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1.
BMC Infect Dis ; 19(1): 995, 2019 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-31771520

RESUMO

BACKGROUND: In 2017, an outbreak of onychomadesis occurred in kindergarten H, Hubei province, China. We investigated the field to learn about the magnitude and reason of the outbreak. METHODS: The case definition was that a child with onychomadesis or transverse ridging (Beau's line) in fingernails and toenails without previous traumatic or systemic disease in kindergarten H from Sep. 1st to Nov. 30th, 2017. A retrospective cohort study was carried out to analyze the epidemiological relationship between onychomadesis and the hand-foot-mouth disease (HFMD) in Primary Class #2, kindergarten H. We also performed a serological survey for neutralizing antibodies against coxsackie virus A6 (CVA6), coxsackie virus A10 (CVA10) among 15 cases and six healthy children in the kindergarten. Meanwhile, some children were carried out with routine blood, fungal microscopic and microelement tests. Indoor environment examinations had been done for all classes. RESULTS: A total of 20 cases were identified in Kindergarten H. Seventy-five percent (15/20) cases occurred in Primary Class #2. Fifty-five percent of the cases (11/20) had suffered from HFMD within two months. The median time between onychomadesis and HFMD was 45 days (ranging from 31 to 58 days). A retrospective cohort study in Primary Class #2 showed the attack rate was 90.0% among 10 children who suffered from HFMD in the past two months compared to 30.0% among 20 children who didn't (Rate Ratio [RR] =3.0, 95% Confidence Interval [CI] =1.5-6.0). The positive rates of neutralizing antibodies were 66.7% for CVA6 and 26.7% for CVA10 in tested cases. The result of routine blood, fungal microscopic, microelements tests were normal in cases. The indicators of environment were within the normal range. CONCLUSION: The results of this study suggested that the outbreak of onychomadesis in Hubei province was probably associated with HFMD epidemic within two months.


Assuntos
Doença de Mão, Pé e Boca/epidemiologia , Doenças da Unha/epidemiologia , Doenças da Unha/etiologia , Anticorpos Neutralizantes , Anticorpos Antivirais , Pré-Escolar , China/epidemiologia , Surtos de Doenças , Enterovirus Humano A/imunologia , Feminino , Doença de Mão, Pé e Boca/etiologia , Humanos , Incidência , Masculino , Estudos Retrospectivos , Instituições Acadêmicas
2.
BMC Cancer ; 19(1): 1002, 2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31653251

RESUMO

BACKGROUND: Amputation is the standard of care even for early-stage subungual melanomas (SUMs), known as nail apparatus melanoma, because the nail bed and nail matrix are close to the distal phalanx. However, a recent study demonstrated that not all patients with SUMs had histologic invasion of the underlying distal phalanx. As most SUMs occur in the thumb or big toe, amputation of either the thumb or big toe substantially interferes with activities of daily living, including poor cosmesis, loss of function, and phantom pain. Non-amputative digit preservation surgery can thus be applied in such cases without compromising patient prognosis. METHODS: We are conducting a multi-institutional single-arm trial to confirm the safety and efficacy of non-amputative digit preservation surgery. We will compare our results with those reported in the Japanese Melanoma Study, in which patients underwent amputation for SUMs as a traditional standard of care. Patients aged between 20 and 80 years with stage I, II, or III without evidence of tumor invasion to the underlying distal phalanx on preoperative radiograph are included in the study. The primary endpoint is major relapse-free survival (major RFS), which does not include local recurrence as an event; secondary endpoints include overall survival, digit-preservation survival, relapse-free survival, local relapse-free survival, partial relapse-free survival, and incidence of adverse events. A total of 85 patients from 21 Japanese institutions will be recruited within 5.5 years, and the follow-up period will last at least 5 years. The Japan Clinical Oncology Group Protocol Review Committee approved this study protocol in August 2017, and patient enrollment began in November 2017. Ethical approval was obtained from each institution's Institutional Review Board prior to patient enrollment. DISCUSSION: This is the first prospective trial to confirm the safety and efficacy of non-amputative digit preservation surgery for SUM without distant metastasis or bony invasion. The results of this trial could provide evidence to support this less-invasive surgery as a new standard of care to preserve adequately functioning digits. TRIAL REGISTRATION: Registry number: UMIN000029997 . Date of Registration: 16/Nov/2017. Date of First Participant Enrollment: 12/Dec/2017.


