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3.
An Bras Dermatol ; 94(3): 344-347, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31365667

RESUMO

BACKGROUND: Of all nail disorders seen in dermatology offices, half of them are due to onychomycosis. The main differential diagnosis is nail psoriasis. The objective of this study was to compare the microscopic findings, other than the presence of fungi, in the clipping of onychomycosis versus normal nails and nail psoriasis. METHODS: Cross-sectional study of onychomycosis cases, analyzed by clipping and compared with data on normal nails and those with nail psoriasis. RESULTS: Sixty-two onychomycosis samples were compared with 30 normal nails and 50 nails with psoriasis. In onychomycosis, measurement of subungual region, serous lakes, neutrophils and number of layers of parakeratosis are more intense than in psoriasis. Onychocariosis is less common in psoriasis, while bacteria are more frequent. The nail transition zone is more commonly blurred and irregular in onychomycosis. CONCLUSION: Clipping helps in the differential diagnosis of onychomycosis and nail psoriasis and may be useful even when fungi are not found.


Assuntos
Doenças da Unha/patologia , Unhas/patologia , Onicomicose/patologia , Estudos Transversais , Diagnóstico Diferencial , Humanos , Doenças da Unha/microbiologia , Unhas/microbiologia , Neutrófilos , Onicomicose/microbiologia , Paraceratose , Psoríase/microbiologia , Psoríase/patologia
4.
Dermatol Online J ; 25(7)2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31450272

RESUMO

Onychomycosis is a prevalent disease of the nail. Traditional methods for diagnosis include direct microscopy with potassium hydroxide (KOH microscopy) and fungal culture. Other techniques using histochemical staining have higher sensitivity, but cannot identify genus or species of the infecting agent. PCR assays are sensitive, specific, and capable of genus and species level identification. We describe a real-time PCR assay for 15 different fungi that are associated with onychomycosis. Of 425 clinical samples suspected of onychomycosis analyzed by fungal culture and PCR, 219 samples were positive for both (52% agreement). Of the 206 discordant samples, 95% were resolved in favor of PCR by DNA sequencing. On a larger data set of 2,452 samples, positivity rates for histopathology, PCR, and culture were 85%, 73%, and 54% respectively. Further, 48% of PCR positive and 51% of histopathology positive samples were negative by culture. PCR outperformed culture compared to histopathology for sensitivity (80% versus 49%), specificity (92% versus 79%), positive predictive value (94% versus 77%), and negative predictive value (76% versus 52%). These results indicate the culture method lacks the sensitivity to be a reliable assay for onychomycosis, that PCR and histopathology are highly concordant, and that PCR provides the highest degree of diagnostic accuracy available.


Assuntos
DNA Fúngico/análise , Unhas/microbiologia , Unhas/patologia , Onicomicose/diagnóstico , Técnicas de Cultura , Humanos , Onicomicose/microbiologia , Onicomicose/patologia , Reação em Cadeia da Polimerase em Tempo Real , Sensibilidade e Especificidade , Análise de Sequência de DNA , Coloração e Rotulagem
6.
Cutis ; 103(6): 340-342, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31348447

RESUMO

A 53-year-old woman presented with an asymptomatic nodule on the distal subungual right fifth fingernail that had slowly enlarged over the last year. An excisional biopsy showed an acanthotic epidermis surmounted by hyperkeratotic scale as well as a fibrotic dermis with collagen bundles assuming a vertical orientation to the long axis of the epidermis, characteristic of an acquired digital fibrokeratoma (ADF). There was no sign of recurrence 4 months following excision. There are no known associations or risk factors for development of ADF, though prior trauma might play a role. This case describes the clinical and histopathological features of ADF and the differential diagnosis and treatment options. It is important to consider ADF when examining subungual nodules, and to be able to identify and differentiate between other benign and malignant nail tumors.


Assuntos
Ceratose/diagnóstico , Unhas/patologia , Dermatopatias/diagnóstico , Biópsia , Diagnóstico Diferencial , Feminino , Dedos , Humanos , Ceratose/patologia , Pessoa de Meia-Idade , Dermatopatias/patologia
8.
Lasers Med Sci ; 34(8): 1513-1525, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31254131

