Search

The dermoscopic features of glomus tumors have only been described in a few case reports. The aim of this research was to define the clinical and dermoscopic features of subungual glomus tumors.Thirty-two patients with subungual glomus tumors were evaluated retrospectively.On the photographs, longitudinal erythronychia, longitudinal leukonychia, punctate leukonychia, splinter hemorrhage, isolated capillaries, distal notching, distal subungual hyperkeratosis, onycholysis, and onychoschizia were found. There was no statistical difference between the rates of detection of these findings by evaluation from clinical photographs alone and from both clinical and dermoscopic photographs. While ramified vessels with bluish spots could be detected in only five of 26 cases with bluish spots in their clinical photographs, these ramified vessels were seen in 14 cases in bluish spots in dermoscopic photographs (P = 0.004). Compared to clinical examination, dermoscopy was able to detect blue spots in three more cases. Lesion duration was higher in the cases with ramified vessels (P = 0.018).Dermoscopy seems to contribute to the clinical examination in displaying only ramified vessels located in bluish spots and in determining the localization of the subungual tumors. The presence of ramified vessel in the bluish spots is strongly related to lesion duration.

Lichen planus is a benign inflammatory disorder of unknown etiology that may affect the skin, mucosae, scalp, and nails. When the nails are affected, it may lead to permanent destruction with severe functional and psychosocial consequences. Therefore, prompt diagnosis and early treatment are essential, even in mild cases. There are currently no guidelines for the management of nail lichen planus and the published literature on treatment is limited. The aim of this review is to provide practical management recommendations for the classical form of nail lichen planus, especially when restricted to the nails. Topical treatment has poor short-term efficacy and may cause long-term side effects. Instead, intralesional and intramuscular triamcinolone acetonide should be considered first-line therapies. Oral retinoids are second-line choices, and immunosuppressive agents may also be considered., SCOPUS: re.j, info:eu-repo/semantics/published

A case of adult onset longitudinal melanonychia caused by a compound nevus is described. Longitudinal melanonychias are mainly caused by melanocytic activation (hypermelanosis), lentigo (benign melanocytic hyperplasia), nevus and melanoma. Nevi are more commonly seen in children than adults; however, melanocytic activation, atypical melanocytic proliferation and melanoma are more frequent in adults. The majority of nail matrix nevi causing longitudinal melanonychia first appear in childhood and are junctional. Rarely, compound nevi are reported to cause longitudinal melanonychia in childhood. This article is protected by copyright. All rights reserved.

Onychocryptosis, or ingrown toenail, is a frequent, painful condition affecting young individuals. Controversies still exist regarding its etiopathogenesis and treatment options, including conservative and surgical techniques. The choice of treatment method depends on the stage of disease as conservative measures are mostly effective in early stages and surgical procedures are required in the later stages. Among surgical techniques, phenol cauterization of lateral nail matrix has been the most effective, safe, and commonly performed method. Other more destructive surgical procedures are rarely done nowadays. In this review, we briefly discuss the etiopathogenesis, clinical features, and different treatment options of ingrown toenail.

Nail apparatus melanoma (NAM) is a rare dermatologic malignancy. Its prognosis is poor because it is often diagnosed late. However, progression and survival of NAM patients have only been studied among small populations. Early biopsy could help to identify suspicious lesions at a less invasive stage. While surgery is generally seen as the treatment of choice, the extent of excision margins and the use of sentinel biopsy remain debated. This systematic review aims to summarize the treatment procedures and observed prognosis in the literature during the last two decades and present pooled survival and progression rates of NAM by using meta-analysis. A systematic review on studies assessing pathology, treatment and prognosis of NAM was carried out up to end of 2018. After evaluation of eligible studies, the main emerging topics were outlined and pooled survival outcomes estimated. A total of 30 articles out of 624 identified records were included for systematic review. Finally, meta-analysis of pooled mortality rates including 18 studies was 4.6 × 100 patient-years (95% CI: 2.7, 6.8) equivalent to 5-year cumulative survival of 77.0%. Additionally, the pooled progression rate based on 17 studies was 6.3 × 100 patient-years (95% CI: 4.1, 8.9) with estimated 5-year cumulative progression-free survival of 68.5%. While the optimal extent of surgical treatment remains debated, prompt biopsy could help to identify early lesions. This is the first study to present pooled survival and progression rates by meta-analysis.

