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Summary: Background: Onychoscopy is a technique that uses a dermatoscope for the evaluation of specific features of different skin conditions that are not visible to the naked eye. There are few studies establishing parameters for the diagnosis of onychomycosis based on onychoscopy. Determining the sensitivity and specificity of a potentially new diagnostic test for onychomycosis requires an evaluation study of this new diagnostic test, as there are limited studies reporting onychoscopy results. Aim: To determine the sensitivity, specificity, positive predictive value and negative predictive value of onychoscopy findings in a Colombian population with onychomycosis. Methods: We assessed outpatients with a diagnosis of toenail onychomycosis confirmed by potassium hydroxide preparation or fungal culture. Onychoscopy was performed using a dermatoscope, and digital images collected using a smartphone. Results: The onychoscopy findings were: longitudinal striae, distal spiked pattern, distal irregular termination, linear edge and ruins aspect, while some patients were confirmed as having traumatic onycholysis. A statistically significant association was found between the clinical symptoms of onychomycosis and both the clinical feature of dyschromia and the onychoscopy feature of longitudinal striae. Conclusion: We suggest that this technique is an alternative method that should be used in patients with onychopathies because it has the potential to differentiate onychomycosis from traumatic onycholysis and another nail involvement. [ABSTRACT FROM AUTHOR]

Click here for the corresponding questions to this CME article. [ABSTRACT FROM AUTHOR]

Summary: The lunula is the white half‐moon‐shaped area located at the base of the fingernails and toenails, and is the only visible part of nail matrix. Red lunula can present as a complete form (the whole lunula is red), incomplete form (only the proximal lunula is red) or mottled form. Red lunula has been associated with a number of dermatological and systemic conditions. It is one of the less common manifestations of nail lichen planus (LP). However, the pathogenesis of the red lunula is not yet clear. We present a series of six patients with nail LP presenting with red lunula, and describe the findings of intraoperative onychoscopy and histopathology in an attempt to understand the pathogenesis underlying the condition. [ABSTRACT FROM AUTHOR]

This study was carried out to determine whether slow nail growth is a predisposing factor for onychomycosis or if onychomycosis results in slow nail growth. Forty-nine patients with unilateral onychomycosis of the great toenail were enrolled and classified in two groups according to the size of affected area, i.e. more than half or less than half of the toenail. The growth rates of affected and unaffected great toenails of all patients were measured. Before a normal appearance was reached, the growth rates of affected great toenails, when the affected area occupied more than half of total nail plate, was slower than that of the unaffected great toenails. After a normal appearance was achieved, there were no differences in growth rates between affected and unaffected great toenails. Therefore, this study of patients with unilateral toenail onychomycosis did not support the hypothesis that slow nail growth rate is a predisposing factor for onychomycosis. [ABSTRACT FROM AUTHOR]

Summary Patients with toenail onychomycosis remain a therapeutic challenge despite the introduction of new systemic therapies. Around 20% of patients remain uncured even with optimal oral therapy, but the reasons for treatment failure are unclear. Thus far there are no data to suggest that treatment failures can be identified on the basis of their presenting features or progress during treatment. In a series of patients, we have attempted to identify clinical parameters that determine the patient response to 12 weeks of oral terbinafine for confirmed dermatophyte onychomycosis. As part of a dose-defining randomized multicentre study, 35 patients were followed for 48 weeks. The unaffected nail length, growth rate, hyperkeratosis, onycholysis and presence of a dermatophytoma were assessed prospectively. To confirm our findings, at the end of the study period we analysed retrospectively photographs that had been taken regularly throughout the trial. The average degree of hyperkeratosis was less severe in the group achieving a disease-free nail, meaning clinical and mycological cure. For mycological cure alone, no predictive factors could be identified. [ABSTRACT FROM AUTHOR]

Nail growth was studied over 20 weeks in five healthy volunteers by indenting eight nails in each subject with a dental burr. The indentations were drilled in the middle part of the lunula with the proximal edge of the indentation 1 mm from the cuticle. Their volume was measured by filling them with an elastic two-component material immediately after indentation and 4, 8, 12, 16 and 20 weeks thereafter. Nail growth as reflected by the volume changes of the indentations could be followed of 8-12 weeks in the thumb, the middle finger and the second toe and for 20 weeks in the big toe. The most rapid outgrowth, 8-12 weeks, occurred in the second toe and middle finger. The decrease in the volume of the indentations by approximately 30-35%, as the travelled from the lunula towards the distal end of the nail plate, also reflects nail growth from the nail bed. This study has shown that indentation of the nails and the measurement of their volume changes provides a reliable and simple method for the study of nail growth. [ABSTRACT FROM AUTHOR]