RESUMO

Laser therapy for onychomycosis is emerging but its efficacy remains unestablished. To examine current evidence on efficacy of laser treatment of onychomycosis. A systematic review and one-arm meta-analysis, including all prospective clinical trials, identified on PubMed, Cochrane Library, and EMBASE databases. Trials with participants as unit of analysis (UOA), n = 13, were analyzed separately from trials with nails as UOA, n = 7. Summary proportions and 95% confidence intervals (95% CI) were calculated. Outcomes were mycological cure, clinical improvement, or complete cure. Twenty-two prospective trials (four randomized controlled trials and 18 uncontrolled trials) with a total of 755 participants were analyzed. Summary proportions with 95% CI for participants as UOA were mycological cure 70.4%, 95% CI 52.2-83.8%; clinical improvement 67.2%, 95% CI 43.2-84.7%; and complete cure 7.2%, 95% CI 1.9-23.5%. High statistical heterogeneity was detected (mycological cure I2 = 88%, P < 0.01; clinical improvement I2 = 69%, P < 0.01; complete cure I2 = 60%, P = 0.11). The current level of evidence is limited and with high heterogeneity, making it difficult to assess the true efficacy of laser treatment for onychomycosis. Larger randomized controlled trials with well-defined methodology are warranted.


Assuntos
Terapia a Laser , Unhas/patologia , Onicomicose/cirurgia , Humanos , Estudos Prospectivos , Resultado do Tratamento
9.
Rev Iberoam Micol ; 36(2): 72-78, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31153723

RESUMO

BACKGROUND: Onychomycosis affects between 2% to 30% of the world population. Nail biopsy may help in making a diagnosis and can distinguish between invasion and colonisation. AIMS: To evaluate the diagnostic usefulness of nail biopsy with Periodic acid-Schiff (PAS) staining for onychomycosis, compared to direct KOH examination, culture and its combination in a reference laboratory in Colombia. METHODS: The study included 66 patients in whom a blind and independent reading of the three tests was performed. The usefulness was defined based on the validity (sensitivity, specificity, Youden's index, likelihood ratios), performance (predictive values) efficiency (proportion of correctly diagnosed patients), and reproducibility (kappa coefficient). RESULTS: The mean age of the patients was 55±16 years, and included 76% women. The direct tests with KOH were positive in 66.7% (n=44), 62.1% (n=41) were positive with culture, and 56.1% (n=37) with the biopsy. The main causal agents were non-dermatophytes moulds in 36.4% (n=24). The most frequent species were Neoscytalidium dimidiatum (n=11), Trichophyton rubrum (n=11), and Candida parapsilosis (n=13). The sensitivity of nail biopsy, when compared to the standard (KOH and/or culture), was 71%, specificity 83%, Youden's index 0.54, positive likelihood ratio 4.25, negative likelihood ratio 0.35, positive predictive value 92%, negative predictive value 52%, efficiency 74% and kappa coefficient 0.45. When biopsy was evaluated only in patients with onycholysis of the nail plate greater than 50%, all the parameters of diagnostic usefulness increased. CONCLUSIONS: The overall usefulness of the biopsy was moderate for patients with more severe symptomatology, which makes its use advisable in cases of extensive onycholysis, and when discriminating colonisation from invasion is required.


Assuntos
Unhas/patologia , Onicomicose/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia/métodos , Colômbia , Feminino , Humanos , Hidróxidos , Indicadores e Reagentes , Masculino , Pessoa de Meia-Idade , Unhas/microbiologia , Onicomicose/diagnóstico , Onicomicose/microbiologia , Compostos de Potássio , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Coloração e Rotulagem , Adulto Jovem
10.
J Am Acad Dermatol ; 81(4): 917-922, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31202868

RESUMO

BACKGROUND: Evidence on whether functional surgery is not inferior to amputation for the treatment of in situ or minimally invasive (Breslow thickness ≤0.5 mm) nail melanoma is limited. OBJECTIVE: To investigate the difference in local recurrence between the 2 interventions for in situ or minimally invasive nail melanoma using available published studies. METHODS: We performed systematic search on PubMed, Embase, Cochrane Library, trial registers, and grey literature databases from inception to June 28, 2018. We included observational studies with at least 5 patients with in situ or minimally invasive nail melanoma. Main outcome was local recurrence. RESULTS: The odds ratio synthesized from 5 studies including 109 patients (88 functional operations and 21 amputations) was 1.57 (95% confidence interval, 0.31-8.00). LIMITATIONS: Small sample size and possible interstudy heterogeneity. CONCLUSIONS: Our meta-analysis revealed no difference in local recurrence between the 2 interventions. Considering the functional deficit after amputation, conservative surgery should be the treatment of choice for in situ or minimally invasive nail melanoma.


