Cross-sectional study of the prevalence of hyperextension of the first metatarsophalangeal joint and its relationship to onycholysis in women with hallux valgus.

BACKGROUND: Hallux Valgus (HV) deformity is associated with misalignment in the sagittal plane that affects the first toe. However, the repercussions of the first toe hyperextension in HV have been scarcely considered. The purpose of this study was to provide evidence of the association between first-toe hyperextension and the risk of first toenail onycholysis in HV. METHODS: A total of 248 HV from 129 females were included. The extension of 1st MTP joint was measured while the patient was in the neutral position of the hallux using a two-branch goniometer. The classification of the HV severity stage was determined by the Manchester visual scale, and the height of the first toe in the standing position was measured using a digital meter. An interview and clinical examination were performed to collect information on the presence of onycholysis of the first toe. RESULTS: Of the 248 HV studied, 100 (40.3%) had onycholysis. A neutral extension > 30 degrees was noted in 110 (44.3%) HV. The incidence of onycholysis was higher in HV type C than in type B (p = 0.044). The probability of suffering onycholysis in the right foot was 2.3 times greater when the neutral position was higher than 30 degrees (OR = 2.3; p = 0.004). However, this was not observed in the left foot (p = 0.171). Onycholysis was more frequent in HV with more than 2 cm height of the first toe (p < 0.001). For both feet, the probability of suffering onycholysis was greater for each unit increase in hallux height (right foot OR = 9.0402, p = 0.005; left foot OR = 7.6633, p = 0.010). CONCLUSIONS: The incidence of onycholysis appears to be significantly associated with HV showing more than 30º extension, and more than 2 cm height of the first toe. Height and hyperextension of the first toe together with first toenail pathology should be mandatory in the evaluation of HV.

Nail abnormalities in subepidermal blistering diseases: a cross-sectional study.

BACKGROUND: Nail involvement in subepidermal autoimmune blistering diseases (SEABD) is not common. Although these changes can be transient, permanent changes can also occur. This study addresses nail involvement manifestations and their associated factors in patients with SEABD. METHODS: From March 2020 to March 2021, we enrolled 56 patients with SEABD who were being examined at a tertiary skin hospital and checked their nail changes. We investigated the association between the SEABD subtypes and treatments that patients were receiving and the nail abnormalities. Additional factors including age, gender, duration since diagnosis, presence of mucosal involvement, and anti-bp230 and anti-bp180 IgG antibody quantitative levels (in those patients with bullous pemphigoid) were analyzed. RESULTS: The most common nail abnormalities were ridging, onycholysis, and onychoschizia. We observed a lower prevalence of onycholysis in EBA, a lower prevalence of periungual bullae in MMP, and a higher prevalence of scarring loss in EBA. Rituximab and dapsone were effective in preventing onycholysis as well as prednisolone in preventing subungual hematoma. Multiple lesions were found to be more common in the foot digits including great toes, probably because of higher exposure to trauma. CONCLUSIONS: In summary, in patients with SEABD and concomitant nail involvement, the underlying disease control, proper treatment, and avoidance of trauma may be helpful.

Nail findings in patients with psoriatic arthritis: A cross-sectional study with special reference to transverse grooves.

BACKGROUND: Patients with psoriatic arthritis (PsA) commonly present with nail manifestations; however, little is known about these manifestations. OBJECTIVE: This study investigated whether nail findings can be used to discriminate between PsA and psoriasis without arthritis. METHODS: We performed a retrospective analysis of 118 patients with PsA and 974 patients with psoriasis without arthritis who visited St. Luke's International Hospital (Tokyo, Japan) between July 2003 and February 2015. Patients with PsA were classified according to the Classification of Psoriatic Arthritis criteria. Skin lesion severity was assessed by using the Psoriasis Area and Severity Index, and 9 types of nail findings were investigated. RESULTS: The incidence of nail involvement in patients with PsA was 67.6%. Female sex, presence of transverse grooves, onycholysis, and splinter hemorrhages were significantly related to PsA, with transverse grooves demonstrating the strongest association (odds ratio, 5.01; 95% confidence interval, 2.31-10.8; P < .01). Furthermore, the presence of transverse grooves was strongly related to both distal interphalangeal arthritis and enthesitis. LIMITATIONS: The PsA population was relatively small. CONCLUSIONS: Nail findings enabled us to distinguish patients with PsA from those without arthritis. The presence of transverse grooves is significantly associated with PsA and may be associated with distal interphalangeal arthritis and enthesitis.

Phototoxicity of Doxycycline: A Systematic Review on Clinical Manifestations, Frequency, Cofactors, and Prevention.

