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1.
Medicine (Baltimore) ; 98(50): e17917, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852063

RESUMO

OBJECTIVE: Psoriasis is a chronic inflammatory disease that affects the skin, joints, and nails. To investigate the efficacy of sonoelastographic evaluation for assessing nail involvement and severity in psoriasis. MATERIALS AND METHODS: Thirty-one psoriasis patients and 31 healthy control subjects were included in the study. The nail thickness and nail bed thickness of the thumbs of all cases were measured by gray scale ultrasonography. In addition, the values of strain elastography were measured by sonoelastography. RESULTS: Of the participants, 38 were male and 24 were female; the ratio of males and females was equal in both groups. There was no significant difference between the patient and control group in terms of gender and age. In the patient group, the mean duration of illness was 13.87 ±â€Š9.8 years, mean PASI score was 5.53 ±â€Š2.38, and mean NAPSI score was 33.97 ±â€Š37.99. The nail plate thickness and elastography strain ratios were found to be statistically higher in the psoriasis group compared to the control group. There was also significant correlation between elastography strain ratios and nail thickness (P = .014), nail bed thickness (P < .001) and NAPSI scores (P = .01). CONCLUSION: Due to the superiority of ultrasound in real-time imaging of the nail structure and the compatibility of sonographic elastography with clinical scores in the assessment of the nail bed, we believe that it can be used as a complementary method.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Doenças da Unha/diagnóstico , Unhas/diagnóstico por imagem , Psoríase/diagnóstico , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças da Unha/etiologia , Psoríase/complicações , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Adulto Jovem
5.
Saudi J Kidney Dis Transpl ; 30(4): 978-981, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31464259

RESUMO

Melanonychia is described as a brown to black pigmentation of nail, due to stimulation and hyperplasia of nail matrix. Various systemic disorders, trauma, inflammatory disorders, fungal infections, drugs, benign melanocytic hyperplasia, etc., are responsible for this condition, and most of them are benign. A number of chemotherapeutic agents can cause melanonychia. Cases of cyclophosphamide-induced melanonychia are not frequent. We report a 38-year-old female, a known case of steroid dependent nephrotic syndrome, who developed melanonychia on starting treatment with cyclophosphamide. It is a benign condition, which resolves on discontinuation of the drug.


Assuntos
Ciclofosfamida/efeitos adversos , Melaninas/metabolismo , Doenças da Unha/induzido quimicamente , Unhas/efeitos dos fármacos , Síndrome Nefrótica/tratamento farmacológico , Transtornos da Pigmentação/induzido quimicamente , Esteroides/uso terapêutico , Adulto , Feminino , Humanos , Doenças da Unha/diagnóstico , Doenças da Unha/metabolismo , Unhas/metabolismo , Síndrome Nefrótica/diagnóstico , Transtornos da Pigmentação/diagnóstico , Transtornos da Pigmentação/metabolismo
6.
Clin Podiatr Med Surg ; 36(4): 685-694, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31466575

RESUMO

The lower extremity presents several challenges from a dermatologic standpoint: there are different anatomic areas that not only vary from a stratum corneum thickness and histologic standpoint but are also subject to trauma that is unique (shoe gear, gait cycle). Attention to appropriate diagnosis and management is always warranted but should be especially vigilant to those treating issues of the lower extremity. This article reviews diagnosis and treatment of the most common skin and nail conditions of the foot and ankle.


Assuntos
Dermatoses do Pé/diagnóstico , Dermatoses do Pé/terapia , Doenças da Unha/diagnóstico , Doenças da Unha/terapia , Feminino , Dermatoses do Pé/etiologia , Humanos , Masculino , Doenças da Unha/etiologia , Adulto Jovem
8.
J Cutan Pathol ; 46(10): 794-797, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31148238

RESUMO

Perianal keratoacanthomas are rare, with 10 cases reported to date. Perineal keratoacanthoma has not previously been described. In this report, we describe two cases of keratoacanthoma, one perianal and one perineal. Both lesions show prominent dyskeratotic keratinocytes, with striking and curious histologic resemblance to subungual keratoacanthoma.