Assuntos
Amputação , Tratamento Conservador/métodos , Melanoma/cirurgia , Doenças da Unha/cirurgia , Neoplasias Cutâneas/cirurgia , Tomada de Decisão Clínica , Humanos , Melanoma/patologia , Doenças da Unha/patologia , Unhas/patologia , Unhas/cirurgia , Invasividade Neoplásica , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/prevenção & controle , Estudos Observacionais como Assunto , Seleção de Pacientes , Neoplasias Cutâneas/patologia , Resultado do Tratamento
11.
Rev. iberoam. micol ; 36(2): 72-783, abr.-jun. 2019. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-185479

RESUMO

Antecedentes: La onicomicosis afecta a entre el 2 y el 30% de la población mundial; la biopsia ungueal facilita el diagnóstico y diferencia invasión de colonización. Objetivos: Evaluar la utilidad diagnóstica de la biopsia ungueal con coloración de PAS en las onicomicosis frente al examen directo con KOH, el cultivo y su combinación en un laboratorio de referencia de Colombia. Métodos: Se incluyó a 66 pacientes, a quienes se les realizó lectura ciega e independiente de las tres pruebas; la utilidad se definió a partir de los resultados de validez (sensibilidad, especificidad, índice de Youden, cocientes de probabilidad), desempeño (valores predictores), eficiencia (proporción de pacientes correctamente diagnosticados) y reproducibilidad (índice kappa). Resultados: La edad media de los pacientes fue 55 ± 16 años, el 76% fueron mujeres y el 66,7% (n = 44) de los exámenes directos con KOH resultaron positivos; para el cultivo, el 62,1% (n = 41) de las muestras fueron positivas y con la biopsia lo fueron el 56,1% (n = 37). Los principales agentes causales fueron mohos no dermatofitos en un 36,4% (n = 24) y las especies con la mayor frecuencia fueron Neoscytalidium dimidiatum (n = 11), Trichophyton rubrum (n = 11) y Candida parapsilosis (n = 13). La sensibilidad de la biopsia ungueal frente al KOH o el cultivo fue del 71%, la especificidad del 83%, el índice de Youden 0,54, el cociente de probabilidad positivo de 4,25, el cociente de probabilidad negativo de 0,35, el valor predictivo positivo el 92%, el valor predictivo negativo el 52%, la eficiencia el 74% y el coeficiente kappa 0,45. Al evaluar la biopsia solo en pacientes con onicólisis de la lámina ungueal superior al 50%, aumentaron todos los parámetros de utilidad diagnóstica. Conclusiones: La utilidad global de la biopsia fue moderada para pacientes con mayor sintomatología, por lo que se recomienda su uso en presencia de onicólisis extensa y en los casos en los que se requiera discriminar colonización de invasión


Background: Onychomycosis affects between 2% to 30% of the world population. Nail biopsy may help in making a diagnosis and can distinguish between invasion and colonisation. Aims: To evaluate the diagnostic usefulness of nail biopsy with Periodic acid-Schiff (PAS) staining for onychomycosis, compared to direct KOH examination, culture and its combination in a reference laboratory in Colombia. Methods: The study included 66 patients in whom a blind and independent reading of the three tests was performed. The usefulness was defined based on the validity (sensitivity, specificity, Youden's index, likelihood ratios), performance (predictive values) efficiency (proportion of correctly diagnosed patients), and reproducibility (kappa coefficient). Results: The mean age of the patients was 55 ± 16 years, and included 76% women. The direct tests with KOH were positive in 66.7% (n = 44), 62.1% (n = 41) were positive with culture, and 56.1% (n = 37) with the biopsy. The main causal agents were non-dermatophytes moulds in 36.4% (n = 24). The most frequent species were Neoscytalidium dimidiatum (n = 11), Trichophyton rubrum (n = 11), and Candida parapsilosis (n = 13). The sensitivity of nail biopsy, when compared to the standard (KOH and/or culture), was 71%, specificity 83%, Youden's index 0.54, positive likelihood ratio 4.25, negative likelihood ratio 0.35, positive predictive value 92%, negative predictive value 52%, efficiency 74% and kappa coefficient 0.45. When biopsy was evaluated only in patients with onycholysis of the nail plate greater than 50%, all the parameters of diagnostic usefulness increased. Conclusions: The overall usefulness of the biopsy was moderate for patients with more severe symptomatology, which makes its use advisable in cases of extensive onycholysis, and when discriminating colonisation from invasion is required


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Unhas/patologia , Onicomicose/patologia , Biópsia/métodos , Colômbia , Hidróxidos , Indicadores e Reagentes , Unhas/microbiologia , Onicomicose/diagnóstico , Onicomicose/microbiologia , Compostos de Potássio , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Coloração e Rotulagem
13.
Arch Dermatol Res ; 311(7): 505-512, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31076847

