Nail lichen planus: A review of clinical presentation, diagnosis and therapy.

Lichen planus is a multifaceted disease of complex etiopathogenesis. Nails are involved in up to 10% of patients with lichen planus. Although most cases are mild, serious consequences may occur due to rapid progression of the disease, the high risk of scarring, and the resulting irreversible damage to the nail structure. Permanent damage of at least one nail occurs in approximately 4-12% of patients with nail lichen planus. In this narrative review, we emphasize the pathophysiology of nail lichen planus, the emergent nature of the disease, and the spectrum of different clinical manifestations. Diagnosis of nail disease in general, and of nail lichen planus in particular, is rapidly evolving. This review provides a comprehensive account of the non-invasive and invasive diagnostic techniques and treatment options reported in the literature, with emphasis on the efficacy and safety of the drugs used, the associated evidence, and the factors to be taken into account in planning and providing adequate treatment. The role of aesthetic and camouflage options is also summarized.

Evaluation of intraocular pressure and retinal nerve fiber layer, retinal ganglion cell, central macular thickness, and choroidal thickness using optical coherence tomography in obese children and healthy controls.

OBJECTIVE: Obesity affects many organ systems. There have been few studies on the ophthalmological effects of obesity. The aim of the present study was to evaluate the changes in the ophthalmological parameters in obese children. SUBJECTS AND METHODS: The study included 61 obese and 35 age-and gender-matched control subjects. Obesity was defined as body mass index-standard deviation score (BMI-SDS) >2 SD. Children with a BMI-SDS between >-1 SD and <+1 SD whilst otherwise healthy were recruited as the control group. All clinical and ophthalmological investigations were performed by a pediatric endocrinologist and an experienced ophthalmologist. The ophthalmological examination and intraocular pressure (IOP) measurement was performed. The average retinal fiber layer (RNFL), retinal ganglion cell (RGC), central macular thickness (CMT), cup-to-disk ratio (C/D), and central choroidal thickness (CT) were measured using spectral domain optical coherence tomography. The anthropometric, biochemical, and ophthalmological parameters of the obese and control subjects were compared. RESULTS: IOP was higher in the obese group compared to the control group (P = 0.008), whereas the average RNFL was lower in the obese group (P = 0.035). There was a negative correlation between the average RNFL and BMI-SDS (P = -0.044) and waist-hip ratio (P = 0.015). There was no statistically significant difference between the RGC, C/D, CMT, and CT of the obese and control groups. IOP was negatively correlated with HOMA-IR, body fat mass, body fat percentage, and diastolic blood pressure. CONCLUSION: In the present study, which evaluated obesity and its effects on ophthalmological parameters, the elevated IOP and decreased RNFL thickness detected in the obese group may suggest an increased risk for these patients of developing glaucoma at a younger age. Therefore, regular ophthalmological examinations of obese children are essential for prompt diagnosis and appropriate management.

Photoonycholysis: new findings.

First described in 1961, photoonycholysis (PO) is a rare nail alteration that may result from drug intake, from topical aminolevulinate photodynamic therapy or from photosensitive conditions such as porphyria or pseudoporphyria. Spontaneous PO is rare. This review updates the numerous causes of PO and highlights some new ways producing this condition. Four different types of PO are clearly recognized without relationship with the responsible drug. An updated list of potential inducing drug is provided. Some practical points on PO have been raised. The inability to reproduce photoonycholysis experimentally should be emphasized, and the pathogenesis of PO still needs to be clarified.

Longitudinal subungual acanthoma: one denomination for various clinical presentations.

BACKGROUND: Benign subungual proliferation of the distal nail matrix and bed such as longitudinal keratosis, seborrhoeic keratosis or onychocytic matricoma should belong to a single spectrum of diseases. OBJECTIVE: This article intends to demonstrate clinically and histologically the different facets of Nail unit longitudinal acanthoma. METHODS: We report three new cases that present as a longitudinal melanonychia with thickening of the nail plate in two of them and as leukoxanthonychia in the third one. We compared them with the two original cases we described in 1999, reminiscent of seborrhoeic keratosis and all the new cases published since then. RESULTS: We therefore consider that all these tumours belong to a single spectrum of diseases, we have called 'nail unit longitudinal acanthoma' which describes a histopathological process. The distinct clinical features of these tumours, melanonychia or leukoxanthonychia may be linked to their variable anatomic locations in different zones of the nail unit.