BACKGROUND: One of the most important dermatologic side effects of doxycycline is photosensitivity. As doxycycline is important for malaria prophylaxis and malaria is mainly spread in countries with high sun radiation, special attention should be paid to this adverse effect. While there are many publications on the phototoxicity of tetracyclines in general, only a few exist focusing on doxycycline. The objective of this systematic review was to summarize all available reports on clinical manifestations, influencing factors like UV dose or dose of medication, and the possibilities of prevention by sun protection. METHODS: This review is based on a systematic search in PubMed for articles in English and German and a manual search between 1990 and 2015. RESULTS: The number of publications is low. Clinical symptoms vary from light sunburn-like sensation (burning, erythema) to large-area photodermatitis. Also, onycholysis is possible. The triggering UV spectrum seems to consist mainly of UVA1 (340-400 nm), so UV-protective products should be used that cover this range. Travelers to tropical countries taking doxycycline for malaria prophylaxis need thorough medical counseling to avoid possibly severe phototoxic reactions. CONCLUSION: Evidence base must be improved for giving advice on appropriate prevention measures to travelers taking doxycycline and having a risk of significant sun exposure.

Treatment of nail psoriasis with Pulse Dye Laser plus calcipotriol betametasona gel vs. Nd:YAG plus calcipotriol betamethasone gel: an intrapatient left-to-right controlled study / Tratamiento de psoriasis ungueal con Pulse dye laser frente a Nd: YAG, en asociación con gel de betametasona: un estudio con control intrapaciente izquierda-derecha

BACKGROUND: Treatment of nail psoriasis remains a challenging and often disappointing situation. OBJECTIVE: To compare the efficacy, adverse reactions and tolerability of treatment of nail psoriasis with PDL vs. Nd:YAG, in association with betametasona calcipotriol gel. METHODS: An open, prospective intrapatient left-to-right study was designed. The right hand of each patient received treatment with PDL and the left hand with Nd:YAG. Betamethasone calcipotriol gel was applied once a day during the first week after each laser session. A total of four sessions were administered. RESULTS: The clinical efficacy was evaluated according to the NAPSI score. All patients showed improvement in nail bed and nail matrix psoriasis. The global NAPSI mean declined in 15.46 (p < 0.000). There was neither statistical difference between the reduction in nail bed and matrix NAPSI nor in the treatment with PDL vs. Nd:YAG. The administration of Nd:YAG was more painful. No serious adverse effects were documented. Limitations. No random assignment and the small number of patients. CONCLUSIONS: PDL and Nd:YAG have proven to be an effective treatment for nail psoriasis with no serious adverse effect. No statistically significant difference was found between the two treatments

ANTECEDENTES: El tratamiento de la psoriasis ungueal es una situación de difícil manejo y a menudo decepcionante para el dermatólogo. OBJETIVO: Comparar la eficacia, las reacciones adversas y la tolerabilidad del tratamiento de la psoriasis ungueal con PDL vs. Nd: YAG en asociación con gel de betametasona calcipotriol. MÉTODOS: Estudio prospectivo abierto con control intrapaciente izquierda-derecha. La mano derecha de cada paciente recibió tratamiento con PDL y la mano izquierda con Nd: YAG. Se aplicó gel de betametasona calcipotriol una vez al día durante la primera semana después de cada sesión de láser en las 2 manos. Se administraron un total de 4 sesiones. RESULTADOS: La eficacia clínica se evaluó de acuerdo con la escala NAPSI. Todos los pacientes mostraron una mejoría en las lesiones del lecho y de la matriz ungueal. La media global del NAPSI disminuyó en 15,46 (p < 0,000). No hubo diferencia significativa entre la mejoría de las lesiones del lecho y la matriz ni en el tratamiento con el PDL vs. Nd: YAG. La administración de Nd: YAG fue más dolorosa. No se documentaron efectos adversos graves. Limitaciones. Falta de asignación aleatoria y muestra pequeña. CONCLUSIONES: PDL y Nd: YAG han demostrado ser tratamientos eficaces para la psoriasis ungueal sin documentarse efectos adversos graves. No se encontró diferencia estadística significativa entre los 2 tratamientos

A chemical mixer with dark-green nails.

Nails are integral extensions of the skin and they together form the largest organ of the human body. Changes in nail appearance can be due to external insults or internal pathologies, and nail signs have to be interpreted in light of a good history. We present an interesting case of a man who developed dark-green discolouration of his nails over a short period of time. His work as a chemical mixer rendered him susceptible to hazardous chemical exposure. A notification was filed and the local Occupational Health Department discovered insufficient protective gear and lack of protocols regarding hazards of isocyanate-based resin. The patient also reported washing utensils with bare hands. Based on the meniscal demarcation borders between the discoloured and normal areas, plus a positive bacterial culture from nail clippings, the final diagnosis of isocyanate-resin-induced onycholysis with secondary Pseudomonas infection remained as the most likely clinical diagnosis.

Exostosis subungueal / Subungual exostosis

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Digitial endochondroma.

A patient with Ollier disease presenting with onycholysis and nail dystrophy related to a subungual enchondroma is presented.

[POPP syndrome: Psoriatic onychopachydermoperiostitis]. / Síndrome POPP: onicopaquidermoperiostite psoriásica.

