). Our results also revealed that the nail changes were more commonly seen in leprosy patients (86%) than in diabetic patients (68%). CONCLUSION: Nail changes in leprosy are multifactorial, and could be related to one or more of the following: neuropathy, endarteritis, trauma, drugs or superimposed infections. Nail changes in leprosy may be used as an additional clue that helps in the diagnosis.