Assuntos
Melanoma/epidemiologia , Melanoma/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Doenças da Unha/epidemiologia , Doenças da Unha/cirurgia , Atividades Cotidianas , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação/efeitos adversos , Amputação/métodos , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Incidência , Japão/epidemiologia , Masculino , Oncologia/métodos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Prognóstico , Estudos Prospectivos , Polegar/patologia , Polegar/cirurgia , Dedos do Pé/patologia , Dedos do Pé/cirurgia , Adulto Jovem
3.
Cutis ; 103(4): E11-E16, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31116823

RESUMO

Sézary syndrome (SS) is the leukemic form of cutaneous T-cell lymphoma (CTCL) and can be associated with various nail irregularities, though they are infrequently reported. In this retrospective study, we reviewed medical records from a CTCL clinic database at the University of Texas MD Anderson Cancer Center (Houston, Texas) for reported nail abnormalities in patients with a diagnosis of SS. Findings for 2 select cases are described in more detail and are compared to prior case reports to establish a comprehensive list of nail irregularities that have been associated with SS.


Assuntos
Doenças da Unha/epidemiologia , Síndrome de Sézary , Neoplasias Cutâneas , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , , Humanos , Incidência , Masculino , Registros Médicos , Pessoa de Meia-Idade , Doenças da Unha/complicações , Estudos Retrospectivos , Texas/epidemiologia
4.
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
5.
Ann Dermatol Venereol ; 146(5): 354-362, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-30954294

RESUMO

BACKGROUND: Psoriasis affects 0.2-0.7 % of children and is associated with obesity. Published studies have been conducted in hospital settings (tertiary care). The PsoLib study evaluated childhood psoriasis in private practice (secondary care) in terms of epidemiology, clinical aspects and comorbidities. PATIENTS AND METHODS: This was a non-interventional, cross-sectional, multicenter study of children with psoriasis performed by 41 dermatologists working in private practice. The clinical and therapeutic aspects and comorbidities were systemically evaluated. We compared data to the χ-Psocar study performed in hospitals using the same methodology. RESULTS: In all, 207 children (girls: 60.4 %; mean age: 10.5±4.2 years) were included. Scalp psoriasis (40.6 %) was the most frequent clinical type, while plaque psoriasis represented 26 % of cases. Nail, tongue, and arthritic involvement were rare. Less than 1 % of children suffered from hypertension, diabetes or dyslipidemia, but 16.4 % were overweight and 7.0 % were obese. Severity (PG≥4 at peak) was associated with excess weight (P=0.01). CONCLUSION: Scalp psoriasis is the most frequent clinical type of psoriasis in childhood. Comorbidities and extracutaneous localization are rare. Even in private practice, the severity of the disease is associated with excess weight.


Assuntos
Psoríase/epidemiologia , Dermatoses do Couro Cabeludo/epidemiologia , Adolescente , Criança , Pré-Escolar , Comorbidade , Estudos Transversais , Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Feminino , França/epidemiologia , Humanos , Hipertensão/epidemiologia , Lactente , Masculino , Doenças da Unha/epidemiologia , Sobrepeso , Obesidade Pediátrica/epidemiologia , Prática Privada/estatística & dados numéricos
6.
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
7.
Niger J Clin Pract ; 22(2): 245-250, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30729950

