Does the Nail Bed Regenerate?

BACKGROUND: The regenerative potential of the nail bed after trauma remains controversial. METHODS: We performed a retrospective review of 51 patients who underwent nail bed reconstruction with 2 techniques (direct flow island flap or a Tranquilli-Leali "Atasoy" flap) due to trauma involving the nail bed complex. These 2 flaps were used to support the loss of distal substance and to allow the regeneration of the nail bed. Outcomes were analyzed for at least 18 months. There were 34 men (66.7%), and the average age was 16.1 years. Most patients (56.9%) had crush injuries. The little (16) and index (14) fingers were the most affected. Twenty-seven were children (range: 4-11) with an average age of 7.4 ± 1.9 years. The middle finger was the most affected (29.2%). RESULTS: The outcomes were good to excellent in 41 operated patients (80.4%). Hook nail was absent in 84.3% of the patients. Most patients (98%) did not develop necrosis. Children had an excellent/good outcome rate of 85.2%, while in adults, the rate was 75% of cases (P = .485). CONCLUSION: The direct flow island flap is superior in terms of outcome, regardless of age, sex, affected finger, dominant hand, type of trauma, and injury zone. In cases where there was a correct reconstruction of the hyponychium, there was regeneration of the nail bed.

Onychoscopy in a Colombian population with a diagnosis of toenail onychomycosis: an evaluation study for this diagnostic test.

BACKGROUND: Onychoscopy is a technique that uses a dermatoscope for the evaluation of specific features of different skin conditions that are not visible to the naked eye. There are few studies establishing parameters for the diagnosis of onychomycosis based on onychoscopy. Determining the sensitivity and specificity of a potentially new diagnostic test for onychomycosis requires an evaluation study of this new diagnostic test, as there are limited studies reporting onychoscopy results. AIM: To determine the sensitivity, specificity, positive predictive value and negative predictive value of onychoscopy findings in a Colombian population with onychomycosis. METHODS: We assessed outpatients with a diagnosis of toenail onychomycosis confirmed by potassium hydroxide preparation or fungal culture. Onychoscopy was performed using a dermatoscope, and digital images collected using a smartphone. RESULTS: The onychoscopy findings were: longitudinal striae, distal spiked pattern, distal irregular termination, linear edge and ruins aspect, while some patients were confirmed as having traumatic onycholysis. A statistically significant association was found between the clinical symptoms of onychomycosis and both the clinical feature of dyschromia and the onychoscopy feature of longitudinal striae. CONCLUSION: We suggest that this technique is an alternative method that should be used in patients with onychopathies because it has the potential to differentiate onychomycosis from traumatic onycholysis and another nail involvement.

BIO-NAIL: a bacterial cellulose dressing as a new alternative to preserve the nail bed after avulsion.

Avulsion of the nail plate is the most accomplished surgical procedure among the nail apparatus surgeries. Since it is not possible to use the removed nail to cover the nail bed, some materials have been suggested, however, they are generally not available for use and often at a high cost. To evaluate the use of Bacterial Cellulose (BC) dressing as a biological nail (Bio-Nail) after partial or total avulsion of the nail plate. Twenty-six candidates for nail avulsion, were randomized into two groups: Control, using Vaseline with gauze (11 patients) and Experimental group, BC group, using the Bio-Nail (15 patients). The patients were followed up during the 180-day period. The distribution of the patients in the groups was homogeneous for both sociodemographic and clinical data. The occurrence of infection (1 case in the control group) was not statistically relevant. The BC group had lower pain intensity (p = 0.011) with earlier temporal resolution when compared to the control group (p = 0.003). The BC group presented earlier reepithelization (p = 0.022) and better quantitative (p = 0.021) and qualitative conditions (p = 0.011) for the exudate. Regarding satisfaction, all the patients were satisfied. Good preservation of the nail plate area was observed in the BC group at the end of the 180-day period (p = 0.024). Average time of BC dressing permanence was 16.4 ± 7.1 days. BC showed to be appropriate as a dressing after partial or total avulsion of the nail plate. BC is a Bio-Nail promising for nail bed healing.