RESUMO

Retronychia is a condition, first described in 1999, characterized by the embedding of the proximal nail plate into the proximal nail fold and the stacking of a multiple generations of nail plates beneath the proximal nail fold. The disease affects frequently the toenails and is associated with stress-relevant situations including repetitive trauma, ischemic etiologies, postpartum, and compartment syndrome. Predisposing factors including static disorder of the feet may be underestimated. The paucity of data regarding the predisposing factors is because existing studies are limited to small case reports, case series, and retrospective studies. The diagnosis is clinical, which could be challenging because retronychia can easily mimic other nail disorders with chronic paronychia. Since the first description, significant advances have been made regarding diagnostic criteria including ultrasonography. We performed a systematic review of the literature on retronychia from inception to April 2018 with an emphasis on the pathogenesis and new diagnostic and management trends.


Assuntos
Unhas Encravadas/diagnóstico , Unhas/diagnóstico por imagem , Paroniquia/diagnóstico , Diagnóstico Diferencial , Humanos , Unhas/patologia , Unhas Encravadas/etiologia , Unhas Encravadas/terapia , Dedos do Pé , Ultrassonografia
14.
Mycoses ; 62(8): 659-664, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31062415

RESUMO

Because of their similar clinical presentation, discrimination between nail psoriasis and onychomycosis often is difficult. We aim to investigate the actual frequency of onychomycosis in psoriatic patients and to compare it between psoriatic and non-psoriatic patients. This retrospective study included a total of 9281 patients, referring to our Mycology Laboratory from September 2003 to May 2018. The patients are divided into two groups: PsoGroup (patients with psoriasis) and non-PsoGroup (non-psoriatic patient). Direct microscopic examination with 20% KOH and culture was carried out in both groups. In PsoGroup (711 patients, 59.50% female, 40.50% male, median age of 52.22 ± 15.01), the prevalence of onychomycosis was 49.08%. On the other hand, in non-PsoGroup (8570 patients (71.65% female, 28.35% male, median age of 48.51 ± 19.31 years), the prevalence of onychomycosis was 51.30%. There was no statistically significant difference between the prevalence of onychomycosis in PsoGroup 49.08% (349/711) compared to 51.30% (4397/8570) of non-PsoGroup (P = 0.2578). However, yeasts were significantly more prevalent in non-psoriatic than in psoriatic patients (P = 0.0144.). In our Mycological Laboratory, we observed a similar prevalence of onychomycosis in psoriatic patients and non-psoriatic patients. However, the spectrum of fungal species isolated was different from each other, with a higher prevalence of yeasts in non-PsoGroup that reflect a recent oriental trends.


Assuntos
Dermatoses da Mão/epidemiologia , Unhas/microbiologia , Onicomicose/diagnóstico , Onicomicose/epidemiologia , Psoríase/epidemiologia , Adulto , Idoso , Arthrodermataceae/isolamento & purificação , Aspergillus/isolamento & purificação , Candida/isolamento & purificação , Feminino , Dermatoses do Pé/diagnóstico , Dermatoses do Pé/epidemiologia , Dermatoses do Pé/microbiologia , Dermatoses da Mão/diagnóstico , Dermatoses da Mão/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Unhas/patologia , Onicomicose/microbiologia , Prevalência , Psoríase/microbiologia , Estudos Retrospectivos
15.
An. bras. dermatol ; 94(3): 344-347, May-June 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1011119

RESUMO

Abstract: Background: Of all nail disorders seen in dermatology offices, half of them are due to onychomycosis. The main differential diagnosis is nail psoriasis. The objective of this study was to compare the microscopic findings, other than the presence of fungi, in the clipping of onychomycosis versus normal nails and nail psoriasis. Methods: Cross-sectional study of onychomycosis cases, analyzed by clipping and compared with data on normal nails and those with nail psoriasis. Results: Sixty-two onychomycosis samples were compared with 30 normal nails and 50 nails with psoriasis. In onychomycosis, measurement of subungual region, serous lakes, neutrophils and number of layers of parakeratosis are more intense than in psoriasis. Onychocariosis is less common in psoriasis, while bacteria are more frequent. The nail transition zone is more commonly blurred and irregular in onychomycosis. Conclusion: Clipping helps in the differential diagnosis of onychomycosis and nail psoriasis and may be useful even when fungi are not found.


Assuntos
Humanos , Onicomicose/patologia , Doenças da Unha/patologia , Unhas/patologia , Paraceratose , Psoríase/microbiologia , Psoríase/patologia , Estudos Transversais , Onicomicose/microbiologia , Diagnóstico Diferencial , Doenças da Unha/microbiologia , Unhas/microbiologia , Neutrófilos
16.
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
17.
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
18.
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
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