RESUMO

Background: Cutaneous changes commonly occur in chronic kidney disease (CKD), however, there is limited information on its effect on quality of life of these patients. This study determined the prevalence and pattern of skin changes in CKD patients and their effects on the dermatology life quality index (DLQI) of the patients. Materials and Methods: This was a descriptive cross-sectional study that involved stages 3-5 CKD patients who were examined for skin changes. The effects of the observed skin changes on DLQI were assessed using the standardized DLQI questionnaire. Results: One hundred and five CKD patients participated in the study consisting of 56 males and 49 females with a mean age of 51.93 ± 15.23 years. The prevalence of cutaneous changes was 94.3%. Common skin manifestations were pallor 99 (94.3%), hyperpigmentation 58 (55.2%), fluffy hair 55 (52.4%), Lindsay nails 48 (45.7%), and pruritus 44 (41.9%). The effect of dermatoses on DLQI was mild in 34 (32.4%), moderate in 13 (12.4%), and severe in 4 (3.8%).There was no significant association between dermatoses and CKD stage. There was significant positive correlation between DLQI scores and number of skin dermatoses (r = 0.522, P = <0.001), duration on maintenance hemodialysis (r = 322, P = 0.017). There was significant negative correlation between DQOL scores and packed cell volume (r = -0.232, P = 0.022). On multiple regression analysis, number of dermatoses was the only significant predictor of DLQI (P = <0.001). Conclusion: Skin changes occur commonly in CKD patients and significantly affected their DLQI. This study highlights the significant burden that skin changes add to CKD.


Assuntos
Qualidade de Vida , Diálise Renal , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/terapia , Dermatopatias/etiologia , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Doenças da Unha/epidemiologia , Doenças da Unha/etiologia , Nigéria/epidemiologia , Prevalência , Prurido/epidemiologia , Prurido/etiologia , Diálise Renal/efeitos adversos , Insuficiência Renal Crônica/psicologia , Dermatopatias/epidemiologia , Dermatopatias/psicologia , Inquéritos e Questionários , Centros de Atenção Terciária
8.
Int J Dermatol ; 58(7): 811-815, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30677128

RESUMO

BACKGROUND: Alopecia areata (AA) is an autoimmune condition that usually presents as patchy, nonscarring hair loss. Autoimmune disorders and atopy are reported as comorbid conditions. We aimed to investigate the demographics, clinical characteristics, and associations of AA in Tunisian patients. METHODS: Demographic data, pattern of alopecia, age of onset, and associations were evaluated in 204 patients from January 2012 to June 2016. RESULTS: Two hundred and four cases of AA were seen. The male to female ratio was 0.68. The mean age at presentation was 23 years old. Positive family history was noticed in 22.1% of patients. Personal history of atopy was associated with AA in 18.1%. Associated autoimmune diseases were thyroid disorders (12.7%), vitiligo (1.5%), psoriasis (three cases), type 1 diabetes (two cases), autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) syndrome (two cases), lichen sclerosus atrophicus (one case), and pemphigus vulgaris (one case). Patchy AA was the most common manifestation (49.5%) followed by alopecia universalis (27.5%), alopecia ophiasis (12.7%), and alopecia totalis (10.3%). Nail changes consisting of pitting, trachyonychia, and longitudinal ridging were reported in 24.8%. AA patterns were more severe in females (P = 0.049). Severe forms showed more persistent disease duration (P = 0.005), earlier onset (P = 0.001), and more recurring episodes (P = 0.002) and were significantly associated with nail involvement (P < 0.001). CONCLUSIONS: Our study aimed to review epidemio-clinical characteristics and comorbid conditions of AA in Tunisian patients. More severe cases with a pejorative value of early-onset AA, long disease duration, and nail involvement were seen in our study.


Assuntos
Alopecia em Áreas/epidemiologia , Doenças Autoimunes/epidemiologia , Doenças da Unha/epidemiologia , Adulto , Idade de Início , Alopecia em Áreas/diagnóstico , Alopecia em Áreas/imunologia , Doenças Autoimunes/imunologia , Comorbidade , Feminino , Humanos , Masculino , Doenças da Unha/imunologia , Prevalência , Estudos Prospectivos , Recidiva , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Fatores de Tempo , Tunísia/epidemiologia , Adulto Jovem
9.
J Cosmet Dermatol ; 18(1): 204-211, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29577562