Tumor glómico: presentación de dos pacientes / Glomus tumor: presentation of two patients

El tumor glómico es una neoplasia benigna; fue descrita por primera vez en 1924 por Barré y Masson, y se considera de origen hamartomatoso, resultado de la hiperplasia del cuerpo glómico neuromioarterial. Al examen clínico, se presenta como una pápula o nódulo rojo-violáceo; cuando está localizada en el lecho ungueal, aparece como una decoloración roja o azulada, visible a través de la placa ungueal. Se describe como un tumor que produce mucho dolor, y este puede ser provocado por la presión directa de la lesión, la exposición al frío o manifestarse espontáneamente.El tumor glómico es generalmente solitario, aunque puede presentarse de forma múltiple y se ha descrito un carácter hereditario. Constituye una rara neoplasia que aparece frecuentemente entre los 25 y 40 años de edad, y se observa en mayor proporción en mujeres. Los signos y síntomas de esta neoplasia son inconfundibles, por lo que el diagnostico es básicamente clínico. los estudios de imágenes se requieren solo en una minoría de los casos. El tratamiento consiste en una remoción quirúrgica completa de la lesión(AU)

Trauma to the nail complex / Trauma do complexo ungueal

OBJECTIVE: to analyze the results from surgical intervention to treat trauma of the nail complex. METHODS: we retrospectively reviewed a series of 94 consecutive patients with trauma of the nail complex who were treated between 2000 and 2009. In 42 patients, nail bed suturing was performed. In 27 patients, nail bed suturing was performed subsequent to osteosynthesis of the distal phalanx. In 15, immediate grafting was performed, and in 10, late-stage grafting of the nail bed. The growth, size and shape of the nail were evaluated in comparison with the contralateral finger. The results were obtained by summing scores and classifying them as good, fair or poor. RESULTS: the results were considered to be good particularly in the patients who underwent nail bed suturing or nail bed suturing with osteosynthesis of the distal phalanx. Patients who underwent immediate or late-stage nail grafting had poor results. CONCLUSION: trauma of the nail complex without loss of substance presented better results than did deferred treatment for reconstruction of the nail complex...

OBJETIVO: analisar os resultados da intervenção cirúrgica do trauma do complexo ungueal. Métodos: revisamos 94 pacientes consecutivos com trauma do complexo ungueal entre 2000 e 2009. Em 42 pacientes foi feita a sutura no leito ungueal. Em 27, a sutura do leito foi posterior à osteossíntese da falange distal. Em 15, foi feito enxerto imediato e em 10, enxerto tardio do leito ungueal. Foram avaliados o crescimento, o tamanho e a forma da unha comparados ao dedo contralateral. Os resultados foram obtidos com a adição de escores e a classificação deles como bom, regular e ruim. RESULTADOS: foram julgados como bons os pacientes que se submeteram principalmente a suturas do leito ungueal e sutura do leito e osteossíntese da falange distal. Pacientes sub-metidos a enxerto imediato e enxerto posterior da unha tiveram resultados ruins. CONCLUSÃO: o trauma do complexo ungueal sem perda de substância apresentou melhores resultados comparado com a reconstrução do complexo ungueal...

Frequência de micoses superficiais em pacientes atendidos no Serviço de Micologia do Instituto Lauro de Souza Lima no período de 2008 a 2012 / Frequency of superficial fungal infections in patients treated at the Mycology Service of the Institute Lauro de Souza Lima from 2008 to 2012

Existem fungos que são capazes de causar patologias ao homem, essas são chamadas de micoses e estão divididas entre as superficiais, as subcutâneas e as sistêmicas. Nas micoses superficiais os fungos acometem a pele e seus anexos (unhas e pelos) por vezes atingindo os tecidos cutâneos. Os fungos que acometem humanos podem ser leveduriformes, como os dos gêneros, Candida, Rhodotorula, Trichosporon, Cryptococcus, Saccharomyces, Hansenula e Geotrichum, podem ser também filamentosos que estão divididos em Dermatófilos, Hialohifomicose, Feohifomicose. Este estudo teve como objetivo estabelecer a prevalência das micoses superficiais em pacientes atendidos no Serviço de Micologia do Instituto Lauro de Souza Lima (ILSL) no período entre os anos de 2008 a 2012. Por tanto, foi realizado levantamento retrospectivo nos livros de registro desse serviço. Conclui-se que os fungos leveduriformes foram as maiores responsáveis por micoses superficiais em pacientes atendidos no Instituto Lauro de Souza Lima, apesar do fungo dermatófito T. rubrum ter sido o mais frequente na população estudada.

