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Background: Retronychia is characterized by proximal ingrowing of the nail plate into the proximal nail fold. It is always associated with the presence of two or more overlapping nail plates under the proximal nail fold, clinical signs of chronic proximal paronychia refractory to antimicrobial treatment, and a yellowish nail that does not grow. It mainly affects young female adults, with less than 30 pediatric cases described in the literature so far. Methods: Retrospective and observational study of patients between 0 and 18 years with a clinical and/or ultrasound diagnosis of retronychia attending a pediatric dermatology service between December 2020 and January 2022. Results: We identified 9 patients with retronychia, 7 girls and 2 boys. In all cases, the hallux nails were affected with 5 unilateral and 4 bilateral cases. On physical examination we observed the following signs: thickened and opaque nail plate (one patient), yellowish nail plate (7 patients), double nail plate (6 patients), and erythema with edema, pain, and suppuration of the proximal nail fold (7 patients). Ultrasound was performed in 7 patients and specific findings of retronychia were found in 5 of them. All patients received topical treatment and were referred for the appropriate surgical treatment. To date, only one patient underwent nail avulsion, which was followed by complete recovery. Conclusions: Retronychia is underdiagnosed, particularly in the pediatric population. We present a series of 9 cases of retronychia in children, with clinical and ultrasonographic findings consistent with those of adults. We emphasize the importance of recognizing this entity, which will allow early and adequate treatment. [ABSTRACT FROM AUTHOR]

Molecular identification of extremely compromised human remains in forensic field is usually performed from DNA typing of bones, which are a difficult sample to work with. Moreover, autosomal STR profiles do not always result in the identification of the donor due to lack of comparisons or non-hit throughout database searching. An attempt to overcome these issues is represented by fingernails as an alternative DNA source and Y-STRs typing to infer both geographical and familial ancestry of the unknown donor. In this study, we analyzed both 24 autosomal and 27 Y-chromosome STRs from unidentified human remains (UHRs) of five males recovered from the water near the southwestern coast of Sardinia by the Italian Harbor Master's Office. Nail clippings provided an optimal source of autologous DNA for molecular identification in a very short time, producing complete autosomal and Y-STR profiles even under conditions of high body degradation. Unfortunately, no match neither compatibility occurred using autosomal STRs (aSTRs), initially. Upon analyzing the Y-haplotypes, we found out they had already been observed in northern Africa, providing us important investigative leads. This prompted the International Criminal Police Organization (INTERPOL) to provide us with references of alleged relatives that were then confirmed to be related. The use of fingernails represents an excellent DNA source especially for genetic identification of decomposed bodies recovered in seawater environment. Notably, DNA extracted from nails gave high-quality Y-STR haplotypes by which predicting paternal ancestry of the unidentified donors may result fundamental in the forensic investigative context. [ABSTRACT FROM AUTHOR]

Nail technology, including the application of artificial nails and nail care, is a developing sector of the global beauty industry. Nail technicians are exposed to a variety of chemical substances through inhalation, as they spend extended periods of time in close proximity to these materials. This study aimed to evaluate the semi-quantitative health risk of dust-containing heavy metals among nail technicians. This analytical descriptive study employed the risk assessment method provided by the Singapore Occupational Health Department to evaluate the health hazards of lead, cadmium, nickel, chromium, and manganese. Dust samples from nail filing were collected from the respiratory zone of 20 nail technicians following the NIOSH 7300 method. The samples were analyzed using ICP-OES instrumentation. Monte Carlo simulation was utilized to characterize the risk and its uncertainties. Manganese and cadmium had the highest and lowest mean concentrations, respectively. The risk scores of the metals ranked from highest to lowest were as follows: N i > C r > C d > M n > P b. All five metals had risk rankings below 2.8, signifying a minimal risk level. Sensitivity analysis using Spearman's correlation coefficient demonstrated a positive relationship between concentration, daily hours of exposure, and the number of workdays per week with the risk score (RR) and exposure level (ER). Conversely, the variable of weekly working hours (W) showed a negative correlation with these parameters. Despite the low-risk level of the examined metals, continuous exposure and potential long-term effects on nail technicians warrant preventive measures. Recommendations include implementing local exhaust ventilation systems, using table fans, establishing work-rest cycles, wearing N95 dust masks, and using reputable and high-quality nail polishes. [ABSTRACT FROM AUTHOR]

BACKGROUND: Hypertension is a major cause of death worldwide. Although arsenic exposure has been associated with the risk of hypertension, this association appears nonuniform due to inconsistent results from studies conducted in different populations. Moreover, hypertension is a complex condition with multiple underlying mechanisms and factors. One factor is impaired production and bioavailability of vascular nitric oxide (NO). However, the implications of the effects of arsenic exposure on circulating NO and its association with hypertension in humans are largely unknown. OBJECTIVE: We investigated the dose–response relationship between arsenic exposure and hypertension with vascular NO levels as a potential mediator of arsenic-related hypertension in individuals exposed to a broad range of arsenic. METHODS: A total of 828 participants were recruited from low- and high-arsenic exposure areas in Bangladesh. Participants’ drinking water, hair, and nail arsenic concentrations were measured by inductively coupled plasma mass spectroscopy. Hypertension was defined as a systolic blood pressure (SBP) value of = 140 and a diastolic (DBP) value of = 90 mmHg. Serum NO levels reflected by total serum nitrite concentrations were measured by immunoassay. A formal causal mediation analysis was used to assess NO as a mediator of the association between arsenic level and hypertension. RESULTS: Increasing concentrations of arsenic measured in drinking water, hair, and nails were associated with the increasing levels of SBP and DBP. The odds of hypertension were dose-dependently increased by arsenic even in participants exposed to relatively low to moderate levels (10–50 µg/L) of water arsenic [odds ratios (ORs) and 95% confidence intervals (CIs): 2.87 (95% CI: 1.28, 6.44), 2.67 (95% CI: 1.27, 5.60), and 5.04 (95% CI: 2.71, 9.35) for the 10–50 µg/L, 50.01–150 µg/L, and >150 µg/L groups, respectively]. Causal mediation analysis showed a significant mediating effect of NO on arsenic-related SBP, DBP, and hypertension. CONCLUSION: Increasing exposure to arsenic was associated with increasing odds of hypertension. The association was mediated through the reduction of vascular NO bioavailability, suggesting that impaired NO bioavailability was a plausible underlying mechanism of arsenic-induced hypertension in this Bangladeshi population. [ABSTRACT FROM AUTHOR]

BACKGROUND Onychomycosis is a common fungal nail infection with a low cure rate. While dermatophytes are the most common causal agent for onychomycosis, the incidence of Candida and nondermatophyte mold (NDM) onychomycosis is increasing. This study aimed to analyze the clinical and microbiological characteristics of patients with onychomycosis. METHODS Patients who visited the Department of Dermatology and Venereology, Cipto Mangunkusumo Hospital, and were diagnosed with onychomycosis from 2017 to 2022 were included. Diagnosis was established through clinical examination, supported by the result of direct microscopic examination with potassium hydroxide. RESULTS Of 171 patients, 93.6% had onychodystrophy, 65.5% were females, and 62.0% were aged 19-59 years. Most patients had onychodystrophy in more than three nails, affecting fingernails (31.6%) and toenails (34.5%). Interestingly, 84.8% of patients had no history of nail diseases. The median onset of disease was 24.0 (1-1,040) weeks, while the median onychomycosis severity index was 10.0 (2-40). Most cases were caused by Candida albicans (48.3%). Fusarium was the only NDM documented (2.3%). Some patients were resistant to itraconazole (11.4%) and miconazole (4.5%). Overall, 49.1% of the patients were declared not cured. CONCLUSIONS Candida was the predominant cause of onychomycosis, and onychodystrophy was the dominant feature. Current treatment regimens with systemic or topical antifungal agents did not yield satisfactory results, with more than half of the patients deemed not cured. [ABSTRACT FROM AUTHOR]

