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The nail apparatus is an integral part of the functional unit of the digital tip. Although overall uncommon, all cells and tissues occurring in this area can give rise to neoplastic lesions. Given the special anatomical location, such tumors frequently show morphological and symptom-related differences compared to similar lesions located elsewhere on the skin. Though particularly threatening, there is often a substantial delay in the diagnosis of Bowen's disease, ungual squamous cell carcinoma, and melanoma. Nevertheless, local excision with sufficient surgical margins is usually sufficient and superior to amputation of the distal phalanx. In recent years, a number of nail-specific tumors have been described. Tumors such as onychomatricoma, onychocytic matricoma, onychocytic carcinoma, and onychopapilloma originate from the nail matrix. Onycholemmal cysts, onycholemmal horn, and the proliferating onycholemmal tumor are characteristic nail bed tumors. Onycholemmal carcinoma is a slowly growing low-grade malignancy. Using modern diagnostic methods, careful examination - including biopsy and histopathology - of nail changes not responding to conservative treatment will help identify nail-specific neoplasms and prevent the progression of malignant nail tumors.

Nagelveranderungen sind haufig, aber oft nicht einfach einzuordnen. Grundlegende Kenntnisse der Anatomie und Biologie des Nagels erleichtern ihre Zuordnung. Vielfach lassen sich daraus die Entstehung und Morphologie zwanglos ableiten. Die folgende kurze Ubersicht gibt Hinweise zu den wichtigsten Infektionen, entzundlichen Nagelkrankheiten und Tumoren.

Six cases of vascular compromise after hyaluronic injection are reported. Clinical symptoms realized a Nicolau syndrome, which is characterized by immediate pain, livedoid pattern and a few days later by the appearance of scabs and skin necrosis. This type of complication is rare, but may be dramatic and injectors must be aware of that. A thorough knowledge of facial anatomy is mandatory to avoid the risky facial areas. The use of a flexible cannula instead of a sharp needle has much less risk of hurting vessels and must be preferred. The support of the patient is discussed and a treatment protocol is proposed.

Glomus tumor is a rare benign vascular hamartoma derived from the modified smooth muscle cells of the glomus body. Paroxysmal pain is the leading symptom. A 78-year-old woman presented at our clinic with a 50-year history of a slow growing painful purple blue tender nodule under the right fourth finger nail. Dermoscopy and magnetic ressonance confirmed the presence of a large subungual tumor and total surgical excision was performed after partial nail plate avulsion. Histologic examination confirmed a glomus tumor. After 1 year of follow-up, the nail grew with normal shape and neither complications nor recurrence were observed.

A rudimentary accessory or double nail of the little toe is not rare, although only described three times before. Most cases are accidentally detected and only few patients seek help because they have discomfort or pain. Some have a positive family history, but most patients cannot give any information concerning heredity. Clinically, the nail of the little toe is abnormally wide and is split or shows a longitudinal depression corresponding to a slight protuberance of the cuticle. Histopathology shows a complete though short nail. The treatment of choice is segmental excision of the entire accessory nail unit with mobilization of the lateral skin and primary suture.

Ungual melanomas are considered rare, being difficult to diagnose, and having a poor prognosis. The aim of the present study was to discuss the epidemiology, potential causes, treatment options, and outcome of ungual melanomas. In contrast to assumptions in many articles, ungual melanomas are not rare when calculated for the cumulative size of the nail apparatus of both the fingers and toes. The prognosis is not worse than that of melanomas with the same thickness, mitotic rate, or presence of ulceration on other sites. Melanomas of the nail apparatus behave similar to melanomas in other localizations. What makes them enigmatic is the high rate of misdiagnoses and very late diagnoses.

Background Several studies have proven the efficacy of pulsed dye laser (PDL) in the treatment of plaque type psoriasis. However, only two published studies indicate the effectiveness of PDL on nail psoriasis. Objective We sought to study the effect of different pulse durations in the treatment of nail psoriasis with the 595-nm PDL to determine the optimal pulse duration. Methods Twenty patients with bilateral fingernail psoriasis were recruited and completed a 6-month trial. PDL was applied on the proximal and lateral nailfolds based on random assignment. Forty nails were treated with 6-millisecond pulse duration and 9 J/cm 2 whereas 39 nails were treated with 0.45-millisecond pulse duration and 6 J/cm 2 . Patients were blinded to pulse durations. One blinded dermatologist used the Nail Psoriasis Severity Index (NAPSI) to assess the clinical outcome from pretreatment and posttreatment photographs. Patients were monitored for adverse events. Pain was evaluated after the procedure using a visual analog scale assessed by the patient. Results After 6 months of first treatment, there was a significant reduction in overall NAPSI, nail matrix NAPSI, and nail bed NAPSI scores from baseline in both groups; however, no significant difference was found between the two pulse duration groups. Side effects were mild including transient petechiae and hyperpigmentation. Limitations There was no placebo group. Conclusions PDL was found to be an effective and well-tolerated option in the treatment of nail psoriasis. No significant difference in terms of efficacy was found between the longer and shorter pulse duration treatment groups.