Influence of the nature and environment of manganese in Mn-BEA zeolites on NO conversion in selective catalytic reduction with ammonia.

Manganese-containing BEA zeolites, MnxSiBEA (x = 1-4 wt%) and Mn(I.E.)AlBEA, were prepared by a two-step post-synthesis method and a conventional wet ion-exchange, respectively, and applied as catalysts in the selective catalytic reduction of NO with ammonia (NH3-SCR). The physicochemical analysis of zeolite properties by high-energy-resolution fluorescence-detected XANES (HERFD-XANES) and X-ray emission spectroscopy (XES) uncovered that the coordination, geometry and oxidation state of Mn species are strongly related to the preparation method. Additionally, the study of catalyst acidity by FTIR spectroscopy with CO and pyridine probe molecules provided important insight into the number and type of acidic centres present on the catalyst surface. The catalytic results revealed that NO conversion depended on the state and content of Mn. The zeolites obtained by the two-step post-synthesis method and with a low Mn content were very active in the medium temperature range (NO conversion ∼100%) with simultaneous high selectivity to N2 due to the presence of isolated, framework Mn(iii) and Mn(ii) species. The N2O formation was especially high in the case of catalysts containing extra-framework polynuclear Mn species and negligible in the case of Mn(I.E.)AlBEA containing predominantly isolated, extra-framework Mn(ii) species.

[Scabies of the nail unit in an infant]. / Scabiose de l'appareil unguéal chez un nourrisson.

BACKGROUND: There are no guidelines regarding the management of scabies in infants and recurrence is common at this age. We report the case of an infant with subungual hyperkeratosis and ungual lesions subsequent to classic scabies. PATIENTS AND METHODS: A 7-month-girl, treated 6 weeks earlier with esdepallethrin for scabies, consulted for acquired lesions on 3 toe nails. These nails were thickened and displayed subungual hyperkeratosis. Physical examination of the skin, the finger nails and mucous membranes was otherwise normal. Fungal analyses were negative, but direct microscopic examination revealed numerous larvae of Sarcoptes scabiei as well as ovular debris. The child was treated with urea 40% to obtain chemical avulsion of the nails, and with topical esdepallethrin and a quarter tablet of ivermectin orally; there was no follow-up of the child. DISCUSSION: Ungual scabies has already been reported in crusted scabies and very rarely in classic scabies. Subungual and ungual locations of S. scabiei may constitute a source of reinfestation with scabies in infants. Treatment is not well defined and currently involves chemical avulsion of the nails and the application of topical antiscabies treatment.

Nail features in healthy term newborns: a single-centre observational study of 52 cases.

INTRODUCTION: The anatomy and embryology of the nail are well known, and nail abnormalities are a feature of many genodermatoses. However, the physiological aspect is not well described. We aimed to analyse the physiological features of nails in healthy newborns. METHODS: We performed an observational, prospective study at University Hospital Center of Tours between July and October 2015. Newborns were included by a dermatologist assistant during the systematic examination on release of the mother from the hospital. The medical history of the mother and infant were recorded by using a standardized questionnaire. Finger- and toenails were systematically photographed for a second interpretation by a dermatologist with blinding to the first photograph. RESULTS: Fifty-eight patients were eligible, and 52 were included. Half of the newborns were males, and the mean age at inclusion was 3.6 ± 1.2 days. Fingernails had an oval shape (71.1%) or a flat curvature (63.5%), and half had a lunula. Toenails showed an apparent hypertrophy of the proximal nail fold (38.4%) and lateral nail fold (73.1%). The shape of the nails was triangular (50.0%) or round (21.1%). We noted koilonychia in 32.7% of infants and lunula in 7.7%. Distal parts showed onychoschizia (28.8%) and onycholysis (26.9%). CONCLUSION: Koilonychia, onychoschizia of toenails or absence of lunula are physiological features of nails in newborns.

