RESUMEN
The diagnosis of pigmented nail lesions is a concern for both general practitioners and dermatologists, due to the possibility of indicating nail melanoma. The origin of the dark pigmentation can be either melanocytic or non-melanocytic (fungi, bacteria, or blood), and clinical evaluation alone may not be sufficient for differentiation, requiring additional exams. Onychoscopy provides valuable information prior to biopsy. The causes of nail pigmentation will be described to aid in the differential diagnosis.
Asunto(s)
Melanoma , Enfermedades de la Uña , Humanos , Diagnóstico Diferencial , Enfermedades de la Uña/patología , Enfermedades de la Uña/diagnóstico , Melanoma/diagnóstico , Melanoma/patología , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/diagnóstico , Dermoscopía , Trastornos de la Pigmentación/patología , Trastornos de la Pigmentación/diagnóstico , Uñas/patología , Uñas/diagnóstico por imagen , BiopsiaRESUMEN
BACKGROUND: Histopathology can be crucial for diagnosis of inflammatory nail diseases. Longitudinal excision and punch biopsies are the most used techniques to obtain the tissue sample. However, there is a low clinical-histopathological correlation, besides the risk of nail dystrophy. Tangential excision biopsy (TB) is a well-established technique for the investigation of longitudinal melanonychia. TB could also be used to evaluate diseases in which histopathological changes are superficial, as in psoriasis. OBJECTIVE: To study the value of TB in the histopathological diagnosis of nail psoriasis. METHODS: This is a prospective and descriptive study of the clinical-histopathological findings of samples from the nail bed or matrix and nail plate of 13 patients with clinical suspicion of nail psoriasis. Biopsies were obtained through partial nail avulsion and TB. RESULTS: In nine patients, the hypothesis of psoriasis was confirmed by histopathology; in one, the criteria for diagnosing nail lichen planus were fulfilled. The tissue sample of only one patient did not reach the dermal papillae, and, in four of 13 patients, the adventitial dermis was not sampled. No patient developed onychodystrophy after the procedure. STUDY LIMITATIONS: In three patients, the clinical and, consequently, histopathological nail changes were subtle. Also, in one patient's TB didn't sample the dermal papillae. CONCLUSIONS: TB is a good option to assist in the histopathological diagnosis of nail psoriasis, especially when appropriate clinical elements are combined. Using this technique, larger and thinner samples, short postoperative recovery time, and low risk of onychodystrophy are obtained.
Asunto(s)
Enfermedades de la Uña , Psoriasis , Humanos , Enfermedades de la Uña/patología , Enfermedades de la Uña/diagnóstico , Psoriasis/patología , Psoriasis/diagnóstico , Estudios Prospectivos , Biopsia , Femenino , Masculino , Adulto , Persona de Mediana Edad , Uñas/patología , Adulto Joven , Anciano , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: Severe nail lichen planus (NLP) does not respond well to treatment and is often poorly considered and described in detail. OBJECTIVE: We sought to describe the characteristics of severe NLP. METHODS: A retrospective data analysis was performed, including the photographic records of the most compromised nails of patients with NLP over 18 years old, who consulted between 2009 and 2019 at the Instituto de Dermatologia Professor Rubem David Azulay in Rio de Janeiro, Brazil. Descriptive and statistical analysis using Fisher's exact test was performed to verify the hypothesis of independence between characteristics (P < 0.05). RESULTS: A total of 102 patients were included. Anonychia was associated with severe thinning of the nail plate, retraction of the nail bed or nail plate, residual nail plate, loss of proximal nail fold limits, and onychoatrophy. Dorsal pterygium was associated with loss of proximal nail fold limits, onychoatrophy, and distal splitting greater than 50%. CONCLUSION: We provide descriptions of the most severe signs in order to facilitate the clinical diagnosis when a biopsy is not feasible and suggest an update of current NLP classifications.