RESUMO

BACKGROUND: Dermatologic complications are common in patients with end-stage renal disease and also have a high diversity. OBJECTIVES: This meta-analysis reviews prevalence of dermatological manifestations among hemodialysis patients in Iran. MATERIALS AND METHODS: Using PubMed and NLM Gateway (for MEDLINE), Institute of Scientific Information (ISI), and SCOPUS as the main international electronic data sources, and Iran-Medex, Irandoc, and Scientific Information Database, as the main domestic databases with systematic search capability, we systematically searched surveys, papers, and reports on the prevalence of dermatological manifestations (until February 2016). Heterogeneity of reported prevalence's between studies was assessed using the Q test; overall prevalence of dermatological manifestations was estimated using random-effect meta-analysis model. RESULTS: We found 1229 records; from them, a total of eight studies comprising 917 hemodialysis patients were included. In all of studies, skin discoloration, pruritus and xerosis have the highest prevalence. According to random-effect meta-analysis model, the pooled prevalence of skin discoloration, pruritus, ecchymosis, xerosis, and half-and-half nail in hemodialysis patients were 48.03% (95% CI: 45.09-51.01), 52.85% (95%CI: 49.23-56.47), 19.88 (95% CI: 17.57-22.19), 51.14% (95% CI: 48.25-54.02), and 18.50% (95% CI: 16.0-21.0), respectively. CONCLUSIONS: his study shows that the prevalence of dermatological manifestations seems high among the hemodialysis patients in Iran, and skin discoloration, pruritus, and xerosis are more common.


Assuntos
Falência Renal Crônica/terapia , Diálise Renal , Dermatopatias/epidemiologia , Equimose/epidemiologia , Humanos , Irã (Geográfico)/epidemiologia , Doenças da Unha/epidemiologia , Transtornos da Pigmentação/epidemiologia , Prevalência , Prurido/epidemiologia
11.
BMC Pediatr ; 18(1): 277, 2018 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-30131060

RESUMO

BACKGROUND: Coxsackievirus A6 (CVA6) is one of the major agents to cause hand, foot and mouth disease (HFMD) outbreaks globally. The objective of this study is to investigate the epidemiologic and clinical manifestations of CVA6 outbreak, and thus guide the diagnosis and treatment of the disease, as well as disease prevention. METHODS: An HFMD outbreak in a kindergarten was reported to Shijingshan District Center for Disease Control and Prevention (SCDC) on November 2, 2015 in Beijing, China. Epidemiological investigation was conducted. We performed a nine-week follow-up study to collect and analyze the clinical manifestations of HFMD cases. RESULTS: The outbreak yield 56 (15.7%) clinical diagnosed HFMD cases out of 357 registered children in the kindergarten with the mean age of 3.5 years old. This outbreak lasted for three days and ceased after initiating infectious disease controlling procedures, including periodical suspension of the kindergarten activities, environmental disinfection, and family health education. Fifty-one cases were followed for nine weeks. The positive rate of clinical manifestations of rash, fever, desquamation, pigmentation and onychomadesis were 100.0%, 84.3%, 68.6%, 17.6% and 43.1%, respectively. Children developed desquamation within the first 4 weeks after disease onset and developed onychomadesis between the 3th and 8th week after disease onset. Children with desquamation had 9.3 (95%CI: 1.836-47.437) times higher odds of developing onychomadesis compared to those without this manifestation. Ten out of 14 collected samples were CVA6 positive, and five positive samples shared a high degree of similarity in the VP1 nucleotide and amino acid sequences (99.9-100.0% and 100%). CONCLUSION: This HFMD outbreak was caused by CVA6, featured with delayed symptoms. Emerging CVA6-associated HFMD and its delayed symptoms should be paid more attention to reduce outbreaks and provide more information to doctors and parents.