Purpose: Diet-related diseases are advancing as the leading cause of death globally. As self-reporting of diet by patients can be associated with errors, stable isotopes of human tissues can be used to diagnose diseases, understand physiology, and detect change in diet. This study investigates the effect of type and amount of food on the nitrogen and carbon concentration (Nconc and Cconc) and isotopic composition (δ15N and δ13C) in human scalp hair and fingernails. Methods: A total of 100 residents participated in the study whereas only 74 individuals provided complete diet history. Sixty-six food items majorly available to them were also collected. The Nconc, Cconc, δ15N and δ13C values of human hair, nails and food items were determined. Results: The Nconc, Cconc, δ15N and δ13C values between plant-sourced and animal-sourced food items, as well as human hair and nail tissue were significantly different (p < 0.05). The δ15N value of human tissues was distinct between lacto-vegetarians and omnivores by 0.9‰. The δ15N and δ13C values of human tissues increased by 0.4–0.5‰ with every 5% increase in the consumption of animal protein. Conclusions: The study helps to demarcate lacto-vegetarians from omnivores, and estimate the percentage of animal protein in diet based on the dual isotope values of human tissues. It also acts as a reference to determine isotopic composition of hair tissue provided the isotope value of nail tissue is known and vice versa. [ABSTRACT FROM AUTHOR]

Background: Data on nail psoriasis (PsO) in China are scarce. Objectives: To provide nail PsO‐related data regarding epidemiologic characteristics, manifestations, fungal infections, arthritic complaints and treatments that may facilitate improved patient management globally. Methods: From August 2021 to August 2022, patients with nail PsO were enrolled in a prospective multicentre observational study at 25 hospitals in China. We collected and analysed data concerning nail PsO demography, clinical signs, fungal detection, arthritic symptoms and treatment. Results: A total of 817 patients with nail PsO were involved, with a mean body mass index of 24.13 ± 2.93. In addition, 71.41% of the patients were male. The Nail PsO Severity Index score was weakly positively correlated with body surface area. The percentage of nail involvement was 95.29% for fingernails and 57.18% for toenails, with pitting (67.11%) and subungual hyperkeratosis (60.40%) being the most prevalent manifestations, respectively. Toenails showed a significantly higher frequency of nailfold scales, subungual hyperkeratosis and nail plate crumbling and a lower frequency of splinter haemorrhages, pitting and erythema of the lunula. A total of 13.26% of the PsO patients had onychomycosis, and 77.08% were observed in the toenails. Articular symptoms were reported by 12.17% of the patients, with the peripheral type being predominant. Significant associations between articular symptoms and nailfold swelling, subungual hyperkeratosis, nailfold scales, onycholysis and longitudinal ridges were found. Only 2.30% (20 out of 871) of patients with nail PsO received treatment. The most frequently employed therapy for cutaneous PsO with nail involvement was biologic therapy (n = 366). Conclusions: PsO showed distinct manifestations in the toenails and fingernails. Additionally, toenail PsO combined with onychomycosis requires special attention. Articular symptoms in psoriatic patients are associated with specific nail changes. It is important to research and advocate for more potent treatments for nail PsO. [ABSTRACT FROM AUTHOR]

Objective To investigate the evolution of nailfold capillary density in patients with SSc in relation to immunosuppressive treatment and autoantibodies. Methods This was a prospective study cohort. Consecutive newly diagnosed SSc patients were included into this study who, in a retrospective review, had at least two nailfold capillary microscopy measurements performed during the first 48 months of follow-up. Capillary density per 3 mm was measured with widefield nailfold capillary microscopy. Improvement of capillary density per finger and mean capillary density were analysed. Longitudinal measurements of mean capillary density were analysed by generalized estimating equation. Results Eighty patients (68 women, 12 men) met the inclusion criteria. The median follow-up time was 27 months. Twenty-eight patients had an improved capillary density in per-finger analysis. MMF was associated with fewer numbers of fingers that had worsened in capillary density. Anti-topoisomerase antibodies were associated with low mean capillary density. Anti-RNA polymerase III antibodies were associated with improvement and anti-centromere antibodies with worsening of capillary density in per-finger analysis. MMF treatment was associated with less steep capillary density decline in a moderated generalized estimating equation model including presence of anti-topoisomerase antibodies and the interaction of MMF with follow-up time. Conclusion Nailfold capillary density improved over time in a substantial proportion of SSc patients. MMF treatment had a positive impact on the evolution of capillary density in these patients. SSc autoantibody phenotype may affect the capillary density development. The data support previous hypotheses that early immunosuppression may favourably affect vascular regeneration in SSc. [ABSTRACT FROM AUTHOR]

Background: Hypothyroidism is a major manifestation of autoimmune thyroid diseases (AITD). We previously reported that a low selenium (Se) status was linked to an elevated prevalence of thyroid diseases. We hypothesized that Se status may also influence the restoration of thyroid function. Thus, this study aimed to investigate the factors affecting the recovery of thyroid function in patients with (sub-)clinical hypothyroidism, with a specific focus on Se status. Methods: We conducted a 6-year prospective cohort study comparing two counties with different Se concentrations. Demographic and disease data were collected from 1,190 individuals (549 Se-adequate and 641 Se-deficient) who completed a follow-up study in 2019. In addition, urinary iodine (I) levels, thyroid function, and serum and nail Se levels were measured. Logistic regression was used to investigate the relationship between Se deficiency and recovery of thyroid function. Results: Sex and smoking status was similar between the two counties studied. Thyroid function recovery rate was significantly higher in Se-deficient counties (46.0% vs. 30.6%, P = 0.008). In the multivariate analysis, our results show that female sex (odds ratio [OR] (95% confidence interval [CI]) = 1.875 (1.080–3.257), P = 0.026] and increasing age [OR (95%CI) = 1.028(1.007–1.049), P = 0.009] were associated with the recovery rate. Additionally, our study revealed that while Se status was significant in the univariate analysis, this association appeared to disappear in the multivariate analysis. Conclusions: Female sex and increasing age have unfavorable effects on the recovery of thyroid function in patients over 30 years of age with (sub-) clinical hypothyroidism. [ABSTRACT FROM AUTHOR]

The purpose of this review is to consolidate and summarize laser-assisted drug delivery (LADD) for nail diseases, particularly onychomycosis and psoriasis. A PubMed search was conducted in June 2023 using search terms (1) "laser assisted drug delivery" AND "nail," (2) "laser" AND "nail," and (3) "nail disorder" AND "laser treatment." References of papers were also reviewed, yielding 15 papers for this review. Fractional ablative CO2 laser (FACL) and Er:YAG laser can be used for LADD of topical medications such as amorolfine, terbinafine, and tioconazole to treat onychomycosis. A fungal culture should be performed to determine the type of dermatophyte, which will help determine which topical will be most effective. Laser settings varied between studies, but overall LADD tended to be more effective than topical treatments alone. Laser-assisted photodynamic therapy (PDT) was also found to be effective in treating onychomycosis. For psoriatic nails, LADD was used to deliver calcipotriol-betamethasone dipropionate foam, tazarotene, triamcinolone, or methotrexate into the nail. Again, LADD was found to be significantly more effective than topical treatment alone. FACL was the only laser noted for use for LADD in both diseases. Laser-assisted drug delivery for nail disease is a newer approach for onychomycosis and nail psoriasis with several benefits and drawbacks. Dermatologists should discuss the option of LADD with their patients who have recalcitrant onychomycosis or nail psoriasis. [ABSTRACT FROM AUTHOR]