Nail melanoma in children is rarely reported in the literature, and all of the published cases were diagnosed in dark-skinned phototypes or in Asians. We report two cases of in situ nail matrix melanoma presenting as longitudinal melanonychia (LM) in fair-skinned children of Italian origin. Nail plate dermatoscopy revealed a brown background with lines of irregular color, spacing, and thickness in both cases. Histopathology of the excised lesions showed melanoma in situ. Clinical, dermatoscopic, and pathological criteria that permit clear differentiation of benign melanocytic activation or proliferation from nail matrix melanoma are not established for children. The presence of a pigmented band of a single nail in a child usually represents a problem for clinicians, because the clinical and dermatoscopic features that are considered possible indicators of nail unit melanoma in adults are frequently observed in benign melanocytic hyperplasia and nevi in children. There is therefore the need to find parameters useful for clinical and dermatoscopic diagnosis in childhood nail pigmentation and to reach a consensus on management of children with a band of LM.

Soft-tissue augmentation with injectable fillers has seen tremendous development during the last 30 years. What started approximately 110 years ago with the injection of vaseline and paraffin and approximately 60 years ago with silicone has now become a big business both for some companies and for physicians dealing with patients who want to be beautified. More than 100 different fillers are available all over the world, many of which have to be used with the utmost care. Permanent fillers that meet patients’ wishes for a definitive solution to their asthetic concerns are particularly problematic. This article focuses on the different permanent fillers that have come onto the market during the last 20 years and, in particular, on their benefits and enormous risks.

Ungual melanoma is the most serious disease affecting the nail. The majority start with a longitudinal brown streak in the nail.To outline the different nail pigmentations, their differential diagnoses, treatment, and prognosis.Clinical and histologic evaluation of dark nail pigmentations.Brown to black nail pigmentation may be due to different coloring substances of exogenous and endogenous origin. Exogenous pigmentations usually are not streaky or do not present as a stripe of even width with regular borders. Bacterial pigmentation, most commonly due to Pseudomonas aeruginosa or Proteus spp., have a greenish or grayish hue and the discoloration is often confined to the lateral edge of the nail. Subungual hematoma may result from a single heavy trauma or repeated microtrauma which often escapes notice. The latter is usually found on the medial aspect of the great toe. Although oval in shape, it commonly does not form a neat streak. Melanin pigmentation in the form of a longitudinal streak in the nail is due to a pigment-producing focus of melanocytes in the matrix. Neither the color intensity nor the age of the patient are proof of benignity or malignancy although subungual melanomas are very rare in children and malignant longitudinal melanonychia is usually wider than 5 mm. Hutchinson's melanotic whitlow, nail dystrophy, and a bleeding mass strongly suggest malignancy. Treatment is as conservative as possible in order to keep the tip of the digit; once the melanoma is completely removed, amputations have not been shown to prolong the disease-free survival time.

Retronychia represents proximal ingrowth of the nail that occurs when the nail embeds backwards into the proximal nail fold. It is suspected when there is a persistent paronychia, particularly in the setting of trauma. Important clinical criteria for diagnosis are inflammation of the proximal nail fold, granulation tissue emerging from under the nail fold, thickening of the proximal portion of the nail plate and interruption of nail growth. The condition is rarely diagnosed and often misinterpreted, and is therefore unnecessarily treated with systemic antibiotics and antifungals. Avulsion of the nail confirms the diagnosis and it is the curative treatment. Conservative treatment with an adhesive technique is a valid option in early cases. We report 20 cases of retronychia diagnosed in our department between 2010 and 2013.