BACKGROUND Severe nail lichen planus (NLP) does not respond well to treatment and is often poorly considered and described in detail. OBJECTIVE We sought to describe the characteristics of severe NLP. METHODS A retrospective data analysis was performed, including the photographic records of the most compromised nails of patients with NLP over 18���years old, who consulted between 2009 and 2019 at the Instituto de Dermatologia Professor Rubem David Azulay in Rio de Janeiro, Brazil. Descriptive and statistical analysis using Fisher's exact test was performed to verify the hypothesis of independence between characteristics (P���

The ABCDE rule systematizes warning signs for malignant melanoma (MM).To evaluate whether the ABCDE signs are associated with early detection of MM.Based on a retrospective study over 11.5 years, we assessed whether ABCDE signs are associated with early diagnosis of MM.In total, 144 MM were included; 52 (36.1%) in situ and 92 (63.9%) invasive lesions. For 23.6%, the MM were first suspected by an individual other than a dermatologist. The "E sign" was significantly less frequent among in situ lesions (32.7% versus 50.0%; p = 0.044). Based on adjusted analyses, the probability of MM being first suspected by a non-dermatologist consistently increased with the number of ABCDE signs of the lesion, ranging from 8% for a neoplasm with no ABCDE signs to 32% for a lesion with five signs (OR = 1.6; 95% CI: 1.2-2.2; p = 0.004).A higher number of ABCDE signs were associated with a greater chance of MM being first suspected by a non-dermatologist, but not in situ MM diagnosis. Relying on the ABCDE rule alone might result in missing early MM lesions.

Introduction: Retronychia is a particular form of post-traumatic ingrown nail associated with repeated microtrauma of the underside of the proximal nail fold. It is caused by the nail embedding backward into the underside of the proximal nail fold, forming multiple generations of nail plate. Methods: The study aims to evaluate the results of a novel nonsurgical treatment of retronychia. A review was performed on 20 patients who underwent the treatment, 16 having suffered from a chronic form of the condition, with the remaining 4 being afflicted with retronychia for less than a year prior to treatment. Results: The treatment was a combination of eliminating the proximal sharp edge of the uppermost nail layer and thinning of the nail with fraises and drills of various sizes. This therapy was repeated every 7–14 days. The patients came for checkup every 6 weeks. Treatment duration varied from 2 to 14 months. The rate, at which the appearance of a healthy nail occurred depended on the length of the intact nail layer below the part of the nail affected by retronychia, the age of the patient, and cofactors such as obesity, diabetes, etc. The treatment result in our case study was completely healthy nail growth without relapse of retronychia in all the 20 patients for a follow-up period of 18 months. Conclusion: By combining a healthy nail growth and the simultaneous protection of the nail, we were able to achieve a normal nail in all cases. In order to maintain the achieved results, we recommended our patients to continue wearing protective tubes whenever they would wear closed shoes because recurrence of retronychia may occur even after minimal trauma.

Cogan syndrome and lichen planus represent two autoimmune disorders. Cogan syndrome is a very rare type of ANCA-negative vasculitis affecting the eyes and vestibulocochlear system. It has been associated with other autoimmune disorders, none of them showing any lichenoid inflammation. We herein report the first case of a patient that suffered from Cogan disease and developed isolated lichen planus on all nails a few years after the first diagnosis. The combination of two autoimmune disorders is not unusual and raises the question of common immunogenetic pathomechanisms.

Supplemental Digital Content is Available in the Text.

Onychopapilloma is a fairly common lesion that is clinically typical enough to make the diagnosis. It is unique in that it stretches from the distal matrix all along the nailbed to the hyponychium. A case is described that developed pain eventually resulting in total excision. Histopathology revealed a malignant onychopapilloma. The differential diagnosis of this lesion is discussed.

Toenail changes are extremely frequent. Onychomycoses were said to be the most frequent cause; however, recent examinations have shown that orthopedic foot and toe abnormalities are at least as frequent as fungal toenail infections. This has first been described as asymmetric gait nail unit syndrome and will be outlined in more detail here. Hallux valgus and hallux valgus interphalangeus, hallux erectus, hallux rigidus, splayfoot, pes planus, short distal toe phalanx, double little toenail, wide base of the distal phalanx, and age-related foot deformations may all cause ungual alterations and vice versa; several specific nail changes are virtually always associated with characteristic bone alterations.

Nail disorders are common and ignored frequently by both patients and physicians due to their asymptomatic nature. But they are cosmetically embarrassing and may manifest an underlying systemic disease (de Berker et al 2016). This chapter illustrates and briefly discusses more than 100 nail problems we encounter in clinical practice.