Assuntos
Surtos de Doenças , Enterovirus/isolamento & purificação , Doença de Mão, Pé e Boca/epidemiologia , Pequim/epidemiologia , Criança , Pré-Escolar , Transmissão de Doença Infecciosa/prevenção & controle , Enterovirus/genética , Feminino , Doença de Mão, Pé e Boca/complicações , Doença de Mão, Pé e Boca/transmissão , Doença de Mão, Pé e Boca/virologia , Humanos , Controle de Infecções/métodos , Masculino , Doenças da Unha/epidemiologia , Doenças da Unha/etiologia , Filogenia
13.
J Eur Acad Dermatol Venereol ; 32(12): 2300-2306, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29894582

RESUMO

BACKGROUND: Nail unit melanoma (NUM) is a rare melanoma variant, usually associated with a poor prognosis because of a delayed diagnosis. Few data are available concerning the management and long-term outcome of in situ NUM. OBJECTIVE: To use a large cohort to provide comprehensive patient data and long-term follow-up information. This will serve to investigate distinctive epidemiological, clinical and histological features of in situ NUM. To report treatment modalities, assess conservative surgery and evaluate its long-term safety. METHODS: Patients with confirmed diagnosis of in situ NUM were retrospectively reviewed. Demographics, clinical presentation, therapeutic data and follow-up were analysed. RESULTS: Sixty-three cases of in situ NUM were identified as follows: 44 were women (70%), with a mean age of 51 years. The mean duration of symptoms prior to consultation was 4.3 years [range 3 months-28 years]. Clinically, with 58 cases, i.e. (92%) longitudinal melanonychia was the most common clinical presentation. The thumb was the most affected digit, being afflicted in 28 cases: 44%. Medical history found a widening and/or recent darkening of the melanonychia in 46 cases (82%). The treatment consisted of, respectively, 56 En bloc excisions of the nail apparatus 89% of the patients we studied, and seven amputations of the distal phalanx. During the follow-up period (mean: 10 years), two patients presented in situ recurrences. CONCLUSION: The recognition of a NUM at an in situ stage allows early treatment and curing of this tumour. At this early stage, a 'functional surgery' is a rational approach with an excellent oncologic safety.


Assuntos
Melanoma/patologia , Melanoma/cirurgia , Doenças da Unha/patologia , Doenças da Unha/cirurgia , Recidiva Local de Neoplasia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Melanoma/epidemiologia , Pessoa de Meia-Idade , Doenças da Unha/epidemiologia , Recidiva Local de Neoplasia/patologia , Estudos Retrospectivos , Neoplasias Cutâneas/epidemiologia , Polegar , Dedos do Pé , Adulto Jovem
16.
J Am Acad Dermatol ; 79(4): 702-705, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29660424

RESUMO

BACKGROUND: Onychotillomania is a nail-picking disorder characterized by nail dystrophy and abnormal morphology of the nail plate, nail bed, and periungual skin. OBJECTIVE: The purpose of this study was to describe the dermoscopic features of onychotillomania. METHODS: A retrospective study of the dermoscopy images of 36 patients affected by onychotillomania. The images were reviewed independently by both authors and a list of dermatoscopic findings was established. RESULTS: Scales were observed in 34 cases (94.4%). Absence of the nail plate was seen in 30 cases (83.3%). Wavy lines were observed in 25 cases (69.4%). Hemorrhages were observed in 23 cases (63.9%). Crusts were seen in 22 cases (61.1%). Nail bed pigmentation was observed in 17 cases (47.2%). Speckled dots were observed in 14 cases (38.9%). Nail plate melanonychia was observed in 4 cases (11.1%). LIMITATIONS: Limitations included small sample size and retrospective study. CONCLUSION: Absence of the nail plate with multiple obliquely oriented nail bed hemorrhages, nail bed gray pigmentation, and presence of wavy lines are characteristic findings of onychotillomania and not seen in other nail diseases.