Psoriatic onychopachydermoperiostitis (POPP) syndrome characterizes a clinical variant of psoriatic arthritis originally described by Fournie et al in 1989. Both great toes are generally affected presenting with nail changes, painful swelling of the soft tissue close to the distal phalanx as well as specific radiologic changes such as periosteal reaction and bone erosions of the distal phalanges. Joint involvement is characteristically absent and classic psoriatic lesions may be associated. Painful symptoms may lead to severe functional and quality of life impairment. Traditional systemic treatment is generally frustrating. Here we report a female patient presenting POPP syndrome refractory to traditional systemic treatments and adalimumab, further presenting a favorable response to treatment with etanercept.

Effectiveness of systemic treatment agents on psoriatic nails: a comparative study.

BACKGROUND: Nails, one of the most visible sites of body, are frequently involved in psoriasis and accepted as the most difficult site for topical treatment because of their anatomical structure. Healing of the psoriatic nails usually occurs when systemic therapy is initiated to treat severe skin psoriasis or joint involvement, but sometimes systemic therapy is essential for severe nail psoriasis, although Psoriasis Area and Severity Index (PASI) score is low or none of the joints are affected. In this case, knowing which systemic agent is most potent on nail findings is important. AIM: We aimed to evaluate the effect of systemic antipsoriatic agents on nail findings. METHODS: Eighty-seven psoriatis patients with fingernail involvement who required systemic treatment but had not used any systemic treatment in the previous 12 weeks were included in this study. Different systemic treatment agents were given to patients, considering factors such as age, sex, and joint involvement, but not nail involvement. The control group was recruited from psoriatis patients with nail involvement who were not receiving any systemic treatment. Baseline and week 16 Nail Psoriasis Severity Index (NAPSI) and PASI were detected in all groups. At the end of the study, effects of the agents on both PASI and NAPSI were compared statistically. RESULTS: Patients were divided into 5 groups to receive either: 1) methotrexate, 2) narrow-band ultraviolet B phototherapy, 3) biological agents, 4) acitretin, or 5) no treatment (control group). None of the conventional treatment agents caused any significant difference on NAPSI at the end of week 16 compared with control group, although PASI decreased significantly. Rate of NAPSI changes were more prominent in the biological treatment group, and a statistically significant difference was detected when compared with the control group.

Nail disease in psoriatic arthritis: distal phalangeal bone edema detected by magnetic resonance imaging predicts development of onycholysis and hyperkeratosis.

OBJECTIVE: To examine the association between magnetic resonance imaging (MRI) features of distal phalanx (DP) disease and the progression of nail pathology in psoriatic arthritis (PsA). METHODS: Clinical nail assessment and hand MRI scans were done on 34 patients with PsA. Twenty patients had repeat nail assessments after 1 year. RESULTS: Nails with onycholysis and hyperkeratosis at baseline were more likely to have corresponding DP bone erosion and proliferation on MRI. DP bone edema on baseline MRI was associated with development of onycholysis and hyperkeratosis in corresponding nails. CONCLUSION: Our data suggest that DP inflammation is central in the development of psoriatic nail disease.

[The blood biochemical indicators as possible markers of destruction of kerato-hyaline tissue of nails in patients with onycholysis].

It is established that the most informative blood biochemical indicators of destructive process in patients with onycholysis are to be considered concentration of oxiproline in blood. The changing of ratio of fractions oxiproline, balance between concentration of enzymes of antioxidant defense and metalloproteinase and concentration of hemoglobin in blood make it possible to diagnose the mixed type of hypoxemia which is a possible cause of destruction of kerato-hyaline tissue in patients with onycholysis.

[Assessment of psoriatic nail lesions therapy by means of nail psoriasis severity index].

The problem of psoriatic nail lesions is known for a long time. According to various authors, psoriatic onychodystrophy has been diagnosed in 15-78% of patients with psoriasis. At the same time, we know that the treatment of psoriatic nail lesions is not always successful. The aim of the study was to evaluate the therapeutic efficacy of the drug onypso in the complex treatment of patients with psoriasis by means of NAPSI index. We observed 39 patients with psoriasis (20 men and 19 women at the age of 19 to 65 years with disease duration of 1 year to 25 years). The distribution of clinical manifestations of psoriatic onychodystrophy was as follow: thimble symptom -150 plates, subungual hyperkeratosis lesion type - 90 plates, onycholysis lesion type was observed in 50 plates. As a systemic treatment we used the cytostatic agent methotrexate - parenteral administration of 25 mg (once a week). In duration of total treatment course the patient received 90 -120 mg. Local treatment was provided by means of varnish onypso (once a day for 6 months). The survey revealed that at 7 weeks of treatment there was a 25 % reduction of initial value of NAPSI index, at the end of 14 weeks of therapy the above mentioned index was reduced for 50 % and at the 24 weeks for 75% respectively. It should be noted, that resolution of the cutaneous pathology was much faster than improvement of the structure of affected nail plates. Thus, drug onypso proposed for the specific treatment of nail lesions used in the complex therapy of patients with psoriasis is simple in use, accessible, compliant and highly effective. As a conclusion, we can say that NAPSI method, used to determine the extent of lesions and the effectiveness of the therapy, can objectively evaluate the dynamics of clinical pathology of the nails and adequacy of used treatment.