Koilonychia: an update on pathophysiology, differential diagnosis and clinical relevance.

Koilonychia, a concave nail dystrophy, has multiple aetiologies and may be hereditary, acquired or idiopathic. Within dermatology, koilonychia is often a manifestation of an inflammatory dermatosis such as psoriasis or lichen planus, or a sign of onychomycosis. Other disease associations include iron store abnormalities, Plummer-Vinson Syndrome, nutritional deficiencies and occupational or traumatic aetiologies. In young children, koilonychia of the toenails is commonly transient and idiopathic, although familial and syndromic cases are reported. The dermatologist must be aware of the potential cutaneous and systemic associations with koilonychia in order to guide appropriate workup, treatment and/or referral. An algorithm for evaluation of koilonychia is presented along with discussion of common causes of koilonychia and a comprehensive list of all known associations.

An open comparative study of nail drilling as adjunctive treatment for toenail onychomycosis (.).

Introduction Novel treatment regimens are being developed to improve drug penetration through the nail plate. This study investigated the efficacy of nail drilling regimens for the treatment of onychomycosis. Methods Participants were assigned to holes with combination (oral plus topical terbinafine) therapy (Group 1), holes with topical terbinafine (Group 2) or topical terbinafine only (Group 3). Measurement of clear nail and mycology was performed at baseline and at weeks 4, 10, 16, 22 and 28. Mixed linear models were used to compare mean percent clear nail. Mycological cure rates were also tabulated for each group. Tolerability and adverse events were documented. Results Ninety-eight participants were enrolled (106 nails). Both groups with holes had significantly higher percentage of clear nail compared with topical terbinafine alone. Although no significant difference between the two groups where holes were drilled in the nail plate, Group 1 demonstrated improvement over Group 3 earlier than Group 2 (visit 2 versus visit 4). Group 1 also had the highest mycological cure rates. Conclusion Treatment with holes plus topical terbinafine produces significantly greater improvement in toenails' appearance and higher mycological cure rates compared to treating the dorsal aspect of the nail plate with topical terbinafine alone.

Incorporation of Mn into the vacant T-atom sites of a BEA zeolite as isolated, mononuclear Mn: FTIR, XPS, EPR and DR UV-Vis studies.

A MnSiBEA zeolite has been prepared via a two-step postsynthesis procedure which consisted, in the first step, of the treatment of a tetraethylammonium BEA zeolite with nitric acid for the formation of vacant T-atom sites and then, in the second step, of the incorporation of Mn ions into the framework, resulting in a SiBEA zeolite, through their reaction with the silanol group of the vacant T-atom sites. The incorporation of Mn ions into the framework of the SiBEA zeolite has been evidenced using XRD. The formation of isolated mononuclear Mn(ii) and Mn(iii) in a MnSiBEA zeolite has been shown using FTIR, diffuse reflectance UV-Vis, EPR and XPS. The acidic properties of the mononuclear manganese species have been investigated via FTIR spectroscopy using pyridine as the probe molecule. The changes in the oxidation state of the Mn species under various treatments have been proven using EPR.

[Cosmetic nail products]. / Cosmétiques unguéaux.

Cosmetic embellishment of fingernails involves the use of substance that harden either after the evaporation of solvents (varnishes) or after polymerisation (artificial acrylic nails, gel tips, glue-on artificial nails). Pathological reactions to cosmetics usually occur at a remote site for varnishes, and, most commonly, in situ with polymerising substances. Unvarnished artificial nails do not affect pulse oximetry readings, and in theory, patients are not required to remove them. However, a real problem of contamination via artificial nails exists. Increased carriage of pathological Gram-negative organisms and of Staphylococcus aureus and yeasts has been noted among nursing staff wearing artificial nails, both before and after fingernail cleaning. Fingernail fragility manifests itself through a number of different physical signs such as soft, breaking nails, with longitudinal or transverse fissures, showing distal doubling or friability. In some subjects, excessive manicuring with metal instruments or manicure sticks results in rolled onycholysis, of evocative appearance, or transverse onycholysis.