Assuntos
Dermoscopia/métodos , Doenças da Unha/diagnóstico , Doenças da Unha/terapia , Comportamento Autodestrutivo/diagnóstico , Adulto , Fatores Etários , Terapia Cognitivo-Comportamental/métodos , Estudos de Coortes , Terapia Combinada , Fármacos Dermatológicos/uso terapêutico , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Doenças da Unha/epidemiologia , Doenças da Unha/psicologia , Prognóstico , Estudos Retrospectivos , Medição de Risco , Comportamento Autodestrutivo/epidemiologia , Comportamento Autodestrutivo/terapia , Fatores Sexuais , Estados Unidos , Adulto Jovem
17.
Indian J Dermatol Venereol Leprol ; 84(4): 419-423, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29536977

RESUMO

Background: One of the most effective options available for treating psoriatic fingernails is intramatricial injection of triamcinolone acetonide. Efficacies of intramatricial methotrexate and cyclosporine have not been comparatively evaluated to date. Methods: Ninety fingernails in 17 patients were assigned to three groups of thirty nails each, and treated with intramatricial injections of triamcinolone acetonide (10 mg/ml), methotrexate (25 mg/ml) and cyclosporine (50 mg/ml) respectively. Each nail was given two injections with a 6-week interval, and graded at 24 weeks using the Nail Psoriasis Severity Index. Results: In both triamcinolone acetonide and methotrexate groups, 15 (50%) nails out of 30 showed >75% improvement. In the cyclosporine group, only ten (33%) nails showed >75% improvement. Side effects were most in the nails treated with cyclosporine. Limitations: The limited follow-up period of 24 weeks may have been insufficient for detecting delayed remissions. The number of patients was small and there was no randomization or blinding. The lack of a placebo/ no- treatment arm can be considered a limitation. Conclusions: Amongst the three drugs studied, intramatricial methotrexate injection yielded the most improvement with minimum side effects, results being comparable to intramatricial triamcinolone acetonide injection. Cyclosporine was the least effective drug, with the most side effects. Intramatricial injection therapy is a safe, economical, simple and effective therapeutic modality in the management of nail psoriasis.


Assuntos
Ciclosporina/administração & dosagem , Fármacos Dermatológicos/administração & dosagem , Metotrexato/administração & dosagem , Doenças da Unha/tratamento farmacológico , Psoríase/tratamento farmacológico , Triancinolona Acetonida/administração & dosagem , Adulto , Feminino , Seguimentos , Humanos , Injeções Intralesionais , Masculino , Pessoa de Meia-Idade , Doenças da Unha/diagnóstico , Doenças da Unha/epidemiologia , Psoríase/diagnóstico , Psoríase/epidemiologia
18.
J Pediatr ; 197: 154-157, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29576324

RESUMO

INTRODUCTION: To assess the prevalence of nail involvement in children <16 years old with a confirmed diagnosis of scabies. STUDY DESIGN: Observational, prospective study in 7 French dermatology departments between June 2015 and January 2017. Children were included if they had scabies confirmed by dermoscopy and/or microscopy and if nails could be sampled. The first toenails and thumbnails as well as clinically affected nails were systematically sampled for microscopic examination. Individual data were recorded via a standardized questionnaire. RESULTS: A total of 47 children with scabies were included (26 females [55.3%], mean age 3.6 ± 4.0 years). Pruritus was present in 42 children (89.3%); the relapse rate was 38.3% (n = 18). In 3 infants (6.4%), Sarcoptes mites were revealed by dermoscopy or microscopy of the first toenails (2 cases) and a thumbnail (1 case), but nails were normal in 2 children. Two of the 3 infants had already received treatment for scabies in the previous weeks. CONCLUSION: Prevalence of nail involvement in children with confirmed scabies was 6.4%. Nails should not be overlooked during scabies treatment.


Assuntos
Doenças da Unha/epidemiologia , Unhas/parasitologia , Escabiose/epidemiologia , Adolescente , Animais , Antiparasitários/uso terapêutico , Criança , Pré-Escolar , Dermoscopia , Feminino , França/epidemiologia , Humanos , Lactente , Masculino , Doenças da Unha/tratamento farmacológico , Doenças da Unha/parasitologia , Prevalência , Estudos Prospectivos , Sarcoptes scabiei , Escabiose/tratamento farmacológico
19.
J Coll Physicians Surg Pak ; 28(2): 98-102, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29394966