Asunto(s)
Liquen Plano , Enfermedades de la Uña , Adolescente , Atrofia/patología , Brasil , Humanos , Liquen Plano/patología , Enfermedades de la Uña/patología , Uñas/patología , Estudios RetrospectivosRESUMEN
Cerro de Pasco, Peru, has been excessively contaminated with heavy metals due to high mining activities in the region. We investigated the presence of chronic exposure to heavy metals in children living in Cerro de Pasco and its effect on health. Heavy metal concentrations were determined in hair samples collected from 78 children living in a region exposed to an open-pit mine (Paragsha region) and from other 16 children unexposed to mine activities (Carhuamayo region). Children exposed to the mine showed statistically significant higher concentration of aluminum, antimony, arsenic, cadmium, chromium, iron, lead, tin and thallium (p < 0.05) than control children. Hair samples collected from the same children in two occasions (2016 and 2018) showed that the exposure is chronic with higher levels of heavy metals observed in 2018. The concentration of heavy metals was higher in hair tip than in hair root samples. Heavy metals are associated with substantial higher risk of nosebleed (odds ratio, OR = 15.40), chronic colic (OR = 7.30), dermatologic alterations (OR = 6.16), mood alterations (OR = 7.07), presence of white lines on nails (OR = 12.10), reduced visual camp (OR = 3.97) and other symptoms (OR = 5.12). Chronic heavy metal exposure implies various negative consequences on children's health. Preventive measures are crucial to protect children's health.
Asunto(s)
Salud Infantil/estadística & datos numéricos , Cólico/epidemiología , Exposición a Riesgos Ambientales/análisis , Metales Pesados/efectos adversos , Metales Pesados/análisis , Trastornos del Humor/epidemiología , Enfermedades de la Uña/epidemiología , Enfermedades de la Piel/epidemiología , Adolescente , Adulto , Anciano , Estudios de Casos y Controles , Niño , Preescolar , Cólico/inducido químicamente , Cólico/patología , Exposición a Riesgos Ambientales/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos del Humor/inducido químicamente , Trastornos del Humor/patología , Enfermedades de la Uña/inducido químicamente , Enfermedades de la Uña/patología , Perú/epidemiología , Enfermedades de la Piel/inducido químicamente , Enfermedades de la Piel/patologíaRESUMEN
OBJECTIVE: To characterize the ultrasound findings of the nail plate and nail bed in systemic lupus erythematosus (SLE) and its association with nail dystrophy. METHODS: Thirty-two SLE patients, 36 patients with osteoarthritis (OA) and 20 healthy individuals were studied. High-frequency linear ultrasound was performed in nails of the second to fifth fingers in all participants. Disease activity (SLEDAI-2K index), accrued organ damage (SLICC/ACR index), autoantibody profile, and Raynaud's phenomenon were also assessed in SLE patients. RESULTS: Nail bed thickness in SLE patients was higher than in healthy individuals (1.25 ± 0.31 mm vs 1.17 ± 0.29 mm; P = 0.01) but lower than in OA (1.39 ± 0.37 mm; P < 0.001), while nail plate thickness was similar among groups. Nail dystrophy was found more frequently in SLE and OA than in healthy individuals. SLE patients with nail dystrophy were older than their counterparts with no dystrophy (39.4 ± 10.4 years vs 27.8 ± 5.6 years; P = 0.004), although nail dystrophy showed no association with SLICC/ACR, SLEDAI-2K, nail bed vascularity, or autoantibodies. CONCLUSIONS: Nail bed in SLE patients is thicker than in healthy individuals but thinner than in OA patients. Nail dystrophy in SLE is associated with advanced age, but not with accrued organ damage, disease activity, Raynaud's phenomenon, or DIP synovitis assessed by ultrasound.
Asunto(s)
Lupus Eritematoso Sistémico/complicaciones , Enfermedades de la Uña/etiología , Uñas/diagnóstico por imagen , Ultrasonografía/métodos , Adulto , Factores de Edad , Autoanticuerpos/inmunología , Femenino , Voluntarios Sanos/estadística & datos numéricos , Humanos , Lupus Eritematoso Sistémico/diagnóstico , Lupus Eritematoso Sistémico/epidemiología , Lupus Eritematoso Sistémico/patología , Masculino , Persona de Mediana Edad , Insuficiencia Multiorgánica/complicaciones , Insuficiencia Multiorgánica/epidemiología , Enfermedades de la Uña/patología , Uñas/patología , Osteoartritis/epidemiología , Osteoartritis/patología , Enfermedad de Raynaud/complicaciones , Índice de Severidad de la EnfermedadRESUMEN
Acral lentiginous melanoma is a histological subtype of cutaneous melanoma that occurs in the glabrous skin of the palms, soles and the nail unit. Although in some countries, particularly in Latin America, Africa and Asia, it represents the most frequently diagnosed subtype of the disease, it only represents a small proportion of melanoma cases in European-descent populations, which is partially why it has not been studied to the same extent as other forms of melanoma. As a result, its unique genomic drivers remain comparatively poorly explored, as well as its causes, with current evidence supporting a UV-independent path to tumorigenesis. In this review, we discuss current knowledge of the aetiology and diagnostic criteria of acral lentiginous melanoma, as well as its epidemiological and histopathological characteristics. We also describe what is known about the genomic landscape of this disease and review the available biological models to explore potential therapeutic targets.
