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Background: In rare dermatology cases the differential diagnosis is challenging, e.g. when one nail is growing below another, the provisional diagnosis could be confusing. It may present as chronic paronychia, candidiasis, bacterial infections, rheumatoid arthritis, psoriasis, subungual tumours, or cysts. Case description: We present a case of iatrogenic rupture of the nails of both big toes following a commonly known recommendation from physiotherapists in the initial stages of hallux valgus or chronic arthritis by using kinesio tape to prevent the big toe from fixation in the valgus position. The initial provisional diagnosis of retronychia was revised, and a final diagnosis of onychomadesis was made. The patient’s complaint was solved after around one year without any specific therapy. Conclusion: The differential diagnosis for onychomadesis needs a careful and detailed history that may prevent a patient from a frightening diagnosis and painful, long-lasting treatments.

Summary: We report the case of a 67-year-old woman who developed onychomadesis on 9 of her fingers 2 months after recovering from COVID-19, with subsequent full nail regrowth after 4 months. The development of onychomadesis in COVID-19 is probably related to inhibition of nail proliferation due to fever, direct viral damage, or an inflammatory process associated with endothelial damage and obliterative microangiopathy in the nail matrix area. Clinicians should be aware of nail changes and actively seek them out in patients with COVID-19. [ABSTRACT FROM AUTHOR]

Abstract is missing (Short communication)

In dogs, symmetrical lupoid onychodystrophy (SLO) results in nail loss and an abnormal regrowth of the claws. In Bearded Collies, an autoimmune nature has been suggested because certain dog leukocyte antigen (DLA) class II haplotypes are associated with the condition. A genome-wide association study of the Bearded Collie revealed two regions of association that conferred risk for disease: one on canine chromosome (CFA) 12 that encompasses the DLA genes, and one on CFA17. Case-control association was employed on whole genome sequencing data to uncover putative causative variants in SLO within the CFA12 and CFA17 associated regions. Genotype imputation was then employed to refine variants of interest. Although no SLO-associated protein-coding variants were identified on CFA17, multiple variants, many with predicted damaging effects, were identified within potential candidate genes on CFA12. Furthermore, many potentially damaging alleles were fully correlated with the presence of DLA class II risk haplotypes for SLO, suggesting that the variants may reflect DLA class II haplotype association with disease or vice versa. Strong linkage disequilibrium in the region precluded the ability to isolate and assess the individual or combined effect of variants on disease development. Nonetheless, all were predictive of risk for SLO and, with judicious assessment, their application in selective breeding may prove useful to reduce the incidence of SLO in the breed.

Although the popularity of fish pedicures as cosmetic or routine services and/or tourist attractions has peaked in the past decade, the practice is still trending today and accompanying risks are less well-known by the public. More recently, a case of onychomadesis following fish pedicure has gained interest in both public and dermatologic populations, highlighting the importance of patient education. In this study, we aimed to demonstrate the wide reach of the manuscript through social media and news outlets. The majority of social media correspondences have come from Thai accounts whereas news outlets were mostly from the United States and various European or Asian countries. Analyzed by Altmetric score, the report was within the top 5% of all research outputs ever scored by Altmetric. Finally, Google Trend data indicates that fish pedicure interest decreased thereafter to the lowest levels in the past decade after the case report was published, signifying its likely effect on diminishing public interest. This case report and analysis of its news/social media reach emphasize the importance of literature/media outlets in informing patients and the public of adverse effects. As fish pedicures continue to be popular both in the US and overseas, appropriate education of the public remains important in preventing complications.