Assuntos
Canal Anal , Ceratoacantoma , Doenças da Unha , Idoso , Canal Anal/metabolismo , Canal Anal/patologia , Diagnóstico Diferencial , Feminino , Humanos , Ceratoacantoma/diagnóstico , Ceratoacantoma/metabolismo , Ceratoacantoma/patologia , Masculino , Doenças da Unha/diagnóstico , Doenças da Unha/metabolismo , Doenças da Unha/patologia
9.
Orthop Clin North Am ; 50(3): 357-366, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31084838

RESUMO

Subungual melanoma is a rare form of melanoma that presents a unique set of challenges largely based on the complex anatomy of the nail unit. Subungual melanoma often first appears with longitudinal melanonychia. Thus, practitioners must have a high clinical suspicion in any patient with longitudinal melanonychia and a low threshold for a biopsy. The "ABCDEF" guide can be a useful tool to aid in screening any lesion of the nail bed. The authors recommend that biopsies of the nail unit be performed by a surgeon with an in-depth understanding of the pathoanatomy of subungual melanoma.


Assuntos
Melanoma , Doenças da Unha , Neoplasias Cutâneas , Biópsia , Dermoscopia , Detecção Precoce de Câncer , Humanos , Sarda Melanótica de Hutchinson/patologia , Incidência , Linfonodos/patologia , Margens de Excisão , Melanoma/diagnóstico , Melanoma/epidemiologia , Melanoma/patologia , Melanoma/cirurgia , Doenças da Unha/diagnóstico , Doenças da Unha/epidemiologia , Doenças da Unha/patologia , Doenças da Unha/cirurgia , Transtornos da Pigmentação/patologia , Cuidados Pós-Operatórios , Prevalência , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Resultado do Tratamento
10.
J Drugs Dermatol ; 18(5): 465-467, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31141855

RESUMO

We report a rare case of leiomyoma of the fingernail in a 59-year-old woman. She presented with red discoloration, lifting, and distal splitting of her left 2nd fingernail for several months. She reported sensitivity at baseline which became more painful in the cold. Histopathology sections from the nail matrix biopsy specimen showed a dermal proliferation of bland appearing spindle shaped cells with elongated, blunt ended nuclei (SMA and caldesmon positive), arranged in fascicles, which is typical of leiomyomas. Interestingly, our patient had a history of uterine leiomyoma, requiring hysterectomy. To our knowledge, this case is the first report in which a subungual leiomyoma is associated with another leiomyoma in the same patient. J Drugs Dermatol. 2019;18(5):465-467.


Assuntos
Dedos , Leiomioma/diagnóstico , Doenças da Unha/diagnóstico , Neoplasias Cutâneas/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Leiomioma/cirurgia , Pessoa de Meia-Idade , Doenças da Unha/cirurgia , Neoplasias Cutâneas/cirurgia
11.
Dermatol Online J ; 25(3)2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30982304

RESUMO

The nail plate flag sign is a distinctive nail plate change that appears as white, red, white, and red sequential transverse bands beginning at the proximal nail fold. This distinctive nail change was initially described in patients with diabetes mellitus and leprosy; indeed, it was considered to be characteristic, but not diagnostic of leprosy. Subsequently, the flag sign was observed in patients with vitiligo. The flag sign has recently been noted in two men following heart transplantation. In summary, the flag sign is a unique nail change that has occurred in patients with autoimmune disorders, infection, and post transplantation surgery associated with immunosuppressive therapy to prevent organ rejection.


Assuntos
Transplante de Coração , Doenças da Unha/diagnóstico , Unhas/patologia , Idoso , Rejeição de Enxerto/prevenção & controle , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Doenças da Unha/patologia
12.
J Am Acad Dermatol ; 81(3): 717-722, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30930088

RESUMO

BACKGROUND: Nail matrix histopathologic examination is still the criterion standard to diagnose longitudinal melanonychia (LM). OBJECTIVE: To introduce modified shave surgery combined with the nail window technique for managing LM and evaluate the postoperative outcome of the procedure. METHODS: We retrospectively reviewed the medical records of 67 patients with LM who underwent shave surgery combined with the longitudinal-strip nail window technique at our institution from March 2015 to June 2018. RESULTS: Pathologic diagnosis was accessible in all cases, and 60 cases were assessable for the postoperative outcomes. A total of 45 cases (75.0%) had no postoperative nail dystrophy, and recurrence of nail pigmentation was found in only 8 cases (13.3%). LIMITATIONS: This was a retrospective study. CONCLUSION: Modified shave surgery combined with the nail window technique is the preferable management for LM cases, with limited postoperative nail dystrophy and recurrence of pigmentation.


