Treatment of Nail Fold Hypertrophy by Combining Conservative Techniques.

INTRODUCTION: Hypertrophy of the nail folds is a common condition. It occurs by alteration of shape, partial loss, or absence of the nail, resulting in loss of the nail fold physiological limit. This can also occur by the friction of the nail with the nail fold. Consequently, there is an increase in the volume of the lateral or distal nail fold and a decrease in the space of the nail bed and the nail plate. Management of this onychodystrophy may be conservative or surgical. CASE PRESENTATION: We present a case of distal nail embedding after trauma, submitted to conservative treatment. Combined techniques were required as trichloroacetic acid application, rolled cotton padding maneuver, artificial resin nail technique, and orthesis. After 14 months, good functional and aesthetic results were obtained, with correction of the anatomical shape of the nail unit. CONCLUSION: The conservative techniques for hypertrophy of the nail folds are a useful option with good functional and aesthetic results. The indication must be precise, considering the history of the patient and after discarding bone alterations by image exams. The disadvantage of the method is the long treatment time and constant visits to the doctor's office.

Onychomatricoma with Onychomycosis: A Case Report and Review of the Literature.

Onychomatricoma is a primary benign neoplasm of the nail matrix. Currently, a limited number of cases have been reported, so it is still considered a rare neoplasia. However, it is debatable if this condition is underdiagnosed and underreported. Onychomycosis is an important differential diagnosis of onychomatricoma, and sometimes, both these conditions may even coexist in the same nail. As the tumor grows, tissue microenvironment is more vulnerable to dermatophytes. Probably, the altered keratin appears to be susceptible to fungal invasion. Careful clinical assessment and dermoscopic evaluation help nailing the diagnosis. Usually, total nail avulsion is the preferred therapeutic approach when they coexist. Herein, we present a case of a middle-aged woman with onychomycosis and onychomatricoma affecting a single fingernail. The proposed therapy was oral terbinafine for 6 months followed by a conservative surgery. There were dramatic changes in dermoscopic features after fungal treatment, which, to our knowledge, have not been previously reported.

Utilidade da técnica de fechamento cirúrgico "ponto em alfa" na onicocriptose / Benefits of the alpha stitch technique in surgical closure in onychocryptosis

Introdução: Aspecto pouco avaliado da onicocriptose ­ principal causa de cirurgia do aparelho ungueal ­ é como deve ser realizado o fechamento cirúrgico. Descreve-se nova técnica denominada "ponto alfa" que permite a retificação da dobra ungueal por posicioná-la no nível da placa ou abaixo dela. Objetivo: Demonstrar a utilidade da técnica de fechamento cirúrgico "ponto alfa" na matricectomia cirúrgica da onicocriptose. Métodos: Selecionados 20 pacientes com onicocriptose graus II e III, submetidos à matricectomia cirúrgica com acompanhamento durante seis meses. O fechamento cirúrgico foi realizado com a técnica "ponto alfa". Resultados: No total, 27 dobras ungueais laterais foram operadas, 81,8% delas com resultado esperado, e 18,1% com resultado duvidoso. Conclusões: O "ponto alfa" permite correta cicatrização da dobra ungueal retificada, posicionada no nível da placa ungueal ou abaixo dela, com bons resultados estéticos, rápida recuperação, mínima morbidade e baixo número de recidivas. Poderá ser usado em procedimentos cirúrgicos de outras afecções ungueais.

Introduction: A poorly described aspect of onychocryptosis ­ the main cause for nail unit surgeries ­ is how to perform its surgical closure. The present article describes a new technique denominated alpha stitch that allows the straightening out of the nail fold by positioning it at or below the nail plate's level.Objective: To demonstrate the benefits of the alpha stitch surgical closure technique in the surgical matricectomy for onychocryptosis.Methods: Twenty patients with onychocryptosis grades II and III underwent surgicalmatricectomy and were followed up for six months. The surgical closure was performed using the alpha stitch technique.Results: A total of 27 lateral nail folds were operated, with 81.8% yielding the expected result, and 18.1% presenting uncertain outcomes.Conclusions: The alpha stitch allows the proper healing of the straightened out nail fold, which is positioned at or below the nails plate's level, with good results, fast recovery, minimal morbidity and a small number of recurrences. The technique can also be used in surgical procedures involving other nail disorders.

Comparison of nail lacquer clobetasol efficacy at 0.05%, 1% and 8% in nail psoriasis treatment: prospective, controlled and randomized pilot study.