Nail conditions are not only aesthetic concerns, and nail changes may be a clue to an underlying systemic diseases or infection. Without timely treatment, nail diseases can continue to worsen and significantly impair performance of daily activities and reduce quality of life. Examination of the nails is essential at every medical visit, and may uncover important findings. Brittle nail syndrome, onychomycosis, paronychia, nail psoriasis, longitudinal melanonychia, Beau's lines, onychomadesis and retronychia are common nail disorders seen in clinical practice. These conditions stem from infectious, inflammatory, neoplastic and traumatic aetiologies. Though each nail condition presents with its own distinct characteristics, the clinical findings may overlap between different conditions, resulting in misdiagnosis and treatment delays. Patients can present with nail plate changes (e.g. hyperkeratosis, onycholysis, pitting), discolouration, pain and inflammation. The diagnostic work-up of nail disease should include a detailed history and clinical examination of all 20 nail units. Dermoscopy, diagnostic imaging and histopathologic and mycological analyses may be necessary for diagnosis. Nail findings concerning for malignancy should be promptly referred to a dermatologist for evaluation and biopsy. Nail disease management requires a targeted treatment approach. Treatments include topical and/or systemic medications, discontinuation of offending drugs or surgical intervention, depending on the condition. Patient education on proper nail care and techniques to minimize further damage to the affected nails is also important. This article serves to enhance familiarity of the most common nail disorders seen in clinical practice. It will highlight the key clinical manifestations, systematic approaches to diagnosis and treatment options for each nail condition to improve diagnosis and management of nail diseases, as well as patient outcomes. Nail disease is not only a cosmetic issue, as nail changes can indicate the presence of a serious underlying systemic disease, infection or malignancy. Nail pain and changes associated with NP are physically and emotionally distressing and may contribute to functional impairment and diminished quality of life. LM is a hallmark sign of subungual melanoma and this finding warrants further investigation to rule out malignancy. [ABSTRACT FROM AUTHOR]

• CVA6 has become one of the main pathogens of HFMD in the Xi'an area during 2013–2019. • The rashes were more frequently on the trunk and elbows/knees in the CVA6 group than in the EV-A71/CVA16 group, with two or more rash morphologies and with a higher incidence of bullous rash and onychomadesis. • The incidence of fever and the average white blood cell (WBC) count in the CVA6 group was higher than in the EV-A71/CVA16 group. To investigate the clinical features of hand, foot, and mouth disease (HFMD) caused by coxsackievirus A6 (CVA6) and this work may help early diagnose of atypical HFMD. From January 2013 to December 2019, a total of 7,208 patients with a clinical diagnosis of HFMD in Xi'an Children's Hospital, Xi'an Central Hospital, and Xi'an Jiaotong University Second Affiliated Hospital, were included in this observational study. The clinical data, specimens and follow-up results were collected. Real-time RT‒PCR was performed for the detection and typing of enterovirus nucleic acids. Of the 7,208 clinically diagnosed HFMD patients, 5,622 were positive for enterovirus nucleic acids, and the positive proportions of CVA6, enterovirus 71 (EV-A71), coxsackievirus A16 (CVA16), and other enteroviruses were 31.0% (1,742/5,622), 27.0% (1,518/5,622), 35.0% (1,968/5,622), and 7.0% (394/5,622), respectively. Based on the etiology, patients were divided into CVA6 group, EV-A71group, and CVA16 group. The mean age at onset was significantly higher in the CVA6 group (4.62±2.13 years) than in the EV-A71 group and CVA16 group (3.45±2.25 years and 3.35±2.13 years, respectively; both P < 0.05). The male/female ratio was 1.45 (1,031/711) in the CVA6 group and was not significantly different from the other two groups. The incidence of fever was significantly higher in the CVA6 group [82.5% (1,437/1,742)] than in the EV-A71 group [51.3% (779/1,518)] and the CVA16 group [45.9% (903/1,968)] (P < 0.05). In the CVA6 group, the rashes were more frequently on the trunk and elbows/knees and were significantly different from the other two groups (P < 0.05). The number of patients with two or more rash morphologies was significantly higher in the CVA6 group than in the other two groups (P < 0.05). The incidence of bullous rash in the CVA6 group [20.2%; n = 352] was higher than in the EV-A71 group [0.33%; n = 5] and CVA16 group [0.66%; n = 13] (P < 0.05). The incidence of neurological complications was significantly higher in the EV-A71 group [52.1% (791/1,518)] than in the CVA16 group [5.1% (100/1,968)] and the CVA6 group [0.8% (14/1,742)] (P < 0.05). In the follow-up period, 160 patients (9.2%) with CVA6 HFMD experienced onychomadesis, but no onychomadesis was observed in the EV-A71 and CVA16 groups. The average WBC count was significantly higher in the CVA6 group than in the CVA16 group (P < 0.05). The number of patients with increased CRP was significantly larger in the CVA6 group than in the CVA16 group but was significantly smaller than that in the EV-A71 group (P < 0.05). CVA6 has become one of the main pathogens of HFMD in the Xi'an area during 2013–2019. The main clinical manifestations were slightly different from those of HFMD caused by EV-A71 or CVA16, with a higher frequency of fever, diverse morphologies and diffuse distribution of rashes, fewer neurological complications and some onychomadesis. [Display omitted] [ABSTRACT FROM AUTHOR]