There are fungi that are able to cause diseases to humans, these fungal infections are called and are divided into superficial, subcutaneous and systemic. In superficial mycoses fungi affect the skin and its appendages (by nails and) sometimes reaching the skin tissues. The fungi that affect humans can be yeast such as the genus Candida, Rhodotorula, Trichosporon, Cryptococcus, Saccharomyces, Hansenula, Geotrichum, and can also be filamentous which are divided into Dermatófilos, hyalohyphomycosis, phaeohyphomycosis. This study aimed to establish the prevalence of superficial fungal infections in patients treated at the Mycology Service of the Lauro Souza Lima Institute (ILSL) in the period between the years 2008 to 2012. Therefore, a retrospective survey in the record books this service . It is concluded that the yeast-like fungi were most responsible for superficial mycoses in patients treated at the Lauro Souza Lima Institute, despite the dermatophyte fungus T. rubrum was the most frequent in the studied population.

Granuloma piógeno atípico: reporte de caso y revisión de la literatura / Atypical pyogenic granuloma: case report and literature revision

El granuloma piógeno o hemangioma capilar lobular es una lesión vascular adquirida de curso benigno, común en piel y mucosas, que consiste en un desarrollo reactivo focal de tejido fibrovascular con proliferación endotelial. Clínicamente, es una lesión rojo brillante que puede ser pediculada o sésil y cuyo tamaño varía de pocos milímetros a centímetros. Se localiza principalmente en la mucosa oral, pero hace parte también de las lesiones tumorales de la mano. Su presentación en los dedos se produce en su gran mayoría como lesiones en la región lateral de los mismos o como lesión periungueal; existen muy pocos casos reportados en la literatura de lesión subungueal y aún menos de compromiso ungueal. Se describe un caso clínico de una mujer de 63 años con un granuloma piógeno en la uña y se hace una revisión de la literatura.

Conduta das lesões da extremidade distal dos dedos / Management of fingertip injuries

A clínica, o diagnóstico e as possibilidades terapêuticas das lesões da extremidade distal dos dedos (AU)

Clinical presentation, diagnosis and treatment of fingertip injuries (AU)

Identificação de leveduras do gênero Candida nas unhas e em descamação de pele em Goiânia (GO), durante o ano de 2003 / Identification of yeasts of genus Candida on nails and skin desquamation in Goiania (GO), during the year 2003

A candidíase pode ser descrita como a mais freqüente infecção fúngica oportunística. Ela produz lesões que variam de cutâneas a sistêmicas. Embora a Candida albicans seja o agente mais comumente isolado, espécies como C. tropicalis, C. parapsilosis, C. guilliermondii e C. krusei têm sido identificadas como agentes de candidíase. Neste trabalho, foram coletados materiais de lesões superficiais de diferentes regiões do corpo de 2.083 pacientes do Laboratório de Micologia IPTSP-UFG, durante o ano de 2003, para identificação de fungos do gênero Candida. As amostras coletadas foram submetidas a exame direto, usando-se KOH a 40por cento, e cultivadas em ágar Sabouraud dextrose acrescido de cloranfenicol. Os isolados foram identificados por produção de tubo germinativo e clamídoconídios e assimilação de hidratos de carbono. Foram isoladas 190 leveduras do gênero Candida (9,1por cento), entre as quais C. albicans (63,2por cento), C. parapsilosis (14,2por cento) e C. tropicalis (9,5por cento) foram as espécies mais freqüentes. As lesões por Candida foram predominantes nas unhas das mãos (42,1por cento) e dos pés (42,6por cento). Os resultados obtidos mostraram um aumento de C. parapsilosis e C. tropicalis como agentes de candidíase, comprovando a participação de outras espécies não-albicans como patógenos emergentes.

Alterações ungueais como manifestações de doenças sistêmicas / Nails manifestations of systemic diseases

Os autores revisam as manifestações ungueais de diversas doenças sistêmicas, focando os sinais presentes ao exame físico. Proporcionam pistas para o diagnóstico de diversas patologias através da simples inspeção das unhas durante a consulta médica

[Onychomycosis by common non-dermatophyte moulds]. / Onicomicosis por hongos ambientales no dermatofíticos.

