Zigzag longitudinal melanonychia: a peculiar dermoscopic pattern.

BACKGROUND: Longitudinal melanonychia (LM) can present a diagnostic challenge and dermoscopy is of utmost importance for its evaluation and differential diagnosis of LM. OBJECTIVE: This report aimed to describe an unusual dermoscopic pattern in a group of patients that presented with LM. METHODS: The clinical course and features of five LM patients that presented with an unusual 'zigzag' dermoscopic pattern were analyzed retrospectively. RESULTS: In all, four of the five patients were children (age range: 10-13years). In all five patients, the thumb nail was affected. A nail matrix biopsy was available for only one patient and was reported as lentigo. In two (one child and one adult) out of the five patients, spontaneous total regression of the LM was observed. CONCLUSIONS: The peculiar 'zigzag' dermoscopic pattern of LM described herein seems to occur primarily in children. Although this pattern is a benign in nature, it is not clear if it is related to trauma. Further investigation is warranted to clarify the association between the histopathological findings and the zigzag pattern observed via dermoscopy.

Ungual warts: comparison of treatment with intralesional bleomycin and electroporation in terms of efficacy and safety.

BACKGROUND: Ungual warts are considered the most common benign nail tumour, and they are caused by the human papillomavirus. Despite the numerous treatments reported in the medical literature, ungual warts are considered frustrating, with high relapse rates and a potential risk of nail dystrophy. Bleomycin is a therapeutic option showing a good safety profile and high cure rates. OBJECTIVE: To evaluate the efficacy of electrochemotherapy using intralesional bleomycin for the treatment of ungual warts in comparison with intralesional bleomycin alone and describe the side-effects related to the use of both techniques. METHODS: This was a prospective, randomized, double-blind, controlled clinical trial. Forty-four 18- to 60-year-old female and male patients with ungual warts of only one finger were included. The patients were divided into two treatment groups: GA - intralesional bleomycin; and GB - electroporation and intralesional bleomycin. Following a single application, the patients were followed up for 180 days. RESULTS: The patients' mean age was 36 years for GA and 37 years for GB. Most patients were female (68%). Of 22 patients in GA completing the study, 11 (50%) achieved the cure, while 18 (85.7%) of 21 patients completing the study in GB showed cure. A significant association of patients with or without cure after the GA and GB treatments (P = 0.022) was observed. None of the patients in either group had systemic side-effects. Independent of the technique used, all the participants considered the adverse effects tolerable. CONCLUSION: The intralesional use of bleomycin associated with electroporation for the treatment of ungual warts (both periungual and subungual) showed a statistically superior cure when compared with intralesional bleomycin alone. Side-effects were more frequently observed in the electrochemotherapy with bleomycin group than in the bleomycin monotherapy group.