RESUMEN
Purpose: Onychopapilloma is a rare benign nail tumor affecting the distal matrix and the nail bed. Currently, the only available treatment is surgical resection, which has a recurrence rate of 20% and may lead to various complications. Here we report a new method to treat onychopapilloma with pulsed dye laser (PDL).Materials and methods: We retrospectively analyzed 13 cases and evaluated disease classification, dermoscopic examination, laser treatment parameters, photographs before and after treatment, and treatment outcome.Results: The site distribution of onychopapilloma was consistent with previous reports. PDL treatment was performed with 595 nm laser, with 1.5 ms pulse duration, spot diameter 3-5 mm, and 11.5-13.5 J/cm2 fluence. Irradiation covered the telangiectatic area up to the edge of the nail folds, with the terminal response of purpura occurrence. The overall effective rate was 77%; the effective rates for erythronychia, leukonychia, and melanonychia were 88%, 67%, and 50%, respectively.Conclusions: PDL treatment for onychopapilloma provides an alternative to traditional surgery with comparable effectiveness but much less risk for complications.
Asunto(s)
Láseres de Colorantes , Terapia por Luz de Baja Intensidad , Enfermedades de la Uña , Púrpura , Humanos , Láseres de Colorantes/uso terapéutico , Estudios Retrospectivos , Resultado del Tratamiento , Terapia por Luz de Baja Intensidad/efectos adversos , Enfermedades de la Uña/radioterapia , Enfermedades de la Uña/cirugíaRESUMEN
BACKGROUND: There are many methods to treat subungual wart, but the treatment results are not satisfactory. CASEPRESENTATION: A patient with a 10-year history of subungual warts was cured after using paiteling, and no warts recurred after six months of follow-up. CONCLUSION: Paiteling is effective and safe to treat subungual warts.
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Enfermedades de la Uña , Verrugas , Humanos , Verrugas/terapia , Resultado del Tratamiento , Enfermedades de la Uña/cirugía , Pacientes , RecurrenciaRESUMEN
BACKGROUND AND OBJECTIVES: There are limited treatment options for nail psoriasis. It is important to find new therapies and improve existing ones. The aim of this study was to compare the effectiveness of pulsed dye laser (PDL) versus combined PDL and Nd:YAG lasers in patients with nail psoriasis. METHODS: Fourteen patients (with a total of 126 nails affected by nail psoriasis) were treated with PDL (6 J/cm2, 7 mm, 0.45 milliseconds) on both hands and additionally with Nd:YAG (10 J/cm2 , 6 mm, 15 milliseconds) on the right hand. Three treatment sessions were applied at 4-week intervals and patients were followed up for 6 months after the last session. Disease severity was assessed using the Nail Psoriasis Severity Index, both 8- and 32-point variant. Additionally, Dermatology Life Quality Index was assessed before and after treatment. RESULTS: Overall, there was a statistical difference in 8- and 32-point NAPSI score before and after treatment for both hands. However, there was no statistical difference between the score for the right and left hands based on both scale variants. Some aspects of patients' lives showed improvement due to the treatment. CONCLUSIONS: Both PDL in monotherapy and combined Nd:Yag+PDL lasers are safe and effective in treatment of nail psoriasis, although combined therapy shows no advantage over the use of a single laser.
Asunto(s)
Láseres de Colorantes , Láseres de Estado Sólido , Terapia por Luz de Baja Intensidad , Enfermedades de la Uña , Psoriasis , Humanos , Láseres de Colorantes/uso terapéutico , Láseres de Estado Sólido/uso terapéutico , Enfermedades de la Uña/cirugía , Psoriasis/terapia , Resultado del TratamientoRESUMEN
Abstract: Nail changes are present in about 50% of psoriasis patients and tend to be refractory to conventional treatments. Pulsed dye laser has emerged as an alternative therapy. Our aim is to evaluate the efficacy of pulsed dye laser in nail psoriasis and the impact of treatment on quality of life. Fourteen patients were treated in monthly sessions for three months. The outcome assesment was made by the Nail Psoriasis Severity Index (NAPSI). The median improvement in the scores of the overall NAPSI, nail bed NAPSI, and nail matrix NAPSI were 44.2% (P = 0.002), 50% (P = 0.033) and 65.1% (P = 0.024), respectively.
Asunto(s)
Humanos , Adulto , Persona de Mediana Edad , Psoriasis/cirugía , Láseres de Colorantes/uso terapéutico , Enfermedades de la Uña/cirugía , Calidad de Vida , Factores de Tiempo , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Reproducibilidad de los Resultados , Resultado del TratamientoRESUMEN
Nail changes are present in about 50% of psoriasis patients and tend to be refractory to conventional treatments. Pulsed dye laser has emerged as an alternative therapy. Our aim is to evaluate the efficacy of pulsed dye laser in nail psoriasis and the impact of treatment on quality of life. Fourteen patients were treated in monthly sessions for three months. The outcome assesment was made by the Nail Psoriasis Severity Index (NAPSI). The median improvement in the scores of the overall NAPSI, nail bed NAPSI, and nail matrix NAPSI were 44.2% (P = 0.002), 50% (P = 0.033) and 65.1% (P = 0.024), respectively.