Between 1990 and 2000, The Medical Mycology Laboratory at University of Antioquia (Medellín, Colombia), attended 4621 patients, with nail dystrophies. We used the direct test and culture of nail samples for diagnostic purposes. This report includes 310 patients, 7% (310/4621), with positive cultures for the same non-dermathophyte fungi, in five or more places of inoculation. From the 310 positive cultures, 284 (92%) were positive in direct test. No characteristic morphology for any of the genera could be detected. Until 1989 we had an average of 9 cases per year and between 1990 and 2000 we found 28 cases per year (an increase of 211%). The implicated genera were: Fusarium 50%, Nattrassia 31%, Aspergillus and Dendrophoma 7% each, Penicillium and Scopulariopsis contributed with 2% each, and Acremonium was found in less of 1% of cases. The general prevalence of onychomycosis due to non-dermatophytic fungi was about 12,4% between 1990-2000. This report describes the main epidemiological characteristics found, comparing them with results from other authors, and defines the basic profile of affected patients: adults (31-40 years old) who use occlusive shoes (trainers) and practice sport, which predispose to hyperhydrosis and consequently to onychomycosis. The course of the disease takes in average 30 months in both sexes. The percentage of onychomycosis found was 62% for women and 38% for men.

Estudio clínico y micológico de pacientes con onicopatias referidos al laboratorio de micología del Hospital "Dr. Rafael González Plaza" en un lapso de cuatro años / A clinical and mycologic study in patients with nail onychopathies referred to the mycology laboratory of the Dr. Gonzalez Plaza Hospital in a four year period

Se realizó una Investigación de tipo transversal clínico-micológico en 464 pacientes con onicopatías referidos al laboratorio de Micología del Hospital "Dr. Rafael González Plaza", U.C., en el período 1993-1996 confirmándose mediante exámenes directo y cultivo, etiología micótica en 296 (63.79 por ciento) y descartándose en 168 (36,21 por ciento). En las onicopatías micóticas encontramos que el mayor número de casos pertenecían al grupo de edades entre 45-54 años (26,35 por ciento), sexo femenino (76,35 por ciento), profesión amas de casas (42,57 por ciento) procedentes del Estado Carabobo (93,91 por ciento), localización de las lesiones en ambas manos (23,31 por ciento) y de menos de un año de evolución (32,09 por ciento). Se determinaron onicopat¡as dermatofíticas, tinea unguim en 150 pacientes (50,68 por ciento) aislándose dos especies: T. rubrum (82,67 por ciento) y T. mentagrophytes (17,33 por ciento), perteneciendo el (25,81 por ciento) al grupo entre 45 - 54 años producidos por T. rubrum y (30,77 por ciento) al grupo entre 35 - 44 por T. mentagrophytes, siendo las características predominantes por ambas: sexo femenino (60,67 por ciento), profesionales (32 por ciento), localización en ambos pies (47,33 por ciento), dos años de evolución (25,33 por ciento), afectación de varias uñas (62 por ciento) y forma clínica Distal subungueal (76 por ciento). De la forma clínica leuconiquia superficial solo encontramos 3 casos producidos por T. rubrum

Paquioniquia congênita(Sindrome de Jadassohn Lewandowsky) / Pachyonychia Congenita (Syndrome of Jadassohn Lewandowsky)

A sin drome de jadassohn lewandowsky ou paquioniquia conjenita (PC) hereditaria autossomica dominante de ocorrencia rara com expressividade fenotipica altamente variavel. Caracteriza-se pela formação de quantidades excessivas de queratina nas unhas pele e mucosas, manifestada por hiperceratose ungueal simetrica hiperceratose palmoplantar e leucoceratose folicular. Apresenta-se o caso de um jovem portador dessa anomaliacom onicodistrofa generalizada de mâos e pes, hiperceratose palmoplantar dentes natis maculas no dorso comedões e cistos multiplos pelo corpo paquitriquia e placas alopecias ocipitais. Neste artigo citam-se aspectos geneticos compilam-se manifestações clinicas revisam-se propostas de classificação descreve-se o quadro histologico e aventam-se as possibilidades terapeiticas da PC.