Topical treatments for onychomycosis are of interest to those seeking to avoid systemic drug interactions and to improve systemic safety. This work aimed to develop aqueous-based, simple, and cost-effective vehicles that provide high solubility for ciclopirox and enable the delivery of an active through channels created by nail microporation. Following solubility tests, aqueous gels and thermogels based on hydroxypropylmethylcellulose and poloxamer 407, respectively, were loaded with 8% and 16% ciclopirox. Their performance was then compared to the marketed lacquer Micolamina® in in vitro release tests with artificial membranes and in in vitro permeation tests with human nail clippings with and without poration. Finally, a microbiological assay compared the best gel formulations and the reference product. Little correlation was observed between the in vitro release and the permeation data, and the drug release was highly membrane-dependent. Ciclopirox nail retention in single-dose, porated nails tests was larger than in daily-dosing, non-porated nail conditions. The series of new gel and thermogel vehicles delivered ciclopirox more effectively than Micolamina® in single-dose, porated nail experiments. The inhibition of Trichophyton rubrum activity was significantly increased with microporated nails when the gel formulations were applied but not with Micolamina®. Overall, the results suggest that the new vehicles could be successfully combined with nail microporation to improve the drug delivery and efficacy of topical antifungal medication while reducing the dosing frequency, facilitating patients' adherence. [ABSTRACT FROM AUTHOR]

Objectives: To determine the association between hip capsular distension, the computed tomography (CT) capsular sign, and lipohemarthrosis as they relate to occult femoral neck fracture (FNF) in the setting of ipsilateral femoral shaft fracture (FSF). Design: Retrospective comparative study. Setting: Level 1 trauma center. Patients/participants: Two hundred and forty-two patients with high-energy FSF and no evidence of FNF on preoperative radiographs and pelvis CT. All patients were stabilized with non-reconstruction style nails. Intervention: Pelvis CT scans were examined for hip capsular distension irrespective of the other side, differing side-to-side measurements of capsular distension (i.e., the CT capsular sign), and lipohemarthrosis. Main outcome measurements: FNF was observed for on postoperative radiographs. Relative risk (RR), number needed to treat (NNT), sensitivity (SN), and specificity (SP) were determined. Results: Fifty-eight patients (24.0%) had capsular distension. Forty-two patients (17.4%) had differing capsular measurements (i.e., the CT capsular sign), and 16 (6.6%) had symmetrical distension from bilateral hip effusions. Eight patients (3.3%) had lipohemarthrosis. Four FNFs (1.7%) were identified. Three patients had capsular distension, 2 had CT capsular signs, and 1 had lipohemarthrosis. The last patient had no CT abnormalities. Only capsular distension (RR = 10, CI = 1.001–90, P = 0.049; SN = 75%, SP = 77%; NNT = 22) and lipohemarthrosis (RR = 23, CI = 1.6–335, P = 0.022; SN = 50%, SP = 96%; NNT = 8) were associated with occult FNF. Conclusions: Capsular distension is associated with FNF irrespective of the contralateral hip. Preemptive stabilization using a reconstruction nail could be considered in the setting of capsular distension or lipohemarthrosis to prevent displacement of an occult FNF. Level of evidence: Diagnostic Level III. [ABSTRACT FROM AUTHOR]

BACKGROUND The data underlying this article are available in the article. Longitudinal melanonychia (LM) presents a challenge because nail unit melanoma (NUM) must be considered as a differential diagnosis. Because nail matrix biopsy may result in nail dystrophy, it is important to distinguish NUM from LM. OBJECTIVE To provide evidence of previously reported clinical factors indicative of NUM in patients with LM. METHODS This was a retrospective study of patients who presented with LM and had biopsy-confirmed NUM from 2005 to 2021. Benign LM was either confirmed by biopsy or considered benign if followed without the need for biopsy. Clinical factors associated with LM and NUM were compared by multivariate regression. RESULTS A total of 177 patients (97 LM and 80 NUM) were included. Multivariate regression showed that high band color intensity (p = .0031), variegation (p = .0005), nail plate splitting (p = .0017), Hutchinson sign (p = .0027), and band change (p = .001) correlated with malignancy. Nail plate splitting was associated with Breslow thickness. CONCLUSION Malignancy should be suspected and biopsy performed in patients with LM and high band color intensity, variegation, nail plate splitting, Hutchinson sign, and band change. [ABSTRACT FROM AUTHOR]

This study reports on the successful use of a machine learning approach using attenuated total reflectance Fourier transform infrared (ATR FT-IR) spectroscopy for the classification and prediction of a donor's sex from the fingernails of 63 individuals. A significant advantage of ATR FT-IR is its ability to provide a specific spectral signature for different samples based on their biochemical composition. The infrared spectrum reveals unique vibrational features of a sample based on the different absorption frequencies of the individual functional groups. This technique is fast, simple, non-destructive, and requires only small quantities of measured material with minimal-to-no sample preparation. However, advanced multivariate techniques are needed to elucidate multiplex spectral information and the small differences caused by donor characteristics. We developed an analytical method using ATR FT-IR spectroscopy advanced with machine learning (ML) based on 63 donors' fingernails (37 males, 26 females). The PLS-DA and ANN models were established, and their generalization abilities were compared. Here, the PLS scores from the PLS-DA model were used for an artificial neural network (ANN) to create a classification model. The proposed ANN model showed a greater potential for predictions, and it was validated against an independent dataset, which resulted in 92% correctly classified spectra. The results of the study are quite impressive, with 100% accuracy achieved in correctly classifying donors as either male or female at the donor level. Here, we underscore the potential of ML algorithms to leverage the selectivity of ATR FT-IR spectroscopy and produce predictions along with information about the level of certainty in a scientifically defensible manner. This proof-of-concept study demonstrates the value of ATR FT-IR spectroscopy as a forensic tool to discriminate between male and female donors, which is significant for forensic applications. [ABSTRACT FROM AUTHOR]

Background: Wide local excision (WLE) of the nail unit is widely used in treating in situ and minimally invasive malignant subungual tumours. After WLE, diverse reconstruction methods have been reported. However, the best repair method has yet to be determined. Objective: To compare the repair effects and postoperative morbidity of secondary intention healing (SIH), artificial dermis grafting combined with secondary intention healing (ADGSIH) and full‐thickness skin grafting (FSG) after WLE of the nail unit. Methods: We retrospectively reviewed 21 patients who underwent WLE of the nail unit. The re‐epithelializing time, functional and cosmetic outcomes, postoperative complications and patients' satisfaction were assessed from the follow‐up records. Results: The FSG group showed more rapid healing and better functional and cosmetic outcomes than the SIH and ADGSIH groups. The ADGSIH and FSG groups showed significant pain relief compared to the SIH group. No serious early and late postoperative complications were reported. The median follow‐up period was 26 months, and no recurrence was observed. All patients were satisfied with the treatment. Conclusions: FSG after the WLE of the nail unit is a therapeutic option with convenient application, significant pain relief, rapid recovery and satisfying functional and cosmetic outcomes. [ABSTRACT FROM AUTHOR]