RESUMO

OBJECTIVE: To determine skin changes in patients of End Stage Renal Disease (ESRD) on maintenance hemodialysis (MHD) and factors affecting these changes. STUDY DESIGN: Cross-sectional observational study. PLACE AND DURATION OF STUDY: Nephrology Department, Mayo Hospital, Lahore in collaboration with Dermatology Department, King Edward Medical University, Lahore, from October 2015 to January 2016. METHODOLOGY: Two hundred patients who were undergoing MHD for more than three months were included in the study. Patients' demographic data, laboratory reports and dialysis records were noted in a predesigned questionnaire. Skin examination was carried out by consultant dermatologist after patient's permission. RESULTS: Among 200 patients included in study, 105 were malesand rest of them were females. Major causes of ESRD were Diabetes Mellitus (n=83, 41.5%, followed by Hypertension (n=80, 40%), Nephrolithiasis (n=15, 7.5%) and Chronic glomerulonephritis (n=5, 2.5%). At least one cutaneous finding was present in every patient. Common skin findings observed were pigmentation (86%), xerosis (83%), pallor (79%), pruritus (69%), acquired ichthyosis (50.5%), and bacterial skin infections (18.5%). Among them, nail manifestations were half-and-half nails (52%), onychomycosis (30.5%), onycholysis (20.5%), subungual hyperkeratosis (23.5%), and Mee's lines (7.5). Among hair changes were sparse scalp hair (38.5%), brittle and lustreless hair (28%). The factors contributing to skin changes were patient's age, cause of ESRD, anti HCV positivity, high urea and creatinine levels, duration and frequency of hemodialysis, hemoglobin levels, calcium phosphate product and socioeconomic status. Some skin manifestations were interrelated with each other like xerosis with pruritus (p<0.001), pruritus with bacterial infection (p<0.022), acquired Ichthyosis (p=0.008) and hair changes (p=0.035). CONCLUSION: ESRD patients on hemodialysis develop various skin changes during the course of disease process, which contribute to increased morbidity. Different factors affecting skin changes were the cause of ESRD, adequacy and duration of dialysis, employment, financial status, anti HCV positivity, and metabolic factors.


Assuntos
Falência Renal Crônica/complicações , Doenças da Unha/epidemiologia , Dermatopatias/epidemiologia , Pele/patologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Doenças da Unha/etiologia , Unhas/patologia , Paquistão/epidemiologia , Transtornos da Pigmentação/etiologia , Prevalência , Prurido/epidemiologia , Prurido/etiologia , Diálise Renal/efeitos adversos , Dermatopatias/etiologia , Dermatopatias Infecciosas/epidemiologia , Adulto Jovem
20.
Acta Derm Venereol ; 98(2): 212-217, 2018 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-28967977

RESUMO

Alopecia areata (AA) is an immune-mediated disease causing temporary or permanent hair loss. Up to 46% of patients with AA also have nail involvement. The aim of this study was to determine the presence, types, and clinical implications of nail changes in patients with AA. This questionnaire-based survey evaluated 256 patients with AA. General demographic variables, specific nail changes, nail-related quality of life (QoL), and treatment history and need were evaluated. Prevalence of nail involvement in AA was 64.1%. The specific nail signs reported most frequently were pitting (29.7%, p = 0.008) and trachyonychia (18.0%). Red spots on the lunula were less frequent (5.1%), but very specific for severe AA. Nail-related QoL was only minimally affected by nail changes. In conclusion, nail involvement is common in patients with AA and presents mostly with pitting and trachyonychia. The presence of these nail changes reflects the severity of the disease, with red spots on the lunula as a predictor for severe alopecia.


Assuntos
Alopecia em Áreas/epidemiologia , Doenças da Unha/epidemiologia , Unhas Malformadas , Unhas/patologia , Qualidade de Vida , Adulto , Idoso , Alopecia em Áreas/patologia , Alopecia em Áreas/psicologia , Alopecia em Áreas/terapia , Estudos de Casos e Controles , Efeitos Psicossociais da Doença , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças da Unha/patologia , Doenças da Unha/psicologia , Doenças da Unha/terapia , Países Baixos/epidemiologia , Prevalência , Prognóstico
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