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Láseres de Colorantes/uso terapéutico , Enfermedades de la Uña/cirugía , Psoriasis/cirugía , Adulto , Humanos , Persona de Mediana Edad , Calidad de Vida , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del TratamientoRESUMEN
Nail procedures require an effective and reliable approach to anesthesia of the distal digit. Several techniques have been described in the literature. Herein, the relevant anatomy of the nail unit, pain pathways, anesthetic options, and several injection approaches to achieve complete anesthesia are reviewed. Also considered are the potential pitfalls and complications and their management. Ultimately, the physician's approach must be individualized to the patient, procedure, and setting.
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Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Enfermedades de la Uña/patología , Enfermedades de la Uña/cirugía , Uñas/patología , Bloqueo Nervioso/métodos , Anestesia Local/efectos adversos , Anestesia Local/instrumentación , Biopsia , Epinefrina/administración & dosificación , Humanos , Agujas , Bloqueo Nervioso/efectos adversos , Bloqueo Nervioso/instrumentación , Dolor/prevención & control , Temperatura , Vasoconstrictores/administración & dosificaciónRESUMEN
Nail surgery is a special branch of hand and dermatologic surgery. It is not widely performed, and many physicians do not feel at ease to perform it. The objective of this contribution is to give a short overview of the most important surgical procedures in clinical practice. References from the literature and the author's own experiences are condensed to describe what a dermatologic practitioner with knowledge of the nail and some surgical skills can perform. Nail surgery is a precise technique that requires careful administration and attention to details. Proper patient preparation starts with a patient history to identify potential contraindications and to prevent unnecessary complications. The author recommends isopropyl alcohol scrub and chlorhexidine for disinfection and ropivacaine 1% for anesthesia. The technique used for anesthesia depends on the type of surgery. Surgical procedures are described for diagnostic biopsies, nail avulsion in general, onychogryposis, paronychia treatment, hematomas and bone fracture due to trauma, removal of subungual foreign bodies, ingrowing nails, pincer nails, warts, ungual fibrokeratomas, digital myxoid pseudocyst, subungual exostoses, and various tumors. If performed correctly with adequate skills, nail surgery will lead to functionally and aesthetically satisfying results in the majority of instances.
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Procedimientos Quirúrgicos Dermatologicos , Enfermedades de la Uña/cirugía , Uñas Malformadas/cirugía , Uñas/cirugía , Cuidados Preoperatorios , Anestesia Local , Biopsia , Contraindicaciones , Desinfección , Cuerpos Extraños/cirugía , Hematoma/cirugía , Humanos , Enfermedades de la Uña/diagnóstico , Uñas/lesiones , Uñas/patologíaAsunto(s)
Enfermedades de la Uña/cirugía , Bloqueo Nervioso/métodos , Cuidados Preoperatorios/métodos , Anestesia Local/efectos adversos , Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Anestésicos Locales/efectos adversos , Biopsia/métodos , Humanos , Hielo , Dolor/etiología , Dolor/prevención & controlRESUMEN
This paper provides an introductory overview of nail surgery, including basic principles, anesthesia, wound dressings, and several common nail procedures. In detail, it reviews how to achieve complete anesthesia and hemostasis, perform matrix injection, punch biopsy of the plate, bed, and matrix, and nail fold biopsy, with practical tips and suggested surgical indications.
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Enfermedades de la Uña/cirugía , Uñas/cirugía , Anestesia Local , Biopsia , Humanos , Inyecciones Intralesiones , Uñas/lesionesRESUMEN
Patients often fear nail surgery because of the pain associated with anesthesia and post-operative care. Potential dystrophic sequelae are of concern to the practitioner. A thorough knowledge of the techniques of anesthesia, nail anatomy, and surgical procedures is a prerequisite for successful nail surgery with almost no pain and minimal scarring. It also is mandatory to involve a dermatopathologist who is familiar with the histologic idiosyncrasies of the nail unit.
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Enfermedades de la Uña/cirugía , Anestesia Local , Humanos , Enfermedades de la Uña/patología , Procedimientos Quirúrgicos OperativosRESUMEN
There are many procedures available to the podiatric surgeon to deal with a painful, deformed nail. The Syme's procedure should not be overlooked, though more conservative options should be attempted before this procedure. With the proper surgical candidate (ie, intact neurovascular status), this is a successful, safe procedure easy to perform under local anesthesia.
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Amputación Quirúrgica/métodos , Hallux/cirugía , Enfermedades de la Uña/cirugía , Uñas/cirugía , Colgajos Quirúrgicos , Anestesia Local , HumanosRESUMEN
Correct partial or total nail plate avulsion may be performed in the physician's office. The author recommends certain preoperative, operative, and postoperative procedures that may help assure a more successful outcome.