Forty two patients with mycologically proven onychomycosis involving 48 nails were treated topically with a paste formulation of 1% bifonazole and 40% urea following one of two treatment regimens. The results using the most effective regiment (regimen 2), which involved daily application of the medication for 1 weeks, produced a mycological cure rate of 62.5% at 12 weeks, reduced to 46% at follow-up at 24 weeks. These results compare favorably with those obtain by long-term systemic treatment with griseofulvin. Such topical treatment ought to be considered as an alternative in onychomycosis especially that of the toenails. [ABSTRACT FROM AUTHOR]

Marked yellow discoloration of all the nails is the main symptom of the yellow nail syndrome, which is further characterized by chronic oedema, lymphatic abnormalities and chronic respiratory disease. The following case report shows that yellow nails may also occur in lichen planus. A 30-year-old male bookkeeper had noted a greyish yellow discoloration, thickening and reduced growth rate of his fingernails and toenails over a period of 2 years. Histology showed a normal proximal nail fold, matrix and corresponding nail plate.

Describes a nail dystrophy transmitted by an autosomal dominant gene of variable expression.Case reports for this condition, which wereculled from members of several generations of the same family; Discussion of these cases; Significance of these mutations.

Highlights notable research published in various dermatology-related journals. Clinicopathological features of metastasizing thin melanomas; Management of multiple atypical melanocytic naevi; Oral therapy for toenail onychomycosis; Clinical trial of Infliximab for the treatment of severe psoriasis; Role of the vascular system in the mediation of ultraviolet-induced skin damage.

We report a case of lichen planus affecting the toe nails without involvement of the skin or finger nails. To our knowledge this is the first time this has been reported. We also discuss the clinical features, histology and treatment of nail lichen planus. [ABSTRACT FROM AUTHOR]

Nail surfaces of toe-nail fragments were analysed by optical profilometry in patients treated with two different dosages of itraconazole: 200mg continuous dosing for 12 weeks, or a pulse-dose regimen of I week per month of 400mg itraconazoic daily for 3-4 months. The use of the latter regimen seemed clinically to increase nail growth, which was accompanied in several patients by the occurrence of nail surface irregularities. This aspect was studied by computerized optical profilometry. Nail beading was characterized by a higher number of peaks and a larger mean roughness value (Ra). Such findings are reminiscent of other nail alterations resulting from a faster matrix turnover. A substantially greater number of peaks and larger Ra were found in the patients receiving the pulse treatment than in those receiving the continuous-dose regimen. Pulse therapy with itraconazole therefore appears to modify the structure of the nail plate, probably as a result of, or in association with, an increased rate of growth. [ABSTRACT FROM AUTHOR]

Malalignment of the great toe-nails has been described for some time as occurring at birth, but there is still some dispute as to whether it is an inherited condition. We hope to provide some evidence that it may be inherited. [ABSTRACT FROM AUTHOR]

Recurrent primary lymphoedema associated with irregularities of the nail plate should suggest the Yellow Nail Syndrome (Samman & White, 1964). We report a case of sinusitis, bronchiectasis, transitory lymphoedema and nail changes in a female Nigerian patient. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 52-year-old woman with longstanding and asymptomatic pigmented streak of the right second toenail. She histologically assessed with a thickened, verrucous subungual mass and the nailbed was found to display basal hyperpigmentation including an elongation of the rete ridges. It also discusses the superficial acral fibromyxoma (SAF), a benign slowgrowing soft-tissue tumour which usually affects subungual and periungual regions of the toes and fingers.

The article presents a case study of a 74-year-old man manifesting yellowish discoloration of the nails on his feet and hands. It notes that patient has applied a galenic topical preparation to his fingernails containing ascorbic acid, fluprednidene, and miconazole nitrate. It infers that ascorbic acid was the causative factor of the discoloration. The article discusses the adverse effects of the usage of ascorbic acid as topical treatment, mentioning the condition yellow choromonychia.

The article presents a case study of a healthy 42-year-old man who was diagnosed with onychomycosis. It states that a linear longitudianal ridging with yellowish pigmentation was observed in the patient's right great toe nail despite of having good health and no medical history of trauma or nail abnormalities. Furthermore, the patient was diagnosed with onychomycosis due to Exophiala dermatidis based on morphological tests.

The article presents a case study of a 60-year-old man who suffered from plaque psoriasis. The fingernails and toenails of the patient had been affected and presented oil-drop discoloration, nail-bed hyperkeratosis, onycholysis, pitting, as well as paronychia. The patient had been treated with acitretin and showed improvement after two months.