Background: Glomus tumour is an uncommon soft tissue tumour which commonly occurs in the distal extremities, particularly the subungual region of the finger. Due to its rarity, there is a paucity of literature concerning glomus tumour. Therefore, this paper aims to report a case series based on our institution's experience. Methods: A retrospective cross sectional study was performed in a single tertiary institution in Singapore. All patients diagnosed with glomus tumour confirmed on histology from January 2019 to October 2022 were included in the study. Patient demographics and clinical information (presenting signs and symptoms, tumour parameters and presence of recurrence) were retrieved from existing medical records. Results: A total of 31 cases of glomus tumour were diagnosed from January 2019 to October 2022, and the relevant demographics and clinical presentation were reported. Majority of glomus tumours occurred in the finger (61.3%). Pain was present in almost all the cases (96.8%), while a lump was visible in less than half (48.4%). An average of 44.0 months elapsed before patients were properly diagnosed and treated. There were no cases of recurrence despite involved margins in three cases. Conclusion: Glomus tumour can be easily missed if clinicians do not have an index of suspicion for it, resulting in delayed treatment. Once diagnosed, glomus tumour can be treated with complete excision with good outcomes. [ABSTRACT FROM AUTHOR]

Background: Hand‐held dermoscopy is a valuable tool for dermatologists, but it has been rarely used to assess the nail fold capillary (NFC) in patients with dermatomyositis (DM). Methods: Patients were collected from the Department of Dermatology and Venereology from July 2020 to July 2021, and the follow‐up was conducted until January 2022. Demographic features, disease activity and NFC changes were analysed using a hand‐held dermoscopy. Results: The most common NFC finding in our study was bushy capillary (87.0%). There was no significant improvement in scleroderma–dermatomyositis (SD)‐like nail fold changes or enlarged capillaries from baseline to 12 weeks of treatment (p > 0.05) or from 12 weeks to 24 weeks of treatment (p > 0.05), but there was a significant improvement from baseline to 24 weeks of treatment (p < 0.05). The avascular area did not improve from baseline to 12 weeks of follow‐up, but the changes were significant from 12 weeks to 24 weeks of treatment (p < 0.05) and baseline to 24 weeks of treatment (p < 0.05). Periungual erythema improved significantly from baseline to 12 weeks of treatment (p < 0.05) and baseline to 24 weeks of treatment (p < 0.05), but it did not improve significantly from 12 weeks to 24 weeks of treatment (p > 0.05). There was no significant difference in disease activity between patients with or without specific NFC changes. However, some NFC features improved as disease activity decreased. Conclusion: Dermoscopy of NFC is a cost‐effective option for the preliminary diagnosis of DM. Further, long‐term follow‐up is necessary to study the relationship between disease activity and NFC changes. [ABSTRACT FROM AUTHOR]

Background: Simple onycholysis is a common complaint after trauma and consists in separation of the nail plate from the nail bed. If untreated, prolonged onycholysis may cause a disappearing nail bed (DNB) that leads to the shortening or narrowing of the nail plate. Objectives: This study is aimed at discussing possible treatment of chronic simple onycholysis with DNB by combined conservative methods. Methods: Simple onycholysis and DNB treatment consists of Onygen® cream application, nail bed massages, bracing procedures and nail folds taping with kinesio tape. Results: Long‐lasting simple onycholysis with DNB may be fully eliminated by applying the combined pharmacological, orthonyxia and taping treatment. Conclusion: Advanced simple onycholysis, which leads to the DNB and, in consequence, to the shortening or narrowing of the nail plate, causes cosmetic discomfort for patients. A damaged nail apparatus is also more susceptible to new traumas. Even long‐standing onycholysis with DNB can be successfully treated with easy‐to‐apply conservative methods. The key point of therapy is the use of several methods of treatment with different effects on the nail apparatus. The effects of described therapy are highly satisfactory, the only drawback being its long term, which is caused by slow growth of the nails. [ABSTRACT FROM AUTHOR]

Clomiphene or clomifene is a selective estrogen receptor modulator used to treat female fertility in case of ovulatory dysfunction. In sport, clomiphene is prohibited at all times for use by athletes and is listed in the section S4.2 (hormone and metabolic modulators) by the World Anti-Doping Agency. Indeed, clomiphene can indirectly increase testosterone levels in the body and can mitigate some side effects of synthetic steroid abuse. Despite its prescription to millions of subjects, its detection in human hair or nail clippings has never been reported. The aim of this study was to develop a specific method to identify clomiphene in hair and nail clippings by liquid chromatography–quadrupole tandem mass spectrometry. The procedure was then applied in a case of challenged doping results. The method involves sonication/incubation for 1 h of 30 mg of pulverized material in 1 mL of methanol in the presence of 2 ng diazepam-d5 used as internal standard. The chromatographic separation was performed using a HSS C18 column with a 15 min gradient elution. After spiking blank hair and nail with the corresponding amounts of clomiphene, linearity was verified from 1 to 500 pg/mg (r 2 = 0.9994 and 0.9995 for hair and nail, respectively). The limit of detection was estimated at 0.3 pg/mg for both matrices. No interference was noted from endogenous compounds, particularly steroids. Clomiphene was identified at 85 and 20 pg/mg in the pubic hair and the fingernail clippings, respectively, of a male athlete challenging an adverse analytical finding. [ABSTRACT FROM AUTHOR]

Background: Children are increasingly exposed to stressors that can affect their immune function. Given the possible negative effects of stress and inflammation on health, researchers need to use appropriate biomarkers to measure both the effects of stress and subsequent inflammatory responses. Purpose: The purpose of this paper is to briefly review stress and inflammatory pathways, identify biomarkers used to measure chronic stress and chronic inflammation particularly in children in clinical and community settings, and to discuss methodological considerations when measuring stress and inflammation in children. Discussion: Biomarkers of chronic stress can be classified as central, meaning they are made in the brain, or peripheral, meaning they are made in the peripheral tissues in response to central signals. The peripheral biomarker, cortisol, is most frequently used in the community setting. In addition, indirect measures, such as oxytocin, may complement the assessment of stress. Common biomarkers of chronic inflammation in children are C-reactive protein (CRP), TNF-α, and IL-6. Similarly, indirect biomarkers of chronic inflammation, such as IL-2 and IL-1β, may also be considered. Conclusions: Various types of specimens can be used to measure these biomarkers of stress and inflammation including blood, saliva, urine, sweat, hair, nails, and tears. Each type of specimen has different requirements for collection, storage, and assay. Future research would benefit from standardized biomarker levels across age and development in children and incorporation of other biomarkers. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Digital clubbing is characterized by a focal bulbous enlargement of the terminal segments of the fingers and/or toes due to the proliferation of connective tissue between nail matrix and the distal phalanx. The purpose of this study is to develop a prototype device to measure nail bed angle with significant inter-rater and intra-rater reliability. METHODOLOGY: Assessment eligibility through inclusion and exclusion criteria. Informed consent was signed by the patient before starting the testing procedure and measurement was done using the nail bed angle measuring device in normal and patients with clubbing. RESULTS: The intraclass correlation s test shows that the device has high reliability score ranging from 0.989 to 0.993. DISCUSSION: Lovibond represented the "profile" sign in 1938, which shows the actual clubbing of the fingers if it is >180. Till the day, the Schamroth's window test is used to identify or confirm clubbing where if 2 opposing fingers are held back-to-back against each other, a diamond-shaped space should normally appear between the nail beds and the nails of the two fingers. In clubbing, this space (or window) was missing. This test was useful if the finger clubbing is present graded into class 3 or more as there will not be much angle deviation to be visible in the Schamroth's sign. CONCLUSIONS: This device can measure the angle of the nail bed which will measure the slightest deviation in angle. This device is portable, cost-effective, less time-consuming, and high in accuracy. [ABSTRACT FROM AUTHOR]