Acquired periungual fibrokeratomas are benign fibrous tissue tumors and are considered as the topographical variant of acquired digital fibrokeratoma. They usually present as solitary tumors. In some instance, the entity may appear in multibranched fashion. The main histopathologic features consist of acanthosis, thick collagen bundles mainly oriented in a vertical axis forming a central core, and numerous proliferating fibroblasts. In this article, we present two cases of acquired multibranched periungual fibrokeratoma and depict their varying clinical features over time. Binucleation and perinuclear halos of keratinocytes mimicking human papillomavirus (HPV) infection were detected microscopically, but there was no reactivity with HPV immunostaining. In context, anti-HPV immunostaining may be helpful in the differentiation of fibrokeratomas from HPV infection. On the other hand, it should be kept in mind that these histopathologic findings may be found in acral biopsies independent of viral effects.

® ) is an oral multikinase inhibitor that blocks tumor cell proliferation and angiogenesis and is used for the treatment of advanced renal cell carcinoma, hepatocellular carcinoma, and other solid tumors including metastatic differentiated thyroid cancer, at a starting dose of 400 mg twice daily (1-4). The most common adverse effects are fatigue, diarrhea, and various other dermatologic side effects (1). Recently, a meta-analysis of dermatological toxicities associated with sorafenib has been published, (5) and a hand-foot-skin reactions (HFSR) was most often found, but also rash/desquamation, alopecia, pruritus and dry skin. Nail involvement has been reported, in particular sub-ungual splinter hemorrhages (6). We describe a patient with longitudinal melanonychia and blue lunulae that developed during sorafenib therapy of metastatic thyroid carcinoma.

The nail unit is the largest and a rather complex skin appendage. It is located on the dorsal aspect of the tips of fingers and toes and has important protective and sensory functions. Development begins in utero between weeks 7 and 8 and is fully formed at birth. For its correct development, a great number of signals are necessary. Anatomically, it consists of 4 epithelial components: the matrix that forms the nail plate; the nail bed that firmly attaches the plate to the distal phalanx; the hyponychium that forms a natural barrier at the physiological point of separation of the nail from the bed; and the eponychium that represents the undersurface of the proximal nail fold which is responsible for the formation of the cuticle. The connective tissue components of the matrix and nail bed dermis are located between the corresponding epithelia and the bone of the distal phalanx. Characteristics of the connective tissue include: a morphogenetic potency for the regeneration of their epithelia; the lateral and proximal nail folds form a distally open frame for the growing nail; and the tip of the digit has rich sensible and sensory innervation. The blood supply is provided by the paired volar and dorsal digital arteries. Veins and lymphatic vessels are less well defined. The microscopic anatomy varies from nail subregion to subregion. Several different biopsy techniques are available for the histopathological evaluation of nail alterations.

BACKGROUND Nail unit melanoma (NUM) is a variant of acral lentiginous melanoma. The differential diagnosis is wide but an acquired brown streak in the nail of a fair-skinned adult person must be considered a potential melanoma. Dermoscopy helps clinicians to more accurately decide if a nail apparatus biopsy is necessary. OBJECTIVE Detailed evaluation of clinical and dermoscopy features and description of conservative surgery of in situ NUM. METHODS Retrospective study of in situ NUM diagnosed and treated with conservative surgical management in the authors' center from 2008 to 2013. RESULTS Six cases of NUM were identified: 2 male and 4 female patients, age range at diagnosis of 44 to 76 years. All patients underwent complete nail unit removal with at least 6-mm security margins around the anatomic boundaries of the nail. The follow-up varies from 4 to 62 months. CONCLUSION Nail unit melanomas pose a difficult diagnostic and therapeutic challenge. Wide excision is sufficient, whereas phalanx amputation is unnecessary and associated with significant morbidity for patients with in situ or early invasive melanoma. Full-thickness skin grafting or second-intention healing after total nail unit excision is a simple procedure providing a good functional and cosmetic outcome.

Nail surgery is mainly performed by dermatologists, hand and plastic surgeons, as well as general surgeons. Provided the surgeon has an in-depth knowledge of the anatomy and biology, as well as the pathology, of the nail organ and its surrounding tissues, good results with excellent function and good cosmetic outcome can usually be achieved, depending on the original diagnosis. This article describes pre- and postoperative care, the different methods of anesthesia, as well as some of the most commonly performed nail operations and their complications. Nail avulsion is commonly performed in a traumatic manner. Ingrown toenails require an approach adapted to their type, pathogenesis and degree of severity. Nail tumors, although rare, can be treated with good functional results if they are not far advanced and malignant. Ungual melanomas do not require amputation of the digit if they are not too advanced and several methods are available to cover the defect after complete ablation of the dorsal half of the d...