Sézary syndrome is a systemic variant of cutaneous T‐cell lymphoma characterized by erythroderma, lymphadenopathy and circulating atypical lymphocytes (Sézary cells). It may present with nonspecific lesions on multiple digits. We describe an atypical case of brentuximab‐induced splinter nail haemorrhages in a patient with Sézary syndrome, associated with a poor prognosis during follow‐up. Concomitantly with the appearance of nail lesions, significant lymphocytosis was detected as well as infiltration of bone marrow and nail matrices. The lesions followed a precise sequence, which can be traced back to the monthly application of brentuximab and its direct cytotoxic effect on CD30+ T lymphocytes in the nail matrix. Brentuximab‐induced nail lesions might be associated with decreased efficacy of brentuximab in this patient with advanced cutaneous T‐cell lymphoma. [ABSTRACT FROM AUTHOR]

Abstract is missing (Short communication)

The most common symptoms of COVID-19 infection are fever and cough; but may cause respiratory, enteric, hepatic, nephrotic, neurological, and skin involvement. Onychomadesis is the proximal separation of the nail plate from the nail matrix due to a temporary cessation of nail growth. Numerous studies about cutaneous manifestations of COVID-19 were reported; however findings of nails were limited. This paper reported a case of onychomadesis which appeared on the nails after a severe COVID-19 infection (MIS-C). [ABSTRACT FROM AUTHOR]

Onychomadesis is an idiopathic shedding of a proximal part of the nail as a result of the temporary suspension of a nail matrix function. It is seen in fingernails, toenails, or both. Various underlying causes like systemic illness, drug reactions, Viral diseases, and bullous diseases have been associated with Onychomadesis. However, the mechanism of any such association remains unclear. Here we present a case of On-ychomadesis and Beau lines in the fingernails of a 13-month-old girl following Hand, foot, and mouth disease. [J Med Allied Sci. 2021; 11(2):183-185]

Abstract Background In 2017, an outbreak of onychomadesis occurred in kindergarten H, Hubei province, China. We investigated the field to learn about the magnitude and reason of the outbreak. Methods The case definition was that a child with onychomadesis or transverse ridging (Beau’s line) in fingernails and toenails without previous traumatic or systemic disease in kindergarten H from Sep. 1st to Nov. 30th, 2017. A retrospective cohort study was carried out to analyze the epidemiological relationship between onychomadesis and the hand-foot-mouth disease (HFMD) in Primary Class #2, kindergarten H. We also performed a serological survey for neutralizing antibodies against coxsackie virus A6 (CVA6), coxsackie virus A10 (CVA10) among 15 cases and six healthy children in the kindergarten. Meanwhile, some children were carried out with routine blood, fungal microscopic and microelement tests. Indoor environment examinations had been done for all classes. Results A total of 20 cases were identified in Kindergarten H. Seventy-five percent (15/20) cases occurred in Primary Class #2. Fifty-five percent of the cases (11/20) had suffered from HFMD within two months. The median time between onychomadesis and HFMD was 45 days (ranging from 31 to 58 days). A retrospective cohort study in Primary Class #2 showed the attack rate was 90.0% among 10 children who suffered from HFMD in the past two months compared to 30.0% among 20 children who didn’t (Rate Ratio [RR] =3.0, 95% Confidence Interval [CI] =1.5–6.0). The positive rates of neutralizing antibodies were 66.7% for CVA6 and 26.7% for CVA10 in tested cases. The result of routine blood, fungal microscopic, microelements tests were normal in cases. The indicators of environment were within the normal range. Conclusion The results of this study suggested that the outbreak of onychomadesis in Hubei province was probably associated with HFMD epidemic within two months.