Objectives: Based on the mainstream adoption of nailfold capillaroscopy as an investigative tool for rheumatologists, this work was carried out by a panel of experts in the field of capillaroscopy and microcirculation to issue a consensus view on capillaroscopic image acquisition and analysis standardization. Materials and methods: After the key clinical questions were identified by the core team, a systematic review of the published research was carried out focusing on variable capillaroscopic techniques, definitions, and characteristics, including capillary density (number of capillaries), capillary morphology (shape of each capillary), capillary dimensions (width of apical, arterial, and venous limb of the capillary), and the presence of hemorrhages. The expert panel attained a consensus and developed recommendations for the standardization of capillaroscopy in clinical practice. These included recommendations for normality and abnormality and the different capillaroscopic patterns. It also involved recommendations for scoring systems, reliability, and reporting. Results: A panel of 11 experts participated in the two rounds with a response rate of 100%. A total of nine recommendations were obtained. The agreement with the recommendations (a score of 7-9) ranged from 81.8 to 90.9%. A consensus (i.e., =75% of respondents strongly agreed or agreed) was reached on all the clinical standards. Conclusion: This work highlighted the main NFC indications, the technical equipment that should be used, how to carry out the procedure, standardization of the terminology of the parameters, and the interpretation of NFC findings. An evidence-based consensus incorporating the advice and experience of a diverse international expert panel was reached. [ABSTRACT FROM AUTHOR]

Introduction: Nail changes are frequent clinical findings in patients with cutaneous psoriasis and psoriatic arthritis, often causing significant impairments in quality of life. Numerous targeted therapies have been previously studied for treatment of nail psoriasis, however, newer agents have not been captured in prior systematic reviews. With over 25 new studies published since 2020, the landscape of nail psoriasis systemic treatments is rapidly evolving, warranting analysis of recently approved therapies. Methods: An updated systematic review of all PubMed and OVID database studies assessing efficacy and safety of targeted therapies for nail psoriasis was performed, with the goal of incorporating clinical data of recent trials and newer agents, namely brodalumab, risankizumab, and tildrakizumab. Eligibility criteria included clinical human studies reporting at least one of the nail psoriasis clinical appearance outcomes (Nail Psoriasis Severity Index, modified Nail Psoriasis Severity Index). Results: A total of 68 studies on 15 nail psoriasis targeted therapeutic agents were included. Biological agents and small molecule inhibitors included TNF-alpha inhibitors (adalimumab, infliximab, etanercept, certolizumab, golimumab), IL-17 inhibitors (ixekizumab, brodalumab, secukinumab), IL-12/23 inhibitors (ustekinumab), IL-23 inhibitors (guselkumab, risankizumab, tildrakizumab), PDE-4 inhibitors (apremilast), and JAK inhibitors (tofacitinib). These agents all demonstrated statistically significant improvements in nail outcome scores, compared with placebo or with baseline values, at weeks 10–16 and weeks 20–26, with some studies assessing efficacy up to week 60. Safety data for these agents were acceptable and consistent with known safety profiles within these timepoints, with nasopharyngitis, upper respiratory tract infections, injection site reactions, headache, and diarrhea being the most reported adverse events. Specifically, the newer agents, brodalumab, risankizumab, and tildrakizumab, showed promising outcomes for treatment of nail psoriasis on the basis of current data. Conclusion: Numerous targeted therapies have shown significant efficacy in improving nail findings in patients with psoriasis and psoriatic arthritis. Data from head-to-head trials have shown greater efficacy of ixekizumab over adalimumab and ustekinumab, as well as brodalumab over ustekinumab, while prior meta-analyses have demonstrated superiority of ixekizumab and tofacitinib to other included agents at various assessed timepoints. Further studies on the long-term efficacy and safety of these agents, as well as randomized controlled trials involving comparison with placebo arms, are needed to fully analyze differences in efficacy of newer agents compared with previously established therapies. [ABSTRACT FROM AUTHOR]

Aim: Lichen planus is a papulosquamous disease that affects skin and mucous membranes. In this study, we aimed to evaluate the clinical and demographic characteristics, treatment models, and accompanying comorbidities of patients with lichen planus. Materials and Methods: Our study included 202 patients who were diagnosed with LP clinically and histopathologically between May 2018 and May 2023. Patients' age, gender, involvement features, additional systemic diseases, laboratory findings and applied treatments were recorded retrospectively. Results: Of the 202 patients in our study, 116 (57.4%) were female and 86 (42.6%) were male. The average age of the patients was 46.42 years (13-84). The average duration of the disease was 10.40 months (1-196). The classic type (120 patients, 64.9%) was observed most typically in skin involvement, while reticular pattern (60 patients, 85.7%) was observed in oral involvement. Skin involvement was detected in 185 (91.6%), oral mucosa involvement in 70 (34.7%), genital involvement in 16 (7.9%), scalp involvement in 30 (14.8%), inverse involvement in 20 (9.9%), palmoplantar involvement in 5 (2.5%) and nail involvement in 21 (10.4%) of the patients, while no ocular involvement was detected. Anti-HCV positivity was found in two (1%) patients. HBsAg positivity was detected in 11 (5.4%) patients. While the most frequent accompanying comorbidity was hypertension with %20.3 (n:41), depression-anxiety was the sequent with 14.4% (n:29). While 154 (76.2%) of the patients received only topical treatment, it was seen that 5 (2.5%) patients were given only systemic treatment. In comparison of the age groups 18-45 and >45, the ratio of DM, hyperlipidemia and hypertension was identified significantly high in the group >45. Conclusion: Our study shows many similarities with the literature data. However, we believe that prospective cohort studies including more patients are needed to understand LP, whose clinical and epidemiology has not been sufficiently elucidated. [ABSTRACT FROM AUTHOR]

Psoriatic onychopathy is one of the clinical presentations of psoriasis and a well-known risk factor for the development of psoriatic arthritis. High-frequency ultrasounds (HFUS > 20 MHz) have recently been used to evaluate the nail apparatus of healthy and psoriatic subjects. The aim of our study was to detect by means of ultra-high-frequency ultrasound (UHFUS 70–100 MHz) alterations of the nail bed and matrix in patients with psoriatic onychopathy and to monitor these parameters during the treatment with monoclonal antibody (mAb). We enrolled 10 patients with psoriatic onychopathy and naive to previous biologic therapies. Patients were evaluated at baseline, after 1 month and after 3 months from the beginning of mAb therapy by a complete clinical assessment and US evaluation. A UHFUS examination with a 70 MHz probe was performed on the thumbnail (I), the index fingernail (II) and the nail with greater clinical impairment (W). The following measurements were analyzed: nail plate thickness (A), nail bed thickness (B), nail insertion length (C), nail matrix length (D) and nail matrix thickness (E). Among the various parameters analyzed, some measures showed a statistically significant decrease with p-value < 0.05 (t0 WA = 0.52 mm vs. t2 WA = 0.42 mm; t0 WB = 2.8 mm vs. t2 WB = 2.4 mm; t0 WE = 0.76 mm vs. t2 WE = 0.64 mm; t0 IIA = 0.49 mm vs. t2 IIA = 0.39 mm). In conclusion, UHFUS could represent a viable imaging technique for the real-time evaluation and monitoring of psoriatic onychopathy, thus supporting the clinical parameters and revealing any subclinical signs of early drug response. [ABSTRACT FROM AUTHOR]