Item does not contain fulltext Fillers are an important tool in the armamentarium of the physician combating aging phenomena. A wide variety of filler substances are now available that meet many, but by far not all, needs in aesthetic medicine. The most commonly used substances now are hyaluronic acid and collagen preparations that have slightly different indications, but collagen requires pre-use testing to rule out inflammatory complications. Poly-L-lactic acid has gained its place in the filling of adipose tissue wasting in HIV-infected patients. Autologous fat is easy to harvest and inject and has virtually no risk of adverse side effects. Permanent fillers may be of advantage but carry the risk of permanent adverse reactions. Skillful combination of different fillers as well as with botulinum toxin injections and other cosmetic procedures may give optimal results.

Injectable fillers nowadays represent a pillar in facial rejuvenation and make a significant contribution to the success of the treatment. Despite their obvious benefits, a wide range of possible complications such as immediate, late, delayed, temporary, or irreversible adverse effects have to be respected. Differentiating the various filler materials, these effects are assigned to histopathology findings and currently available treatment options.

Item does not contain fulltext Hair and nails are often stated to have much in common in relation to their origin, anatomical structures, and common involvement in many diseases. Hair and nails are predominantly epithelial structures derived from primitive epidermis and made up of keratinous fibrils embedded in a sulfur-rich matrix. It was first noted early in the 20th century that the nail unit was comparable in several respects to a hair follicle sectioned longitudinally and laid on on its side. The epithelial components of hair follicle and nail apparatus are differentiated epidermal structures that may be involved jointly in several ways as congenital and hereditary anomalies and acquired conditions such as alopecia areata, lichen planus, iatrogenic causes, and fungal infection. Multielemental characterization of human hair and nails shows that even after sample washing, many elements are enriched in the surface of the nails.

Artecoll was developed about 20 years ago and underwent a number of production changes until it recently became FDA approved under the new name of Artefill. This product contains 20% polymethyl methacrylate (PMMA) microspheres with a diameter of 30 to 40 microm, which are suspended in a 3.5% atelo-collagen solution. The PMMA microspheres are now purified and no longer have an electrostatic charge, which in part was the cause for the early granulomatous reactions. Further, PMMA has long been known as bone cement and has been used in cosmetic surgery with a very good safety record. PMMA microspheres are biologically inert and nondegradable. The treatment results are therefore permanent and technical errors as well as incorrect injections will last. Due to the early record of granuloma formation, there is still a debate as to whether this product-as well as all other permanent fillers-should be injected for cosmetic reasons or not. With proper indications, excellent injection techniques, and realistic expectations as to what can be expected, this product has now proved to be one of the superior permanent filler substances.

There are many procedures that claim to improve the quality and beauty of the nail, however, most of them have absolutely no scientific basis. The nail is a cellularly-derived, plate-like structure composed of keratin fibres embedded in a sulphur-rich material. Both the fibrous and amorphic structures are genetically regulated. Excess amounts of sulphur-rich proteins have therefore only a positive effect in the extremely rare case of true deficiency of sulphur-containing essential amino-acids. Another popular claim, particularly among women, is of a lack of so-called essential nutrients, such vitamins, hormones, essential rare elements, iron, calcium, and so on. With the exception of very rare cases of metabolic diseases, such as alimentary or genetic zinc deficiency, such cases rarely occur in Europe; the excellent quality of nails among the poorest people of the third world suggests that dietary factors are not the cause of nail abnormalities. There is, therefore, no need to supplement ‘nail factors’ and attempts at improving the nail quality by a special dietary regimen are ineffective although they may be psychologically beneficial. Whether or not the ‘hair and nail vitamin’ biotin is active is still not proven. Brittle nails are a relatively common complaint, mainly among women. Repeated hyperhydration and desiccation are thought to decrease the nail's resistance. Formaldehyde-containing preparations are able to harden the nail. Over-treatment may, however, render the nail so inelastic that it breaks more easily. Other cosmetic measures such as nail wrapping, application of acrylic resin-impregnated silk or other tissue both supports the free margin of the nail and is a good measure to repair breaks and splits of the free nail margin. Surface irregularities may be camouflaged with a nail varnish or a thin sculptured nail. Stick-on plastic nails are usually not recommended because their occluding effect may impair the nail quality. Neither can the quality of the nail substance nor the nail shine be improved by surgical methods. To the contrary, nail avulsion is a serious trauma to the nail organ and often worsens abnormalities of the nail shape and form. Surgical measures are effective to improve the width-to-length ratio in brachyonychia and racket nail, to flatten the transverse overcurvature in pincer nails, to repair split nails, etc. Many surgical operations could be carried out with more attention paid to the cosmetic outcome. In general, there are few ways to improve the beauty and quality of nails and most claims remain unsubstantiated.