Assuntos
Procedimentos Cirúrgicos Dermatológicos/métodos , Doenças da Unha/cirurgia , Unhas/patologia , Transtornos da Pigmentação/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Idoso , Biópsia , Criança , Pré-Escolar , Procedimentos Cirúrgicos Dermatológicos/efeitos adversos , Procedimentos Cirúrgicos Dermatológicos/instrumentação , Diagnóstico Diferencial , Feminino , Humanos , Lasers de Gás/uso terapêutico , Masculino , Melanoma/diagnóstico , Melanoma/patologia , Pessoa de Meia-Idade , Doenças da Unha/diagnóstico , Doenças da Unha/patologia , Unhas/cirurgia , Transtornos da Pigmentação/diagnóstico , Transtornos da Pigmentação/patologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Recidiva , Estudos Retrospectivos , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Adulto Jovem
13.
Int J Dermatol ; 58(11): 1239-1245, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31006857

RESUMO

Melanonychia striata is characterized by a tan, brown, or black longitudinal streak within the nail plate that runs from the proximal nail fold to the distal part of the nail plate. Melanonychia striata is due to increased activity of melanocytes or melanocytic hyperplasia in the nail matrix with subsequently increased melanin deposition in the nail plate. The most common cause of melanonychia striata associated with melanocytic activation is ethnic melanonychia which occurs in dark-skinned individuals. Other causes of melanonychia striata related to melanocytic activation include pregnancy, chronic local trauma, infections, medications, dermatological disorders, endocrine disorders, alkaptonuria, hemochromatosis, porphyria, graft-vs-host disease, Peutz-Jeghers syndrome, and Laugier-Hunziker syndrome. Causes of melanonychia striata associated with melanocytic hyperplasia include nail matrix melanocytic nevus, nail lentigo, and nail apparatus/subungual in situ and invasive melanoma. In most cases, melanonychia striata is a benign condition, especially in children. Consequently, most investigators advocate a wait-and-see approach. Nail apparatus/subungual melanoma should be suspected if there is an abrupt onset after middle age, personal or family history of melanoma, rapid growth, darkening of a melanonychia band, pigment variegation, blurry lateral borders, irregular elevation of the surface, a bandwidth >3 mm, proximal widening, associated nail plate dystrophy, single rather than multiple digit involvement, and periungual spread of pigmentation onto the adjacent cuticle and/or proximal and/or lateral nail folds (Hutchinson sign). Prolonged follow-up is mandatory for early detection of possible malignant changes.


Assuntos
Melaninas/metabolismo , Doenças da Unha/diagnóstico , Unhas/patologia , Transtornos da Pigmentação/diagnóstico , Amputação , Biópsia , Dermoscopia , Diagnóstico Diferencial , Hematoma/diagnóstico , Humanos , Cirurgia de Mohs , Doenças da Unha/patologia , Doenças da Unha/terapia , Unhas/diagnóstico por imagem , Unhas/cirurgia , Transtornos da Pigmentação/patologia , Transtornos da Pigmentação/terapia
14.
J Eur Acad Dermatol Venereol ; 33(9): 1800-1805, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30835872

RESUMO

BACKGROUND: Very few studies have been conducted to establish the nature and prevalence of nail disorders in children. OBJECTIVES: To determine the frequency of various nail conditions in the paediatric setting and to report their management and follow-up. METHODS: This was a retrospective study between 2007 and 2017 of children under 18. All the patients were evaluated in our paediatric nail clinic at the dermatology department of Queen Fabiola Children's University Hospital. The data were synthesized from information obtained through medical records as well as from photographs taken during consultation. Follow-up was completed by phone interview. RESULTS: Three hundred and one patients were included. The majority of nail abnormalities involved the toenails (57.6%). The most common clinical signs were, in descending order, Beau's lines, pachyonychia, subungual hyperkeratosis and onycholysis. The most frequent diagnoses were fever-related Beau's lines or onychomadesis (9.7%), trachyonychia (8.4%), longitudinal melanonychia (8.1%) and congenital malalignment of the great toenail (8.1%). The main diagnoses by age group were as follows: congenital hypertrophy of the lateral nail folds (21.4%) [0-2 years old]; fever-related Beau's lines or onychomadesis (21%) [2-6 years old]; trachyonychia (22%) [6-12 years old]; and juvenile ingrown nail (21.4%) [12-18 years old]. Management included clinical observation for 119 patients and specific advices for 108 patients. A treatment was prescribed for 134 patients, topical in 76.5% of cases. Follow-up demonstrated complete healing in 50.6% of patients and improvement in 19.7%. CONCLUSION: The most frequent nail disorders are benign, and their distribution varies with age. Management mainly involves conservative care, and the prognosis is favourable in the majority.