Onychomadesis is an anomaly of nails characterized by shedding of nail plates due to temporary arrest in the activity of the nail matrix. Systemic or local factors ranging from acute febrile illnesses, auto-immune diseases, drugs, chemotherapy, trauma, etc., have been known to cause onychomadesis. We report a unique case of onychomadesis following frostbite in a serving soldier posted at high altitude and extreme cold climate area.

Onychomadesis is a nail plate abnormality with temporary cessation in the growth of the nail plate due to disturbances in the nail matrix. Any local or systemic condition affecting the nail matrix directly or indirectly can lead to onychomadesis. The causes can vary from idiopathic infections to systemic causes. Although onychomadesis is not a finding unique to any disease, it indicates the presence of a preceding trigger, which affects the nail matrix. Here, we report one such case of onychomadesis following acute hepatitis B infection.

Background: In rare dermatology cases the differential diagnosis is challenging, e.g. when one nail is growing below another, the provisional diagnosis could be confusing. It may present as chronic paronychia, candidiasis, bacterial infections, rheumatoid arthritis, psoriasis, subungual tumours, or cysts., Case Description: We present a case of iatrogenic rupture of the nails of both big toes following a commonly known recommendation from physiotherapists in the initial stages of hallux valgus or chronic arthritis by using kinesio tape to prevent the big toe from fixation in the valgus position. The initial provisional diagnosis of retronychia was revised, and a final diagnosis of onychomadesis was made. The patient's complaint was solved after around one year without any specific therapy., Conclusion: The differential diagnosis for onychomadesis needs a careful and detailed history that may prevent a patient from a frightening diagnosis and painful, long-lasting treatments., Learning Points: The differential diagnosis of retronychia, onychomycosis and onychomadesis is challenging.Both onychomadesis and retronychia share a common pathophysiologic mechanism.A careful and detailed history prevents a patient from a frightening diagnosis and painful, long-lasting treatment of nail disorders., Competing Interests: Conflicts of Interests: The Authors declare that there are no competing interests., (© EFIM 2024.)

Summary: Upper extremity allotransplantation (UEA) is the more common type of vascularized composite allotransplantation of which more than 80 patients have benefited worldwide. These allografts include – along with the skin – the nail unit, a specialized epithelial appendage which may be the target of graft rejection. We report an UEA recipient who developed, as an initial manifestation of graft rejection, onychomadesis, that is shedding of the nail plate starting from the proximal nail bed. On this occasion, we reviewed the nail changes we have observed in a series of eight patients with UEA who were grafted and followed in our hospital since 1998 (mean follow‐up period of 9.75 years). We also reviewed the relevant literature reporting nail changes in UEA recipients. A brief discussion on the significance of these changes in the context of UEA is provided with emphasis on onychomadesis, a finding usually related to graft rejection in this specific setting. [ABSTRACT FROM AUTHOR]

Nail dermoscopy in recent years has become an auxiliary noninvasive tool for the diagnosis of nail diseases. It detects the differentiating characteristics of the nail units and assesses in the management of nail diseases. Dermoscopy may not be a diagnostic tool for all nail diseases; however, it is very useful for early observation with high magnification. This article discusses the important and common dermoscopic manifestations of nail disease cases in the daily practice. Currently, the indications of dermoscopy include viral, bacterial, fungal, inflammatory, pigmented, traumatic nail diseases, nail tumors, and connective tissue disease. [ABSTRACT FROM AUTHOR]