Cutaneous elastofibroma is part of the connective tissue nevus complex. Two subungual cases remotely similar to the one presented here have been described before. This patient presented with an unusual form of subungual elastofibroma of the big toe, which was surgically removed. Histopathology revealed a connective tissue tumor extremely rich in very fine elastic fibers. Their relationship to oxytalan and elaunin fibers is discussed as is the potential association of this nail bed lesion with the onychodermis.

Background: There are no proper management guidelines for nail apparatus melanoma (NAM). Objective: This study aimed to describe the clinical features, the presence of locoregional and distant metastases and disease-free and overall survival of NAM treated at our institution. Methods: A retrospective cohort review of patients with single, primary localized histopathologically confirmed NAM was performed. Collected data consisted of patients’ characteristics and tumor features. In addition, local recurrence, locoregional metastases, distant metastases, disease-free survival (DFS) and overall survival (OS) were used as the main outcomes in our analysis. Results: Thirty patients with NAM were included. The overall survival (OS) in our patients at 5 and 10 years was 85.6 and 73.4%, respectively. DFS was significantly higher in patients with primary tumor location in the hand and without tumor-infiltrating lymphocytes (p value = 0.01 and 0.04, respectively). The patients with in situ melanoma or Breslow thickness Conclusion: Primary tumor location in the hand and lower tumor thickness might be correlated with better patients’ survival. The study results suggest that total amputation might not be necessary in all NAM cases.

BackgroundUltrasonography has demonstrated a shortening of the distance between the origin of the nail plate and the base of the distal phalanx in retronychia. The aim of this study was to analyze the clinical and ultrasonographic features of retronychia.MethodsWe evaluated the clinical findings in 18 patients with retronychia, along with the ratio of ultrasonographic distance a, extending between the nail plate origin and the base of the distal phalanx, to distance b, perpendicular to distance a, extending between the nail plate origin and the upper margin of the distal phalanx.ResultsRetronychia was present in 26 nails. The mean ± SD distance a was 7.66 ± 1.64 mm and distance b was 3.56 ± 1.95 mm. The mean ± SD a/b ratio was 2.59 ± 1.11. There was a significant inverse correlation between a/b ratio and clinical severity (Pearson correlation = –0.668; P < .001). The cutoff value of this ratio was 3.319, with specificity of 90% and sensitivity of 69%.ConclusionsThe ratio of distance a/distance b and the cutoff value of this ratio may help in making the diagnosis, in objectively determining the disease severity, and in selecting a patient-specific treatment approach.

Introduction: Onychomycosis is a chronic nail fungal infection resulting in nail damage and a decreased quality of life. Chemical avulsion of the nail with urea and bifonazole ­removes fungally infected debris, increasing antifungal treatment efficacy and penetration. Previous clinical ob­servations describe patients who applied their urea and ­bifonazole ointment less frequently, achieving earlier nail removal. In this study, we analyzed the relationship between duration of urea and bifonazole application and time to nail avulsion. Methods: χ2 tests, multiple regression analysis, and ANOVA were performed to analyze the similarities between treatment regimens (daily, every 3 days, or once a week), association of regimens or patient characteristics to nail removal, and compare time to nail removal between each regimen, respectively. Results: Daily application of ointment and sealing resulted in an average length of time (±SD) to nail removal of 18.7 days (±6.8 days); once every 3 days resulted in nail removal at 12.7 days (±6.2 days) and once per week at 11 days (±4.46 days) (p < 0.001). Age was the only patient factor that affected duration to nail removal. Conclusion: Once weekly application of ointment with sealing for a 1-week duration is associated with a decrease in time to complete chemical avulsion of the nail by approximately 1 week.

Yellow nail syndrome (YNS) is a rare, but relatively well characterized triad of slow growing yellow nails, lymphedema of the distal portions of the upper and lower limbs as well as chronic infection of the respiratory tract and/or pleural effusion. The most characteristic features of this syndrome are the nail changes that allow the diagnosis to be made even if the triad is not complete. Yellow discoloration of the nails is nonspecific and often seen in onychomycosis, nail psoriasis, a variety of other conditions that are associated with onycholysis. Distal limb edema may not be very pronounced. In addition to the bronchopulmonary disorders, malignancies, chronic heart conditions and gastrointestinal diseases may occur. Treatment after exclusion of non-YNS conditions is aimed at finding the underlying systemic disorder, which usually requires a very long therapy and a lot of patience both from the patient as well as the treating physician.