BACKGROUND Local recurrence (LR) rates of melanoma in situ (MIS) of the nail apparatus treated with different surgical modalities are unknown. OBJECTIVE To evaluate the differences in LR rates of nail apparatus MIS treated with Mohs micrographic surgery (MMS) versus nail unit excision (NUE) versus amputation. METHODS Studies of nail/subungual MIS treated with MMS, NUE, or amputation were identified through multiple literature databases, including PubMed, MEDLINE, Embase, Web of Science, and Cochrane Library. Pooled data were assessed through meta-analyses and Fisher exact test. RESULTS Of 280 studies identified, 20 met inclusion criteria (7 comparative studies and 13 single-arm studies). Among the 7 comparative studies, the LR was 4.38% (5/114) after NUE and 2.94% (1/34) after amputation (odds ratio: 0.937; 95% CI: 0.237-3.703). In the 13 noncomparative studies, 23 patients underwent MMS (pooled LR estimate: 11.07%; 95% CI: 3.22%-31.81%) and 140 patients underwent NUE (pooled LR estimate:8.04%, 95% CI: 4.43%-14.16%). The difference in LR rate between MMS, NUE, and amputation was not statistically significant (p 5 .578). CONCLUSION Local recurrence of nail/subungual MIS in cases treated with MMS was not statistically different than in cases treated with NUE and was comparable to amputation. Further studies investigating the use of MMS for the treatment of nail/subungual MIS are warranted. [ABSTRACT FROM AUTHOR]

Nail unit melanoma carries diagnostic challenges conferring with its poor prognosis. This audit aims to characterise both clinical and dermoscopic features of nail unit malignant lesions and compare them with biopsied benign lesions. It focuses on informing future practice by aiding in the stratification and recognition of malignant diagnostic patterns in the Australian context. [ABSTRACT FROM AUTHOR]

Glomus tumours are painful superficial tumours, and ultrasonography is an extremely useful and noninvasive diagnostic technique for superficial organs. In this study, we retrospectively examined glomus tumours using ultrasonography. Among 18 patients histopathologically diagnosed with glomus tumours via ultrasonography, we observed five different development sites: subungual areas or those surrounding the nail bed (12), other areas on the finger surface (3), abdominal wall (1), upper arm (1), and forearm (1). The ultrasonographic images revealed significant differences in tumour size, indicating that tumours on other body surfaces tended to be smaller than those on patients' fingers (p < 0.01). The depth/width ratios of tumours on the other body surfaces were significantly higher than those on the fingers (p < 0.05). The tumours showed a regular shape (72.2%) and clear border (100%). Furthermore, most tumours were low-echo tumours with a diameter of up to 15 mm, clear margins, and no lateral shadows. Abundant blood flow and vessels in and out of the tumours were also observed. In conclusion, our study describes the ultrasonographic characteristics of glomus tumours and reveals that they cannot be ruled out when diagnosing small painful subcutaneous tumours. [ABSTRACT FROM AUTHOR]

Objective: To investigate the mean amount of time it took children with Hip spica casts versus titanium elastic nailing for the treatment of femoral shaft fractures to walk independently. Design: Retrospective cohort study. Place and Duration of Study: From 1st September 2021 to 31st September 2022 at Department of Orthopedic Surgery, Benazir Bhutto Hospital, Rawalpindi. Methodology: A study on 60 pediatric patients suffering from femoral shaft fractures of both genders aged four till eight years of age using convenient sampling. Results: The patients' average age was 5.58 ±1.24 years. There were 39 (65.0%) male and 21 (35.0%) female patients in the study group with a male to female ratio of 1.9:1. Compared to hip spica casts, children treated with titanium elastic nails had a considerably shorter mean time to walk independently (5.60±1.28 weeks vs. 8.93±1.98 weeks; p-Value = 0.001). Numerous patient subgroups based on age, gender, and weight showed similar statistically significant variations among the cohorts. Conclusion: In terms of considerably reducing the mean time to walk freely, this study found that titanium elastic nailing is preferable to the traditional method of hip spice cast. Future orthopaedic practice should prioritise the titanium elastic nails to be used in the fractures of this kind because to their minimally invasive nature, improved patient hygiene, and aesthetic appearance. [ABSTRACT FROM AUTHOR]

Objectives PsA is one of the most serious comorbidities associated with psoriasis. While the early intervention in PsA is demanded, risk factors of PsA development are not well-known. This is the first prospective study to evaluate the clinical significance of nailfold capillary (NFC) changes in patients with psoriasis. Methods We conducted a prospective cohort study in a population of 449 psoriasis patients who had not been treated with systemic therapy or topical finger therapy. NFCs were observed by dermoscopy and capillaroscopy, and the correlation of NFC abnormalities, including nailfold bleeding (NFB) and enlarged capillaries, with the prevalence of PsA, incidence of new PsA, and serum levels of TNF-a, IL-17A and IL-23 were analysed. Results Detailed examination at the time of inclusion revealed that of 449 patients, 236 had Psoriasis vulgaris (PsV) and 213 had PsA. Both NFB and enlarged capillaries were significantly more frequent in patients with PsA (34.7% vs 84.5%, P  < 0.0001; 25.4% vs 100%, P  < 0.0001). In addition, PsV patients were prospectively observed before they developed PsA (mean 21 months, 95% CI 2, 77 months). Multivariate analysis suggested that the appearance of NFB and enlarged capillaries was a predictor of PsA development (HR 2.75, 95% CI 1.38, 5.47 and HR 4.49, 95% CI 2.25, 8.96, respectively). The degree of NFC abnormalities also correlated with the severity of PsA and serum cytokine levels. Conclusions NFC abnormalities were suggested to be a predictor of PsA in psoriasis patients, and at the same time, its degree could be an indicator of disease severity. [ABSTRACT FROM AUTHOR]

Objectives The first objective of this study was to implement and assess the performance and reliability of a vision transformer (ViT)-based deep-learning model, an 'off-the-shelf' artificial intelligence solution, for identifying distinct signs of microangiopathy in nailfold capilloroscopy (NFC) images of patients with SSc. The second objective was to compare the ViT's analysis performance with that of practising rheumatologists. Methods NFC images of patients prospectively enrolled in our European Scleroderma Trials and Research group (EUSTAR) and Very Early Diagnosis of Systemic Sclerosis (VEDOSS) local registries were used. The primary outcome investigated was the ViT's classification performance for identifying disease-associated changes (enlarged capillaries, giant capillaries, capillary loss, microhaemorrhages) and the presence of the scleroderma pattern in these images using a cross-fold validation setting. The secondary outcome involved a comparison of the ViT's performance vs that of rheumatologists on a reliability set, consisting of a subset of 464 NFC images with majority vote–derived ground-truth labels. Results We analysed 17 126 NFC images derived from 234 EUSTAR and 55 VEDOSS patients. The ViT had good performance in identifying the various microangiopathic changes in capillaries by NFC [area under the curve (AUC) from 81.8% to 84.5%]. In the reliability set, the rheumatologists reached a higher average accuracy, as well as a better trade-off between sensitivity and specificity compared with the ViT. However, the annotators' performance was variable, and one out of four rheumatologists showed equal or lower classification measures compared with the ViT. Conclusions The ViT is a modern, well-performing and readily available tool for assessing patterns of microangiopathy on NFC images, and it may assist rheumatologists in generating consistent and high-quality NFC reports; however, the final diagnosis of a scleroderma pattern in any individual case needs the judgement of an experienced observer. [ABSTRACT FROM AUTHOR]