Assuntos
Doenças da Unha/diagnóstico , Adolescente , Bélgica/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Doenças da Unha/congênito , Doenças da Unha/epidemiologia , Doenças da Unha/terapia , Prevalência , Estudos Retrospectivos
15.
Dermatol Clin ; 37(2): 143-147, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30850036

RESUMO

Various advancements in the diagnosis and management of nail diseases have transpired in recent years. To provide the best care for patients with nail complaints, it is essential that physicians be updated on new diagnostic and treatment modalities. The purpose of this article is to discuss new and oncoming diagnostic and management options for nail disorders, including nail psoriasis, retronychia, brittle nails, onychotillomania, trauma, trachyonychia, and pyogenic granulomas.


Assuntos
Doenças da Unha/diagnóstico , Doenças da Unha/terapia , Dermatite Alérgica de Contato/diagnóstico , Dermatite Alérgica de Contato/terapia , Granuloma Piogênico/diagnóstico , Granuloma Piogênico/terapia , Humanos , Unhas/lesões , Psoríase/diagnóstico , Psoríase/terapia
17.
J Am Acad Dermatol ; 81(1): 228-240, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30731172

RESUMO

Nail involvement in psoriasis is common, and the severity of it does not always parallel the intensity of cutaneous disease. We created a consensus group, of which the aim was to provide practical recommendations for the treatment of nail psoriasis in patients without skin psoriasis or with mild skin lesions with no indication for a systemic treatment. This collaborative process was conducted by an international panel of dermatologists with special expertise in nail disorders, using formal consensus methods. During this process, the panel strived to establish an agreement regarding the definition of nail psoriasis, the severity of nail psoriasis, and treatment response. Treatment recommendations are provided regarding nail psoriasis severity and matrix or bed involvement. Few-nail disease was considered as nail psoriasis affecting ≤3 nails. In the case of matrix involvement only, intralesional steroid injections were considered the treatment of choice. Topical steroids alone or in combination with topical vitamin D analogues were suggested for nail psoriasis limited to the nail bed. For the systemic treatment of nail psoriasis acitretin, methotrexate, cyclosporine, small molecules, and biologics may be employed.


Assuntos
Fármacos Dermatológicos/administração & dosagem , Doenças da Unha/diagnóstico , Doenças da Unha/tratamento farmacológico , Guias de Prática Clínica como Assunto , Psoríase/tratamento farmacológico , Acitretina/administração & dosagem , Administração Oral , Administração Tópica , Adulto , Idoso , Produtos Biológicos/administração & dosagem , Consenso , Ciclosporina/administração & dosagem , Gerenciamento Clínico , Prova Pericial , Feminino , Humanos , Injeções Intralesionais , Masculino , Metotrexato/administração & dosagem , Pessoa de Meia-Idade , Psoríase/diagnóstico , Recidiva , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
18.
J Am Podiatr Med Assoc ; 109(2): 166-171, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30649902

RESUMO

Acral lentiginous melanoma (ALM) is a disease that is found on the palms, soles, and nail beds. Because these areas are not often examined during general medical examinations, the presence of ALM often goes unnoticed or the diagnosis is delayed. Research shows that the misdiagnosis of ALM is common, reported between 20% and 34%. We present three cases of ALM that were initially misdiagnosed and referred to the senior author (B.C.M.) in an effort to assess why misdiagnosis is common. The existing literature illuminates clinical pitfalls in diagnosing ALM. The differential diagnosis of many different podiatric skin and nail disorders should include ALM. Although making the correct diagnosis is essential, the prognosis is affected by the duration of the disease and level of invasiveness. Unfortunately, most of the reported misdiagnosed cases are of a later stage and worse prognosis. This review highlights that foot and ankle specialists should meet suspect lesions with a heightened index of suspicion and perform biopsy when acral nonhealing wounds and/or lesions are nonresponsive to treatment.


Assuntos
Erros de Diagnóstico , Melanoma/diagnóstico , Doenças da Unha/diagnóstico , Neoplasias Cutâneas/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade
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