Asunto(s)
Enfermedades del Pie/patología , Melanocitos/patología , Melanoma/patología , Enfermedades de la Uña/patología , Neoplasias Cutáneas/patología , HumanosRESUMEN
Melanonychia is the change in the coloration of the nail plate resulting from the deposition of melanin. Among its causes are melanocytic hyperplasia, melanocytic activation and nail melanoma. Subungual follicular inclusions are histological findings of unknown etiology, possibly related to trauma. We present three cases of melanonychia of different etiologies with subungual follicular inclusions, an association that has not been well described and with an indefinite pathogenesis.
Asunto(s)
Folículo Piloso/patología , Melanosis/patología , Enfermedades de la Uña/patología , Adulto , Dermoscopía , Folículo Piloso/diagnóstico por imagen , Humanos , Masculino , Melanosis/diagnóstico por imagen , Persona de Mediana Edad , Enfermedades de la Uña/diagnóstico por imagen , Uñas/patología , UltrasonografíaRESUMEN
Abstract Melanonychia is the change in the coloration of the nail plate resulting from the deposition of melanin. Among its causes are melanocytic hyperplasia, melanocytic activation and nail melanoma. Subungual follicular inclusions are histological findings of unknown etiology, possibly related to trauma. We present three cases of melanonychia of different etiologies with subungual follicular inclusions, an association that has not been well described and with an indefinite pathogenesis.
Asunto(s)
Humanos , Masculino , Adulto , Folículo Piloso/patología , Melanosis/patología , Enfermedades de la Uña/patología , Ultrasonografía , Folículo Piloso/diagnóstico por imagen , Dermoscopía , Melanosis/diagnóstico por imagen , Persona de Mediana Edad , Enfermedades de la Uña/diagnóstico por imagen , Uñas/patologíaAsunto(s)
Dermoscopía , Enfermedades de la Uña/patología , Nevo Pigmentado/patología , Neoplasias Cutáneas/patología , Adolescente , Niño , Preescolar , Colombia/epidemiología , Humanos , Lactante , Recién Nacido , Enfermedades de la Uña/congénito , Enfermedades de la Uña/epidemiología , Uñas Malformadas/congénito , Uñas Malformadas/epidemiología , Uñas Malformadas/patología , Nevo Pigmentado/congénito , Nevo Pigmentado/epidemiología , Estudios Retrospectivos , Neoplasias Cutáneas/congénito , Neoplasias Cutáneas/epidemiologíaAsunto(s)
Inyecciones Intralesiones/métodos , Metotrexato/administración & dosificación , Enfermedades de la Uña/tratamiento farmacológico , Inhibidores de la Síntesis del Ácido Nucleico/administración & dosificación , Psoriasis/tratamiento farmacológico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades de la Uña/patología , Psoriasis/patología , Reproducibilidad de los Resultados , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Of all nail disorders seen in dermatology offices, half of them are due to onychomycosis. The main differential diagnosis is nail psoriasis. The objective of this study was to compare the microscopic findings, other than the presence of fungi, in the clipping of onychomycosis versus normal nails and nail psoriasis. METHODS: Cross-sectional study of onychomycosis cases, analyzed by clipping and compared with data on normal nails and those with nail psoriasis. RESULTS: Sixty-two onychomycosis samples were compared with 30 normal nails and 50 nails with psoriasis. In onychomycosis, measurement of subungual region, serous lakes, neutrophils and number of layers of parakeratosis are more intense than in psoriasis. Onychocariosis is less common in psoriasis, while bacteria are more frequent. The nail transition zone is more commonly blurred and irregular in onychomycosis. CONCLUSION: Clipping helps in the differential diagnosis of onychomycosis and nail psoriasis and may be useful even when fungi are not found.