Abundance of Cottus poecilopus is influenced by O2 saturation, food density and Salmo trutta in three tributaries of the Roznovská Becva River, Czech Republic.

The distribution patterns of alpine bullhead Cottus poecilopus in three tributary streams of the Roznovská Becva River (Danube basin) were studied with respect to temperature, oxygen concentration and saturation, shading, current, conductivity, total organic carbon (TOC), nitrates and phosphates, biochemical oxygen demand (BOD5 ), pH, redox potential, bottom grain structure, density of macroinvertebrates and the abundance of brown trout Salmo trutta. Sites with lower abundance per hectare of C. poecilopus differed significantly in dissolved oxygen saturation, density of macroinvertebrates during the autumn period (positive correlation with C. poecilopus) and in abundance per hectare of S. trutta (negative correlation). These results indicate that these factors significantly influence the distribution of this endangered species in the studied catchment and that stocking of S. trutta will impair its recovery.

Clinical comparison and complete cure rates of Terbinafine efficacy in affected onychomycotic toenails.

BACKGROUND: Clinical studies regarding complete cure rate of onychomycosis using oral Terbinafine have a very broad range (14-90%) based solely on response to treatment on the big toenail. OBJECTIVE: To evaluate the efficacy of Terbinafine in all affected onychomycotic toenails and, furthermore, to evaluate differences in mycological, clinical and complete cure rate between affected onychomycotic toenails. PATIENTS AND METHODS: Inclusion criteria are as follows: distolateralsubungual onychomycotic involvement of the hallux and additional involvement of at least two more toenails of the same foot. Exclusion criteria are as follows: patients with nail traumata and hypersensitivity to Terbinafine. Patients were treated with oral Terbinafine 250 mg/day for 16 weeks. Mycological analysis was performed using direct microscopy and culture. Clinical improvement was assessed using digital photography. RESULTS: Statistically significant difference was found in clinical improvement between the great toenail and all other involved toenails. The rate of complete cure (100% clinical cure and mycological cure) of the big toenail was lower (23%) as compared to the second (65%), third (51%) and the fourth toenail (67%). LIMITATIONS: This is a case series study that was based on a single-centre cohort. CONCLUSIONS: Our results support findings that efficacy of Terbinafine should be based on all involved onychomycotic toenails; the big toenail is not superior in response compared to other affected toenails.

Acroosteolysis presenting with brachyonychia following exposure to cold.

BACKGROUND: A vast number of conditions ranging from simple trauma to hereditary and collagen vascular disease had been described in association with acroosteolysis. OBJECTIVE: To demonstrate that severe cold exposure not mounting to frostbite may be associated with acroosteolysis. METHODS: A 16-year-old girl with acroosteolysis presenting with brachyonychia was fully investigated for possible cause of her nail and bone deformity. RESULTS: Lab investigations including Parathormone levels, Anti Scl 70, ANA, Anti-CCP and RF levels were all normal. X-ray imaging revealed resorption of the tufts of the terminal phalanges bilaterally. Disruption of nail fold capillaries with sluggish flow in capillary loops was evident on capillaroscopy. CONCLUSION: It had been repeatedly reported that frostbite, Raynaud's disease and diseases associated with repeated chilblains may be associated with secondary cold-induced acroosteolysis. Here, we present a case of acroosteolysis associated with brachyonychia following exposure to severe cold not mounting to frostbite.

[New clinical classification for onychomycoses]. / Nouvelle classification clinique des onychomycoses.

We have updated our clinical classification on onychomycosis (2011) to render it of more practical value for the clinician. It should provide a better understanding of onychomycosis and facilitate an improved approach to treatment, taking into account, for example, the link between the proximal subungual variety and some superficial forms emerging from beneath the cuticle.