Prevalence of Onychomycosis among Patients with Transverse Overcurvature of the Nail: Results of a Cross-Sectional Study.

INTRODUCTION: Transverse overcurvature of the nail (TON) represents one of the main reasons for dermatological consultations due to nail conditions. Association between TON and subungual hyperkeratosis is common and simulates onychomycosis, constituting a difficult differential diagnosis by clinical features. Many cases are treated in daily practice with antifungal therapy even without mycological confirmation. The aim of this study was to determine the prevalence of onychomycosis among patients with TON associated with subungual hyperkeratosis. METHODS: All subjects with clinical diagnosis of TON and subungual hyperkeratosis were subjected to a thorough clinical history, detailed clinical examination, digital photography, and collection of nail clipping and subungual debris for histopathological and microbiological examination (direct microscopy). RESULTS: Sixty-five samples were collected from 62 female (95.4%) and 3 male (4.6%) participants. Age range was between 34 and 83 years (mean age, 61.2 years). Twenty-eight samples were positive for onychomycosis, giving a 43.07% prevalence rate of onychomycosis among TON associated with hyperkeratosis. DISCUSSION/CONCLUSION: According to our data, the prevalence of onychomycosis in patients with TON associated with subungual hyperkeratosis was 43.07%, confirming the need to rule out fungal infection in TON associated with subungual hyperkeratosis prior to considering any unnecessary antifungal treatment.

Randomized Controlled Trial Comparing the Efficacy and Safety of Two Injection Techniques of IncobotulinumtoxinA for Axillary Hyperhidrosis.

Background: Botulinum toxin A (BoNT-A) is an effective treatment for axillary hyperhidrosis (AH) typically applied by multiple injection punctures. Objective: To compare the efficacy and safety of two BoNT-A injection techniques for AH. Methods: Randomized, evaluator-blinded trial, in which each axilla of the same patient received 50 U of incobotulinumtoxin A (IncoA; Xeomin), one injected intradermally using multiple punctures, the other subcutaneously by radial approach. Follow-up visits occurred after 30, 120, 180, and 270 days. Outcomes included procedure duration and pain, gravimetry and starch-iodine tests and safety. Results: Twenty-four patients with severe hyperhidrosis were included; 67% were female and mean age was 34.7 years. Radial injection was faster applied than multiple punctures (P<0.001) but showed higher pain scores (P=0.001). Pre- and post-treatment gravimetric measures showed that IncoA led to a significant sweat reduction, by both techniques, with 95% of responders (≥50% reduction from baseline) after 30 days of treatment. Similarly, Minor's test showed an excellent response (90-100% reduction) by most patients regardless of the technique used, after 30 days and sustained for at least 270 days. At most time points, there were no significant differences between the two techniques; however, multiple punctures showed a higher reduction of gravimetric measures at days 30 and 180, and of Minor's test at day 270. Treatment was well tolerated. Conclusions: IncoA is an effective and safe treatment for AH irrespective to the technique used for injection. Our study suggests that multiple punctures injection may confer better outcomes at some time points. J Drugs Dermatol. 2020;19(7): doi:10.36849/JDD.2020.4989.

Onychomatricoma of the Nail Bed.

Onychomatricoma is a rare and specific benign tumor of the nail complex, with uncertain etiology. The avulsion of the nail plate reveals cavitations and orifices in its proximal extremity. These are associated with villous tumor formations generating digitiform projections at the nail matrix - typical intraoperative findings. We report a rare case of onychomatricoma in which the nail bed was predominantly affected and show evidence of its clinical, intraoperative, and histopathological presentation. The various descriptions of the disease report that its origin is restricted to the nail matrix, leading to secondary changes in the nail plate.

Retronychia

Abstract: Retronychia is a recently described disorder caused by ingrowth of the proximal nail plate into the proximal nail fold. It is suspected when there is persistent paronychia, particularly in the setting of trauma. This disease is probably underdiagnosed due to limited knowledge among dermatologists and the presence of incomplete clinical forms. Nail plate avulsion is the diagnostic and curative procedure of choice, despite reports of relapse.

Retronychia.

Retronychia is a recently described disorder caused by ingrowth of the proximal nail plate into the proximal nail fold. It is suspected when there is persistent paronychia, particularly in the setting of trauma. This disease is probably underdiagnosed due to limited knowledge among dermatologists and the presence of incomplete clinical forms. Nail plate avulsion is the diagnostic and curative procedure of choice, despite reports of relapse.

Unusual size, topography, and surgical resolution of an acquired fibrokeratoma.