BACKGROUND: Nail psoriasis may affect up to 90% of patients with psoriasis in the course of the disease throughout their lives and it is often a therapeutic challenge to dermatologists. Topical treatments described in the literature have demonstrated variable efficacy, and unsatisfactory results have been associated to inefficient penetration of the active ingredient into the nail plate and proximal nail fold. Recently the use of clobetasol on nail lacquer vehicle has been suggested, with satisfactory results and no side effects. OBJECTIVE: To determine the efficacy and safety of clobetasol in nail lacquer vehicle in three concentrations (0.05%, 1% and 8%) in patients with nail psoriasis. METHODS: Prospective, controlled, randomized pilot study in fifteen patients with nail bed and/or nail matrix psoriasis in both hands, subdivided into three groups: A(0.05% clobetasol nail lacquer), B(1% clobetasol nail lacquer) and C(8% clobetasol nail lacquer). All groups used clobetasol nail lacquer on the left hand and base coat nail lacquer as control on the right, twice a week for 16 weeks. Clinical evaluation was done by photographic records and the NAPSI score of both treated and control hands, as well as modified NAPSI score of the most affected nail of the treated hand. RESULTS: Group C showed a statistically relevant clinical response compared to the other groups, reflected in the improvement of clinical parameters, of treated hand NAPSI score, when compared to the control hand, and modified NAPSI score of the most affected nail in the treated hand. CONCLUSION: The 8% clobetasol nail lacquer was effective and safe, and it can be considered a good option of topical therapy in the treatment of nail psoriasis.

Comparison of nail lacquer clobetasol efficacy at 0,05%, 1% and 8% in nail psoriasis treatment: prospective, controlled and randomized pilot study / Comparação da eficácia do clobetasol em esmalte 0,05%, 1% e 8% no tratamento da psoríase ungueal: estudo piloto, prospectivo, controlado e randomizado

BACKGROUND: Nail psoriasis may affect up to 90% of patients with psoriasis in the course of the disease throughout their lives and it is often a therapeutic challenge to dermatologists. Topical treatments described in the literature have demonstrated variable efficacy, and unsatisfactory results have been associated to inefficient penetration of the active ingredient into the nail plate and proximal nail fold. Recently the use of clobetasol on nail lacquer vehicle has been suggested, with satisfactory results and no side effects. OBJECTIVE: To determine the efficacy and safety of clobetasol in nail lacquer vehicle in three concentrations (0.05%, 1% and 8%) in patients with nail psoriasis. METHODS: Prospective, controlled, randomized pilot study in fifteen patients with nail bed and/or nail matrix psoriasis in both hands, subdivided into three groups: A(0.05% clobetasol nail lacquer), B(1% clobetasol nail lacquer) and C(8% clobetasol nail lacquer). All groups used clobetasol nail lacquer on the left hand and base coat nail lacquer as control on the right, twice a week for 16 weeks. Clinical evaluation was done by photographic records and the NAPSI score of both treated and control hands, as well as modified NAPSI score of the most affected nail of the treated hand. RESULTS: Group C showed a statistically relevant clinical response compared to the other groups, reflected in the improvement of clinical parameters, of treated hand NAPSI score, when compared to the control hand, and modified NAPSI score of the most affected nail in the treated hand. CONCLUSION: The 8% clobetasol nail lacquer was effective and safe, and it can be considered a good option of topical therapy in the treatment of nail psoriasis.

FUNDAMENTOS: A psoríase ungueal, de difícil manejo terapêutico, pode afetar até 90% dos portadores de psoríase no transcurso da doença, ao longo de suas vidas. Os tratamentos tópicos descritos na literatura têm eficácia variável, muitas vezes com resultados insatisfatórios causados pela ineficiência da penetração da substância ativa através da placa ungueal e dobra proximal. Recentemente tem sido proposto o uso do clobetasol em veículo esmalte, demonstrando resultados satisfatórios e ausência de efeitos colaterais. OBJETIVO: Determinar a eficácia e segurança do clobetasol em veículo esmalte em três concentrações (0,05%, 1% e 8%) nos pacientes com psoríase ungueal. MÉTODOS: Estudo piloto, prospectivo, controlado e randomizado com quinze pacientes portadores de psoríase ungueal em ambas as mãos. Os pacientes foram subdivididos em três grupos: A (esmalte clobetasol 0,05%), B (esmalte de clobetasol 1%) e C (esmalte de clobetasol 8%). Os pacientes usaram esmalte de clobetasol na mão esquerda e esmalte base (sem medicação - controle) na direita, aplicandoos duas vezes por semana, por 16 semanas. Fez-se a avaliação clínica por registros fotográficos e pelos MÉTODOS: NAPSI da mão tratada e controle e NAPSI modificado da unha mais acometida da mão tratada. RESULTADOS: O grupo C apresentou de forma estatisticamente significativa a resposta clínica mais relevante, refletida na melhora dos parâmetros clínicos, do NAPSI da mão tratada comparado ao da mão controle e do NAPSI modificado da unha mais acometida da mão tratada. CONCLUSÕES: Neste estudo piloto, o esmalte de clobetasol a 8% foi eficaz e seguro, mostrando-se uma boa opção de terapêutica tópica no tratamento da psoríase ungueal.