Nail pigmentations can exhibit many different colors and shades. Most of them are harmless but cosmetically embarrassing, others are potentially serious and may lead to death if not adequately diagnosed and treated. This short review gives an explanation for a number of nail dyschromias and their etiologies as well as some hints as to their treatment.

The nails have important functions such as being extremely versatile tools in daily life–they protect the tip of the digit and enhance the sensory capabilities of the finger tip. They are also of enormous aesthetic importance. Their real and assumed weaknesses are often embarrassing and motivate the patients to seek medical advice. However, whereas many nail diseases can now be effectively treated such common ailments that are particularly frequent in advanced age like brittle and fragile nails still resist most therapies.

In this open label, multicentre trial, 44 patients with clinical and mycological evidence of Candida onychomycosis were treated with itraconazole pulse therapy. Onychomycosis of the toes alone and concomitant disease involving the fingers and toes was treated with three pulses, and onychomycosis of the fingers alone with two pulses. Final evaluation for patients with finger and toe onychomycosis was at 6-9 months and 9-12 months, respectively. There were 29 patients with toe onychomycosis (C. albicans, 27; C. glabrata, one; Candida species, one), 12 patients with finger onychomycosis (C. albicans, two; C. glabrata, one) and three patients had combined toe and finger onychomycosis (C. albicans, two; C. guillermondii, one). In the patients with toe onychomycosis mycological cure was observed in 29 of 32 patients (90.6%). There was complete cure [mycological cure (negative culture and KOH at endpoint evaluation) with clinical cure] or marked improvement (mycological cure with 75% or greater decrease in area of involvement of target nail compared with pretherapy) in 24 of 32 patients (75.0%). All 12 patients with finger onychomycosis alone due to Candida species achieved a mycological cure (100%). In this group of patients complete cure or marked improvement was observed in 11 of 12 patients (91.7%). Itraconazole pulse therapy was well tolerated and no serious adverse events were reported in the patients treated with this triazole. In conclusion, itraconazole pulse therapy is an effective and safe treatment for both finger and toe onychomycosis associated with Candida.

Background: In recent years, itraconazole pulse therapy for onychomycosis has been developed [three 1-week pulses with itraconazole 400 (2 × 200) mg daily every month]. This has proved an effective and safe regimen which requires only 50% of the medication used for continuous dosing schedules. Parallel to the development of the new dosage schedule, additional studies were conducted to further document the safety and efficacy of itraconazole 200 mg once daily for 3 months to treat onychomycosis. Objective: To compare the safety of itraconazole 200 mg once daily for 3 months, with or without itraconazole 200 mg once weekly for a further 3 months, with that of miconazole cream twice daily for 6 months, in the treatment of onychomycosis. Treatment efficacy was compared as a secondary objective. Methods: In this multicenter, double-blind study, patients were randomized to receive itraconazole 200 mg once daily for 3 months followed by either itraconazole 200 mg once weekly for 3 months (ITR-ITR group, n = 599) or oral placebo once weekly for 3 months (ITR-PLAC group, n = 613), or to receive miconazole cream twice daily for 6 months (MIC-MIC group, n = 396). The primary variable was elevation of alanine aminotransferase (ALT) concentration above 50 U/l. Results: Overall incidence of elevation of ALT concentration above 50 U/l, adverse events and rate of withdrawal because of adverse events were low and similar in the three treatment groups. Efficacy was significantly greater in the ITR groups than the MIC-MIC group. Conclusion: Itraconazole and miconazole were well tolerated and had no significant effect on liver function, but itraconazole was significantly more effective.

Les patients presentant un prurit et n’ayant pas d’alterations cutanees representent un defi particulier. Dans ces cas, il convient d’exclure des maladies hepatiques cholestatiques, une insuffisance renale, des troubles thyroidiens, des maladies lymphoproliferatives et des parasitoses. Certaines alterations cutanees caracteristiques sont des paraneoplasies facultatives ou obligatoires.