Abstract Background Coxsackievirus A6 (CVA6) is one of the major agents to cause hand, foot and mouth disease (HFMD) outbreaks globally. The objective of this study is to investigate the epidemiologic and clinical manifestations of CVA6 outbreak, and thus guide the diagnosis and treatment of the disease, as well as disease prevention. Methods An HFMD outbreak in a kindergarten was reported to Shijingshan District Center for Disease Control and Prevention (SCDC) on November 2, 2015 in Beijing, China. Epidemiological investigation was conducted. We performed a nine-week follow-up study to collect and analyze the clinical manifestations of HFMD cases. Results The outbreak yield 56 (15.7%) clinical diagnosed HFMD cases out of 357 registered children in the kindergarten with the mean age of 3.5 years old. This outbreak lasted for three days and ceased after initiating infectious disease controlling procedures, including periodical suspension of the kindergarten activities, environmental disinfection, and family health education. Fifty-one cases were followed for nine weeks. The positive rate of clinical manifestations of rash, fever, desquamation, pigmentation and onychomadesis were 100.0%, 84.3%, 68.6%, 17.6% and 43.1%, respectively. Children developed desquamation within the first 4 weeks after disease onset and developed onychomadesis between the 3th and 8th week after disease onset. Children with desquamation had 9.3 (95%CI: 1.836–47.437) times higher odds of developing onychomadesis compared to those without this manifestation. Ten out of 14 collected samples were CVA6 positive, and five positive samples shared a high degree of similarity in the VP1 nucleotide and amino acid sequences (99.9–100.0% and 100%). Conclusion This HFMD outbreak was caused by CVA6, featured with delayed symptoms. Emerging CVA6-associated HFMD and its delayed symptoms should be paid more attention to reduce outbreaks and provide more information to doctors and parents.

Summary Coxsackievirus A6 (CV‐A6) has been associated with increasingly occurred sporadic hand‐foot‐mouth disease (HFMD) cases and outbreak events in many countries. In order to understand epidemiological characteristics of CV‐A6, we collected the information describing HFMD caused by CV‐A6 to describe the detection rate, severe rate and onychomadesis rate, which is defined as one or more nails defluvium, caused by CV‐A6 from 2007 to 2017. The results showed that there was an outbreak of CV‐A6 every other year, and overall trend of the epidemic of CA6‐associated HFMD was increasing in China. The detection rate of CV‐A6 in other countries was 32.0% (95% CI: 25.0%~40.0%) before 2013 and 28.0% (95% CI: 20.0%~36.0%) after 2013, respectively. Although the severe rate of HFMD caused by CV‐A6 was low (0.10%, 95% CI: 0.01%~0.20%), CV‐A6 can cause a high incidence of onychomadesis (28.0%, 95%CI: 21.9%‐34.3%). Thus, it would be worthwhile to research and develop an effective multivalent vaccine for CV‐A6 to achieve a more powerful prevention of HMFD. [ABSTRACT FROM AUTHOR]

Hand-foot-and-mouth disease (HFMD) is a common viral affection. Onychomadesis can be associated with HFMD. Seven children (3 boys and 4 girls) aged between 7 and 11 years were consulted during 2018 for an acquired onychodystrophy of the nails from the hands and feet. The anamnesis revealed that all patients were diagnosed with HFMD 3-5 weeks before the appearance of onychomadesis. Onychomadesis is a manifestation that can be associated with HFMD. This occurs on average 4-5 weeks after the infection, the Coxsackie A6 virus being the most commonly agent causing the disease. The pathophysiology of onychomadesis is unclear. Evolution is favorable, the nail rising normally about 9 months in the legs and 3 months in the hands. [ABSTRACT FROM AUTHOR]