Asunto(s)
Enfermedades de la Uña/patología , Uñas/patología , Onicomicosis/patología , Estudios Transversales , Diagnóstico Diferencial , Humanos , Enfermedades de la Uña/microbiología , Uñas/microbiología , Neutrófilos , Onicomicosis/microbiología , Paraqueratosis , Psoriasis/microbiología , Psoriasis/patologíaAsunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Psoriasis/tratamiento farmacológico , Inyecciones Intralesiones/métodos , Metotrexato/administración & dosificación , Inhibidores de la Síntesis del Ácido Nucleico/administración & dosificación , Enfermedades de la Uña/tratamiento farmacológico , Psoriasis/patología , Factores de Tiempo , Reproducibilidad de los Resultados , Resultado del Tratamiento , Enfermedades de la Uña/patologíaRESUMEN
Onychocytic matricoma is a newly described tumor of the nail matrix. Clinically, it presents with localized thickening of the nail plate and melanonychia. Histologically, it represents a benign acanthoma of onychocytes. There are 8 cases reported in the literature. A 12-year-old girl presented with localized melanonychia and concurrent thickening of the nail plate restricted to the area of pigmentation affecting the right thumb, with no history of trauma or pain. We report a case of this rare tumor occurring in late childhood and provide a comprehensive review of its clinical presentation and differential diagnosis. Both clinicians and dermatopathologists should be aware of the presentation of onychocytic matricoma and include it in their scope of diagnosis of longitudinal nail bands.
Asunto(s)
Acantoma/patología , Enfermedades de la Uña/patología , Neoplasias Cutáneas/patología , Niño , Diagnóstico Diferencial , Femenino , Humanos , Enfermedades de la Uña/cirugía , Neoplasias Cutáneas/cirugía , PulgarRESUMEN
We report the case of an 8-year-old child with subungual exostosis, whose diagnosis was suspected on the basis of dermoscopic findings and subsequently confirmed by X-ray and histopathology.
Asunto(s)
Neoplasias Óseas/diagnóstico por imagen , Exostosis/diagnóstico por imagen , Enfermedades de la Uña/diagnóstico por imagen , Neoplasias Óseas/patología , Niño , Dermoscopía , Diagnóstico Diferencial , Exostosis/patología , Humanos , Enfermedades de la Uña/patología , Onicólisis/diagnóstico por imagen , RadiografíaAsunto(s)
Síndrome Mucocutáneo Linfonodular/complicaciones , Enfermedades de la Uña/etiología , Uñas/patología , Trastornos de la Pigmentación/etiología , Pigmentación , Corticoesteroides/uso terapéutico , Preescolar , Femenino , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Inmunosupresores/uso terapéutico , Síndrome Mucocutáneo Linfonodular/diagnóstico , Síndrome Mucocutáneo Linfonodular/tratamiento farmacológico , Síndrome Mucocutáneo Linfonodular/etnología , Enfermedades de la Uña/etnología , Enfermedades de la Uña/patología , Trastornos de la Pigmentación/diagnóstico , Trastornos de la Pigmentación/etnología , Resultado del TratamientoRESUMEN
Abstract: Background: Of all nail disorders seen in dermatology offices, half of them are due to onychomycosis. The main differential diagnosis is nail psoriasis. The objective of this study was to compare the microscopic findings, other than the presence of fungi, in the clipping of onychomycosis versus normal nails and nail psoriasis. Methods: Cross-sectional study of onychomycosis cases, analyzed by clipping and compared with data on normal nails and those with nail psoriasis. Results: Sixty-two onychomycosis samples were compared with 30 normal nails and 50 nails with psoriasis. In onychomycosis, measurement of subungual region, serous lakes, neutrophils and number of layers of parakeratosis are more intense than in psoriasis. Onychocariosis is less common in psoriasis, while bacteria are more frequent. The nail transition zone is more commonly blurred and irregular in onychomycosis. Conclusion: Clipping helps in the differential diagnosis of onychomycosis and nail psoriasis and may be useful even when fungi are not found.