Introduction: Regular whole blood donors often suffer from iron deficiency (ID) or iron deficiency anemia due to the loss of 200–300 mg of iron with each donation. Hemoglobin (Hb) as donor eligibility criterion reflects iron stores only poorly. ID in blood donors is typically prevented or treated with orally administered ferrous salts, which frequently cause gastrointestinal side effects. A high daily oral iron dose is counterproductive due to hepcidin upregulation. Oral sucrosomial iron (sucriron) is encapsulated ferric pyrophosphate that may be an option for blood donors due to its supposed high bioavailability and good tolerability. Methods: This monocentric single-cohort pilot study included fifty whole blood donors (divided into premenopausal women, postmenopausal women, and men) who did not meet Hb donation criteria. Participants aged 18–65 years with ferritin <30 ng/mL and venous Hb <12.5 g/dL in women and Hb <13.5 g/dL in men received oral sucriron (30 mg iron) for 90–120 days. Primary endpoints were the increase of Hb and ferritin. Results: Forty-seven participants completed the study. With the limitation that no control group was included, there was a substantial overall median increase of 0.94 g/dL Hb and 4.97 ng/mL ferritin (standardized on 90 days of iron intake). These value improvements were likewise observed in each of the subgroups. sucriron was very well tolerated, with almost no gastrointestinal side effects identified. Conclusion: A clear increase of Hb and ferritin was observed after the intake of sucriron, so it may be a reasonable and useful alternative to traditional oral iron therapy. The ease of administration, pleasant taste, dietary supplement status, and, most importantly, good tolerability highlight the value of sucriron supplementation. [ABSTRACT FROM AUTHOR]

Objectives: We assessed the performance of the Seegene Novaplex™ Dermatophyte Assay for diagnosis of dermatophytosis. Methods: Sixty‐one clinical samples from skin, nail, hair and culture were selected based on RT‐PCR according to Wisselink et al. Of these samples, 26 samples were negative and 35 samples were positive with 39 dermatophytes strains. Emerging fungal strains harbouring terbinafine resistance (i.e. T. indotineae and T. mentagrophytes) were included. Results: The specificities of the Novaplex™ Dermatophyte Assay ranged between 94.3% and 97.9%. The sensitivities for the detection of T. rubrum complex, T. mentagrophytes/T. interdigitale species complex and C. albicans were 94.1% (95% CI: 71.3–99.9), 78.6% (95% CI: 49.2–95.3) and 100% (95% CI: 69.2–100), respectively, with Cohen's kappa of at least 72.9%. Conclusions: The Seegene Novaplex™ Dermatophyte Assay can be used for reliable screening of dermatophytes, including emerging strains in a routine laboratory setting. [ABSTRACT FROM AUTHOR]

Background: Up to 30-50% of cases of psoriasis experience nail involvement, while 5-10% may have only isolated nail disease. Recently, the use of onychoscopy, a non-invasive technology, has emerged as a promising tool that may eliminate the necessity of a nail biopsy in most cases. Objective: The objective of this study was to assess the onychoscopic characteristics of the nail unit in individuals with nail psoriasis. Materials and Methods: The study recruited fifty patients with a clinical diagnosis of nail psoriasis. Each nail underwent onychoscopic assessment. The clinical degree of cutaneous and nail involvement was evaluated with the Psoriasis Area and Severity Index (PASI) and the Nail Psoriasis Severity Index (NAPSI), respectively. Results: The following findings were observed significantly more often on onychoscopy than with the naked eye: pitting (p = 0.03), leukonychia (p = 0.04), onycholysis (p = 0.04), and splinted hemorrhage (p = 0.05). The other novel findings included fuzzy lunula, which was only onychoscopically (8%), We also encountered 4% of cases of triangular onychomadesis and 6% of non-traumatic Median canaliform dystrophy of Heller. Conclusion: Our findings suggest that, even before clinical symptoms become obvious, onychoscopy may help with nail lesion diagnosis. [ABSTRACT FROM AUTHOR]

Background Psoriasis is a common immune mediated, multifactorial disease which is caused by genetic heterogeneity and phenotypic diversities.1 It is characterized by red, scaly, sharply demarcated, indurate plaques mostly over scalp and extensor surface affecting 2-3% global population.3,4 Beside cutaneous involvement, nail involvement is quite common in psoriasis patient (50%) and 5% cases had only nail involvement.5,6 Objective To assess the frequency, types of nail involvement in psoriasis patient and its association with the disease severity. Methods Institution based Cross-sectional study on 100 consecutive patients attending Outpatient department was done for a period of 1 year March 2019 to February 2020. Results 48% have nail changes with male having twice that of female. The mean age of the patients having nail changes was 42.450 with SD 13. Isolated finger nail and Toe nail involvement was noted in 52% and 1%, while 46% have both. Majority nail changes were pitting (68%), distal onycholysis (38%), longitudinal ridging (25%), subungual hyperkeratosis 22%, proximal onycholysis 19%, transverse ridging 8% etc.77% patient with nail changes has disease duration less than 5 years. Frequency of nail changes was noted highest in patient with severe disease (64.58%). Conclusion Psoriatic nail changes are common in psoriasis patients. Severe nail psoriasis can lead to functional and social impairment if left untreated. An association was noted between severity of psoriasis and nail changes but elaborate study with large samples are required to establish that relationship. [ABSTRACT FROM AUTHOR]

This article discusses a case of a 2-year-old boy with Langerhans cell histiocytosis (LCH), a rare neoplastic disorder characterized by a clonal proliferation of Langerhans cells. The boy presented with recurrent fevers, abdominal distension, an eroded skin lesion, and dystrophic nails. The diagnosis was confirmed through histopathological examination of the skin lesion, which showed infiltration of histiocytes with large nuclei. The boy was treated with a combination of vincristine and prednisone, followed by azathioprine, cytosine arabinoside chemotherapy, and targeted therapy with vemurafenib. The nail deformities improved with treatment, but the hepatosplenomegaly showed minimal improvement. LCH involvement of the nail is rare, and nail changes are most likely caused by direct infiltration of Langerhans cells. Treatment for patients with only skin and nail involvement is limited, with few reported cases in the literature. LCH is driven by genetic changes, such as the BRAF V600E mutation, and is associated with more severe disease and higher treatment resistance. The article emphasizes the importance of considering LCH as a differential diagnosis in cases with hepatosplenomegaly and nail changes. [Extracted from the article]

Retronychia refers to the embedding of the nail into the proximal nail fold. Patients present with chronic paronychia in the setting of disrupted nail growth. Nail avulsion is curative and unlike other forms of ingrown nails, it does not tend to recur. We report a case of retronychia who presented with pain and swelling around bilateral great toes. Further examination showed growth of overlapping nail plates, which led to the diagnosis of retronychia. This article emphasizes the clinical features and treatment options available for retronychia, thereby avoiding misdiagnosis. [ABSTRACT FROM AUTHOR]

Ingrown nail or onychocryptosis is a common and prevalent condition associated with pain and discomfort resulting from recurrent inflammation. It is further categorized into 3 grades on the basis of severity as per classification by Heifetz and Mogensen, grade 1 can be easily managed with medical treatment; whereas grades 2 and 3 often requires surgical treatment; the most common surgical technique employed for ingrown nail is the simple nail avulsion by using a nail clipper. we have observed that due to the force of the nail clipper small amount of detachment in between nail plate and nail bed in addition to longer downtime post-procedure, so we proposed a new surgical modification of nail avulsion by using 11 no. surgical blade instead of nail clippers leading to very less trauma to nail bed and fine post-procedure outcomes. [ABSTRACT FROM AUTHOR]

Onychopapilloma is a benign neoplasm of unknown etiopathogenesis of the distal nail matrix and proximal nail bed. It may have different clinical presentations, which constitute a diagnostic challenge. It is usually monodactyl and mainly affects the fingers. Despite that it is not uncommon, doctors outside of dermatology are unaware of this entity. Herein, we report two patients, with a median age of 67 years, who presented with monodactylous chromonychia, including longitudinal erythronychia and longitudinal leukonychia, associated with a subungual keratotic mass. With these clinical features, both patients were diagnosed with onychopapilloma. [ABSTRACT FROM AUTHOR]

Further studies are necessary to distinguish between the signs of onychomycosis and other nail changes in LC-OCT. Nail changes were similar between the different fungal subtypes that caused onychomycosis. Line-field confocal optical coherence tomography for the diagnosis of onychomycosis in comparison with healthy nails: A case series Confocal laser scanning microscopy as a new valuable tool in the diagnosis of onychomycosis - comparison of six diagnostic methods: six diagnostic methods for onychomycosis. [Extracted from the article]