We conducted a retrospective study aiming to assess the risk, and associated risk factors, of developing subsequent skin cancers after having a first diagnosis of skin cancer. We included all patients with biopsy-proven skin cancer attending a dermatology clinic between July 2007 and July 2017. We assessed the frequency of new skin cancers, as well as potential demographic and clinical factors significantly associated with occurrence of such neoplasms, that were identified by means of a survival analysis. We analyzed 969 patients with a total of 1584 skin neoplasms (1122 basal cell carcinomas (BCC), 310 squamous cell carcinomas (SCC), 143 melanomas and 9 other neoplasms). 165 patients (17.0%) developed subsequent skin neoplasms. Factors identified in multivariable models to be significantly associated with development of new skin cancers included older age (adjusted HR = 1.04 per year; 95%CI = 1.02–1.05; p p p = 0.030), while having a previous SCC was associated with occurrence of subsequent SCC (adjusted HR = 3.60; 95%CI = 1.93–6.72; p

1. Maria Pereira, MD* 2. Ana Leite, MD* 3. Eduarda Osorio Ferreira, MD† 4. Ana Filipa Duarte, MD‡ 5. Eckart Haneke, MD, PhD‡,§ 6. Osvaldo Correia, MD, PhD¶ 1. *Pediatrics Department and 2. †Dermatology Department, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal 3. ‡Centro Dermatologia Epidermis, Instituto CUFP, Porto, Oporto, Portugal 4. §Dermatology Department, Inselspital, University of Bern, Bern, Switzerland 5. ¶Centro Dermatologia Epidermis, Instituto CUF Faculdade de Medicina, Universidade do Porto, Oporto, Portugal A 7-year-old boy presents to pediatric consultation with a 5-year history of progressively enlarging and multiplying asymptomatic skin lesions distributed over the right thigh, back, and abdomen. He has no other complaints or relevant medical history. Histopathologic analysis of a punch biopsy from the right thigh performed when the child was 3 years old was suggestive of a nevus lipomatodes superficialis. The maternal family history is notable for osteopoikilosis in members of the 3 previous generations, including his mother (Fig 1) and an aunt who has been evaluated for metastatic bone disease because of radiographic findings. There is no family history of similar skin lesions. Figure 1. Right foot radiograph of the mother showing multiple small round hyperdense foci of osteopoikilosis (arrowheads). Physical examination reveals asymmetrically distributed papules and nodules, 10 to 18 mm in diameter, coalescing into plaques in the anterior surface of his right thigh, sacral region, and left lower abdomen. They have irregular contours, a yellow hue, a smooth surface, and a firm rubbery consistency (Fig 2). Figure 2. Right thigh anterior surface papular skin lesions in the child coalescing into plaques, with irregular contours, a yellow tone, a smooth surface, and a firm rubbery consistency. Histopathologic analysis of a punch biopsy sample from the right thigh at this age is again diagnosed as a nevus lipomatodes superficialis. However, further review of the same biopsy yields the features of a typical cutaneous tissue nevus (CTN) with an increase of elastic fibers and irregular arrangement of the collagen tissue fibers. The overlying epidermis is normal, and there is no inflammatory infiltrate and no increase …

Eckart Haneke1–4 1Department of Dermatology, Inselspital, University of Bern, Bern, Switzerland; 2Dermatology Practice Dermaticum, Freiburg, Germany; 3Centro de Dermatología Epidermis, Instituto CUF, Porto, Portugal; 4Department of Dermatology, University Hospital, Gent, Belgium Abstract: Psoriasis is the skin disease that most frequently affects the nails. Depending on the very nail structure involved, different clinical nail alterations can be observed. Irritation of the apical matrix results in psoriatic pits, mid-matrix involvement may cause leukonychia, whole matrix affection may lead to red lunulae or severe nail dystrophy, nail bed involvement may cause salmon spots, subungual hyperkeratosis, and splinter hemorrhages, and psoriasis of the distal nail bed and hyponychium causes onycholysis whereas that of the proximal nail fold causes psoriatic paronychia. The more extensive the involvement, the more severe is the nail destruction. Pustular psoriasis may be seen as yellow spots under the nail or, in case of acrodermatitis continua suppurativa, as an insidious progressive loss of the nail organ. Nail psoriasis has a severe impact on quality of life and may interfere with professional and other activities. Management includes patient counseling, avoidance of stress and strain to the nail apparatus, and different types of treatment. Topical therapy may be tried but is rarely sufficiently efficient. Perilesional injections with corticosteroids and methotrexate are often beneficial but may be painful and cannot be applied to many nails. All systemic treatments clearing widespread skin lesions usually also clear the nail lesions. Recently, biologicals were introduced into nail psoriasis treatment and found to be very effective. However, their use is restricted to severe cases due to high cost and potential systemic adverse effects. Keywords: nail psoriasis, etiology, pathology, quality of life, impact, treatment