Acquired fibrokeratoma is a rare benign skin tumor that usually manifests as a slow-growing solitary nodular lesion of the digits. We report a case of plantar acquired fibrokeratoma evidencing its atypical size and topography, in addition to the treatment with simple surgical excision followed by healing by second intention. Nondigital fibrokeratomas may occur in 18% of cases and rarely affect the palmoplantar region. These lesions are usually asymptomatic and show ≥ 3cm in size at the time of diagnosis due to delayed diagnosis. Complete surgical excision is the treatment of choice, which is usually curative. In general, primary closure is chosen; however healing by second intention becomes an option in regions of difficult approach.

Unusual size, topography, and surgical resolution of an acquired fibrokeratoma

Abstract: Acquired fibrokeratoma is a rare benign skin tumor that usually manifests as a slow-growing solitary nodular lesion of the digits. We report a case of plantar acquired fibrokeratoma evidencing its atypical size and topography, in addition to the treatment with simple surgical excision followed by healing by second intention. Nondigital fibrokeratomas may occur in 18% of cases and rarely affect the palmoplantar region. These lesions are usually asymptomatic and show ≥ 3cm in size at the time of diagnosis due to delayed diagnosis. Complete surgical excision is the treatment of choice, which is usually curative. In general, primary closure is chosen; however healing by second intention becomes an option in regions of difficult approach.

Tratamento de verrugas virais com bleomicina intralesional / Treatment of viral warts with intralesional bleomycin

A verruga viral representa uma das dermatoses mais prevalentes. O quadro clínico varia de lesão única com cura espontânea até múltiplas lesões recalcitrantes. O sulfato de bleomicina é uma droga de ação citotóxica, aprovada para o tratamento quimioterápico de algumas malignidades. Há mais de 45 anos existem trabalhos demonstrando sua utilidade na dermatologia, em especial na terapia intralesional para verrugas virais, que constitui excelente opção para as lesões em topografias de difícil manejo e para os casos não responsivos a outras abordagens.

Viral warts are one of the most prevalent dermatoses. The clinical picture varies from a single lesion with spontaneous cure to multiple recalcitrant lesions. Bleomycin sulfate is a cytotoxic action drug approved for the chemotherapeutic treatment of some malignancies. There are a number of studies that have been carried out during the last 45 years demonstrating its usefulness in dermatology, especially in intralesional therapy for viral warts, meaning it is an excellent option for lesions in difficult-to-handle topographies and for cases that do not respond to other approaches.

Leprosy: ancient disease remains a public health problem nowadays.

Despite being an ancient disease, leprosy remains a public health problem in several countries -particularly in India, Brazil and Indonesia. The current operational guidelines emphasize the evaluation of disability from the time of diagnosis and stipulate as fundamental principles for disease control: early detection and proper treatment. Continued efforts are needed to establish and improve quality leprosy services. A qualified primary care network that is integrated into specialized service and the development of educational activities are part of the arsenal in the fight against the disease, considered neglected and stigmatizing.

Prevalência de onicomicose na hipercurvatura transversa da unha na clínica de dermatologia do HSPM / Prevalence of omychomycosis in hypercurvature nail transverse at the HSPM dermatology clinic

Resumo A hipercurvatura transversa é uma deformidade na qual a placa ungueal apresenta-se com excesso de curvatura no seu sentido transversal. A sua prevalência na população é desconhecida, no entanto sabe-se que os pododáctilos são mais acometidos. O quadro clínico pode ser assintomático ou cursar com dor intensa, onicocriptose e reabsorção óssea da falange distal. Caracteriza-se por evolução crônica e recorrente, gerando importante prejuízo estético e funcional. Compromete a qualidade de vida e pode afetar as atividades laborais das pessoas afetadas. Existem diversas hipóteses empregadas em determinar a sua etiologia, dentre elas é citada a onicomicose. Além disso, casos de hipercurvatura ungueal transversa associada à hiperqueratose subungueal constituem importante diagnóstico diferencial com a onicomicose, sendo a distinção entre as duas patologias extremamente difícil apenas através dos achados clínicos. Alguns autores sugerem ainda que a hipercurvatura transversa predisponha a onicomicose, devido a alterações estruturais locais. Foi realizado um estudo epidemiológico observacional transversal, com o objetivo de determinar a prevalência de onicomicose nas deformidades ungueais do tipo hipercurvatura transversa associada à hiperqueratose subungueal. Foram selecionados 65 participantes no ambulatório de onicopatia, no setor de Dermatologia do Hospital do Servidor Público Municipal de São Paulo, entre os meses de Fevereiro e Maio de 2016. Todos os casos foram submetidos a exame micológico direto, cultura e clipping ungueal (coloração com ácido periódico de Schiff). Na amostra analisada a prevalência de onicomicose foi de 41,5% (27 casos). Assim, em casos semelhantes a investigação complementar faz-se necessária para confirmação diagnóstica e consequentemente orientar o tratamento específico. Descritores: Doenças da unha; Onicomicose; Unhas