In dogs, symmetrical lupoid onychodystrophy (SLO) results in nail loss and an abnormal regrowth of the claws. In Bearded Collies, an autoimmune nature has been suggested because certain dog leukocyte antigen (DLA) class II haplotypes are associated with the condition. A genome-wide association study of the Bearded Collie revealed two regions of association that conferred risk for disease: one on canine chromosome (CFA) 12 that encompasses the DLA genes, and one on CFA17. Case-control association was employed on whole genome sequencing data to uncover putative causative variants in SLO within the CFA12 and CFA17 associated regions. Genotype imputation was then employed to refine variants of interest. Although no SLO-associated protein-coding variants were identified on CFA17, multiple variants, many with predicted damaging effects, were identified within potential candidate genes on CFA12. Furthermore, many potentially damaging alleles were fully correlated with the presence of DLA class II risk haplotypes for SLO, suggesting that the variants may reflect DLA class II haplotype association with disease or vice versa. Strong linkage disequilibrium in the region precluded the ability to isolate and assess the individual or combined effect of variants on disease development. Nonetheless, all were predictive of risk for SLO and, with judicious assessment, their application in selective breeding may prove useful to reduce the incidence of SLO in the breed.

Onychomadesis is an idiopathic shedding of a proximal part of the nail as a result of the temporary suspension of a nail matrix function. It is seen in fingernails, toenails, or both. Various underlying causes like systemic illness, drug reactions, Viral diseases, and bullous diseases have been associated with Onychomadesis. However, the mechanism of any such association remains unclear. Here we present a case of Onychomadesis and Beau lines in the fingernails of a 13-month-old girl following Hand, foot, and mouth disease. [ABSTRACT FROM AUTHOR]

Kawasaki disease is a vasculitis of medium-sized vessels and the most common cause of acquired heart defects in the United States. Although its etiology is unclear, an infectious trigger has been theorized, which has been highlighted by the recent pandemic. We present a case of a 17-month-old-girl with concurrent Kawasaki disease and non–SARS-CoV2 coronavirus infection and a sequela of onychomadesis. [ABSTRACT FROM AUTHOR]

Ang Li,1,2,* Yanqiong Li,1,3,* Lingzhi Ge,4 Ping Li,1,3 Wenfei Li1 1Department of Dermatology, Qianfoshan Hospital, Shandong University, Jinan, People’s Republic of China; 2Department of Clinical Medicine, Queen Mary School, Medical School, Nanchang University, Nanchang, People’s Republic of China; 3Department of Clinical Medicine, Taishan Medical college, Tai’an, People’s Republic of China; 4Department of Dermatology, Affiliated First Hospital of Taishan Medical college, Tai’an, People’s Republic of China *These authors contributed equally to this work Abstract: The side effects of chemotherapy drugs have increased in recent years, and some side effects can lead to onychomadesis. A 72-year-old woman who was diagnosed with an invasive ductal carcinoma of the right breast underwent a modified radical mastectomy in April 2015, followed by chemotherapy with capecitabine and nanoparticle albumin-bound paclitaxel (nab-paclitaxel). Subsequently, the patient experienced palmoplantar redness, pain, onycholysis, a transparent serous exudate, and onychomadesis. The chemotherapy was discontinued, and the patient was treated with oral vitamin B6, a polymyxin ointment, and a high-energy red light. The palmoplantar redness and pain were alleviated after 1 month. However, although her fingernails improved, dysesthesia symptoms remained, and all her toenails exhibited defects or deformities at a 24-month follow-up. The symptoms of this disorder should be recognized by dermatologists. Keywords: capecitabine and nab-paclitaxel, side effects, onychomadesis loss of nail

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

Dermatology Assessment represents a novel readership-based tutorial module. Each question links to the Journal of the Dermatology Nurses' Association articles (for members) and Journal of the American Academy of Dermatology article citations associated with the topic. [ABSTRACT FROM AUTHOR]

Onychomadesis has been described as proximal separation of the nail plate from the nail matrix due to drastic insult to the matrix that induces a total arrest of matrix activity. A vast variety of health conditions, mainly including infections and autoimmune diseases have been implicated in the etiology of onychomadesis. However, up to now no published data is available on the association of autoimmune thyroid disease with onychomadesis. Here, we present a case of autoimmune thyroid disease induced onychomadesis in a 85-year-old woman. Moreover, we highlighted a distinct feature of the patient in that nail findings of the patient exceptionally resemble thyroid acropachy, which is a very rare manifestation of autoimmune thyroid disease. [ABSTRACT FROM AUTHOR]