The article presents a case study of a 16-year-old boy with aberrant nails on the second, third, and fourth fingers of both hand. After his physical examination, it found out that there is an excess tissue in the semi-nard keratinized structure in the area that separates the free nail plate and the groove. It notes that the semi-hard keratinized structure has produced a wide lesion attached to the distal and visceral nail plate.

A letter to the editor is presented regarding melanonychia caused by Stenotrophomonas maltophilia.

This article cites a study on a 39-year-old Afro-Caribbean woman with a 6-month history of a diffuse, dark brown discoloration over all her finger and toenails. The discoloration was asymptomatic and she reported no other cutaneous symptoms. She had no symptoms of postural hypertension and routine biochemistry was normal. Cyclophosphamide is a rare but well-described cause of nail pigmentation usually after a cumulative dose over 1.2 grams. The discoloration is first seen proximally on the nail, progresses distally and has been reported to grow out on discontinuation of cyclophosphamide.

We report a case of congenital onychodysplasia of the index fingers (Iso-Kikuchi syndrome) in a 2-year-old boy who had nail deformities on both index fingers and the left second toe. He had a micronychia of the left index fingernail, malalignment and abnormal lunula of the right index fingernail and micronychia and malalignment of the left second toenail. Congenital onychodysplasia of the index fingers (COlF) is a rare condition characterized by various forms of nail dysplasia commonly involving the index fingers, but not infrequently also the neighbouring fingers such as the middle fingers and thumbs.[sup1,2] The five criteria characterizing COlF include the following: (i) congenital occurrence; (ii) unilateral or bilateral index finger involvement; (iii) variability in nail appearance; (iv) possible hereditary involvement; and (v) frequently associated bone abnormalities.[sup3] The nails of COlF include the full spectrum of nail dysplasia, from an irregular lunula, malalignment, micronychia (hypoplastic and rudimental), polyonychia (split rudimental), and anonychia, specifically affecting the index fingers.[sup4] Our patient represents various forms of nail dysplasia of the both index fingers and left second toe such as micronychia, malalignment and abnormal lunula. To our knowledge, the association with second toenail dysplasia in COlF has not previously been reported. [ABSTRACT FROM AUTHOR]

Two patients suffering from ARC and AIDS developed extensive whitening of toe nails caused by infection with T. rubrum. The lesions may serve as a clinical clue to the diagnosis of HIV-infection with immune deficiency. [ABSTRACT FROM AUTHOR]

Samman (1978a, b) described several cases of dystrophy limited to one or both great toe nails and present at birth, Samman's illustrations (I978a, b) show exactly what we have termed `congenital malalignment of the big toe nail' because the longitudinni axis of the nail is laterally deviated. Congenital malalignment of the big toe nail quickly results in onychodystrophy following minor trauma of the free edge against the shoe. Transverse ridging develops over the entire surface of the nail plate and appears to follow the recurrent episodes of damage to the matrix so that even shedding of the nail may occur. The nail plate may show greyish, brown or even greenish discolouration. (Pseudomonas can appear as a secondary invader.) These features in addition to the thickening of the nail plate may suggest the diagnosis of onychomycosis. In some cases the deformity of the big toe is accompanied by a medial deviation of the second toe nail. In one of our cases this was associated with pain on local pressure. The early diagnosis of the congenitally maligned big toe nail is very important to the patient. It helps to prevent later problems such as hemionychogryposis which is not the ran's horn nail. In that condition usually the axis of deviation is upward or even downward but seldom laterally. In hemionychogryposis which we are now describing one sees lateral deviation of the axis of the nail plate. This deformity can easily be repaired by a surgical procedure to the matrix, in which the whole nail apparatus is realigned. (Figs 1 and 2). A wedge-shaped resection must be carried back proximal to and below the nail bed and nail matrix. On the lateral side a small triangular area is excised thereby enabling the whole nail apparatus to be swung over the resected area in order that it may be realigned. [ABSTRACT FROM AUTHOR]

Several cases of a dystrophy limited to one or both great toe nails have been seen. One of these cases was shown at the meeting of the St John's Hospital Dermatological Society on May 5, 1977. The condition is present at birth but in no case has there been a family history of a similar condition. The nail is seen to be of a dark colour, shorter than a normal nail and tends to be pointed. The nail grows very slowly and cross ridges develop on its surface. The nail seems to be thick but this is not a real thickening as it is overcurved and partly separated from the nail bed.

The article presents a case study of a 77-year-old homeless woman having ram's horn toenails. It discusses results of her physical examination which indicated that all toenails have increased thickness, curvature and overgrowth. It states that the said case demonstrates how the long-term neglect can worsen the classic appearance of onychogryphosis, giving a ram's horn-like appearance.