Interestingly, in our sample nine patients with onychomadesis and eight patients with nail growth arrest claimed no need to cut their nails for 12 months or more. Nail growth disorders characterize a spectrum of diseases in which nail matrix activity slows down or completely stops. It is possible to appreciate complete nail regrowth and reappearance of the cuticle. gl We enrolled 50 patients with the diagnosis of toenail growth arrest (48%) or onychomadesis (52%), with a total of 84 affected toenails. [Extracted from the article]

Due to practical difficulties in quantifying fluoride exposure in populations, practical and accurate biomarkers can play a major role in the surveillance of fluoride. Among different fluoride biomarkers, spot urine and nail clippings have gained more attention due to their ease of acquisition. However, there is no robust consensus about the accuracy of these biomarkers for the estimation of fluoride exposure. This systematic review and meta-analysis aimed to synthesise evidence on the association between fluoride exposure and the fluoride concentration of spot urine and nail clippings. This review was conducted and reported using the PRISMA Statement. Nine databases (Medline, CINAHL, Web of Science, Scopus, ScienceDirect, Sage Journals Online, Campbell Collaboration, Cochrane Collaboration, and Embase); search engines (Google and Google Scholar); and grey literature were searched up to September 2022. All screening, data extraction, and quality assessments were conducted in duplicate. All experimental and observational research studies that reported the correlation between fluoride exposure and fluoride concentrations of spot urine and/or nail clippings were included. The Mixed-Methods Appraisal tool was used to assess the methodological quality of the included studies. A random effect meta-analysis was carried out to determine the relationship between fluoride exposure and fluoride concentration of biomarkers (i.e., spot urine and nail clippings). Forty-four studies met the inclusion criteria. A total of 694,578 participants were included in this review. Twenty-five studies were included in the meta-analysis. The primary meta-analysis showed a moderate correlation of 0.674 (95% confidence interval [CI]: 0.623–0.725, n = 25) between fluoride intake and fluoride concentration of spot urine and a strong correlation of 0.938 (95% CI: 0.520–1.355, n = 11) between fluoride intake and the fluoride concentration of nail clippings in all age groups. The findings of secondary meta-analyses showed a strong positive correlation between fluoride intake and fluoride/creatinine ratio of spot urine in children (0.929; 95% CI: 0.502–0.991; n = 2). In conclusion, spot urine and nail clippings have the potential to be employed as non-invasively obtained biomarkers in populations. However, due to the scarcity of high quality, relevant studies, more research is needed to establish the validity of these biomarkers. [ABSTRACT FROM AUTHOR]

BACKGROUND Nail psoriasis has a major negative impact on the physical and psychological aspects of the patient's life. Treatment is often unsatisfactory because of the difficult penetration of the drug into the nail. OBJECTIVE To compare the efficacy of fractional CO2 laser monotherapy versus combined fractional CO2 laser and calcipotriol/betamethasone ointment preparation in treatment of nail psoriasis. PATIENTS AND METHODS Thirty patients with nail psoriasis with at least 2 affected fingernails were recruited for this study. Target NAPSI (tNAPSI) score was calculated at the start of the study and at 3 months after the last laser session. One affected fingernail of each patient received 6 sessions of fractional CO2 laser with 4-week intervals. Another affected fingernail of each patient received topical betamethasone/calcipotriol ointment once daily in addition to the 6 fractional CO2 laser sessions. RESULTS In the monotherapy group, there was significant improvement in the nail matrix score, nail bed score, and tNAPSI score. In the combined therapy group, there was significant improvement in nail bed score and tNAPSI score, but nail matrix score showed no statistically significant improvement. Overall, there was no statistically significant difference between the 2 studied groups. CONCLUSION Fractional CO2 laser can be an effective and promising new treatment for nail psoriasis. [ABSTRACT FROM AUTHOR]

Objectives Nailfold capillaroscopy is key to timely diagnosis of SSc, but is often not used in rheumatology clinics because the images are difficult to interpret. We aimed to develop and validate a fully automated image analysis system to fill this gap. Methods We mimicked the image interpretation strategies of SSc experts, using deep learning networks to detect each capillary in the distal row of vessels and make morphological measurements. We combined measurements from multiple fingers to give a subject-level probability of SSc. We trained the system using high-resolution images from 111 subjects (group A) and tested on images from subjects not in the training set: 132 imaged at high-resolution (group B); 66 imaged with a low-cost digital microscope (group C). Roughly half of each group had confirmed SSc, and half were healthy controls or had primary RP ('normal'). We also estimated the performance of SSc experts. Results We compared automated SSc probabilities with the known clinical status of patients (SSc versus 'normal'), generating receiver operating characteristic curves (ROCs). For group B, the area under the ROC (AUC) was 97% (94–99%) [median (90% CI)], with equal sensitivity/specificity 91% (86–95%). For group C, the AUC was 95% (88–99%), with equal sensitivity/specificity 89% (82–95%). SSc expert consensus achieved sensitivity 82% and specificity 73%. Conclusion Fully automated analysis using deep learning can achieve diagnostic performance at least as good as SSc experts, and is sufficiently robust to work with low-cost digital microscope images. [ABSTRACT FROM AUTHOR]

Objective: While the relationship between psoriatic arthritis and skin findings is well-known in patients with psoriasis, the relationship between psoriatic arthritis and nail involvement is less known. In this study, it was aimed to examine the frequency of association between nail involvement and psoriatic arthritis in patients with psoriasis. Materials and Methods: Our study is a retrospective observational study. It was conducted with 250 registered patients who applied to the dermatology polyclinic and clinic of our university hospital. The follow-up forms of the patients were scanned retrospectively and the findings were recorded. Results: The average age of the 250 patients evaluated in this study was 39.62 ± 9.30, and 133 (53.2%) of them were women. The frequency of nail involvement in psoriasis patients was determined to be 36.8% (n = 92) and the frequency of arthritis was determined to be 8.8% (n = 22). Nail involvement was statistically significantly more common in those with arthritis, and nail involvement was present in all of those with arthritis (P < .001). Nail involvement was significantly more common in those with only arthralgia (P < .001). A significantly higher average of nail psoriasis severity index was found in those with both joint and nail involvement compared to those with only nail involvement (P < .001). There was no statistically significant difference in terms of psoriasis area severity index average (P = .235). Proximal and distal interphalangeal arthralgia and sacroiliac arthralgia were found significantly more frequently in those with nail involvement than in those without nail involvement (respectively P = .007 and P < .001). There was no statistically significant relationship between nail involvement with the presence of arthritis and the clinical type (respectively P = .288 and P = .955). Conclusion: Joint involvement and nail involvement in patients with psoriasis are closely related, and we think that nail and joint involvement in psoriasis patients should be evaluated together. [ABSTRACT FROM AUTHOR]

Melanoma of the nail apparatus is challenging to diagnose for both dermatologists and dermatopathologists. Misdiagnosis or delayed diagnosis of nail unit melanoma can have fatal consequences and legal ramifications. This review educates dermatopathologists on challenges and traps they should be aware of to avoid misdiagnosis of nail unit melanoma. We present illustrative difficult cases that introduce several themes regarding challenges in the diagnosis of nail unit melanoma: specimens with subtle histopathologic findings, challenges in immunoperoxidase interpretation, and how clinical knowledge and surgical procedural knowledge are mandatory to make the diagnosis. Dermatopathologists will be aware of when and how to suspect nail unit melanoma in unusual circumstances. [ABSTRACT FROM AUTHOR]