Bilateral Beau’s Lines and Pyogenic Granulomas following Guillain-Barré Syndrome

Mazereeuw‐Hautier, J.; Bonafé, J. L.

doi:10.1159/000079898

Cited by 17 publications

(9 citation statements)

References 5 publications

(7 reference statements)

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“…6 Tosti and colleagues reported cases of periungual pyogenic granulomata after ulnar fracture, with the proposed mechanism being mild peripheral nerve injury after improper casting, 7 but it has also been suggested that the mechanism behind the development of these lesions was secondary to decreased rate of nail growth caused by immobilization of the limb. 8 We feel that our patient's pyogenic granulomata were caused by trauma to the lateral nail folds secondary to pincer nails. Although we anticipate recurrence without definitive treatment of his pincer nails, the patient has been able to avoid this with appropriate nail care.…”

Section: Discussionmentioning

confidence: 74%

“…Several drugs have been implicated, including systemic retinoids, the highly active antiretroviral therapy protease inhibitors indinavir and lamivudine, 4 the tyrosine kinase inhibitor gefitinib, 5 and 5‐fluorouracil along with its oral prodrug capecitabine 6 . Tosti and colleagues reported cases of periungual pyogenic granulomata after ulnar fracture, with the proposed mechanism being mild peripheral nerve injury after improper casting, 7 but it has also been suggested that the mechanism behind the development of these lesions was secondary to decreased rate of nail growth caused by immobilization of the limb 8 . We feel that our patient's pyogenic granulomata were caused by trauma to the lateral nail folds secondary to pincer nails.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of Multiple Periungual Pyogenic Granulomata from Pincer Nails with Pulsed Dye Laser

Miller

Levitt

2011

Dermatologic Surgery

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The authors have indicated no significant interest with commercial supporters.M ultiple periungual pyogenic granulomata are an uncommon phenomenon. We present a case of a 16-year-old boy with multiple pyogenic granulomata of the nail folds caused by pincer nails. These lesions were successfully treated with two sessions of pulsed dye laser (PDL; 595 nm, 7-mm spot size, 8 J/cm 2 , 0.45-ms pulse width) with a 1-week interval after failure of surgical excision, and their recurrence has been prevented with appropriate home nail care. Along with this interesting case, a brief review of the reported causes of multiple periungual pyogenic granulomata and the treatment of pyogenic granulomata with PDL will be discussed. CaseA 16-year-old boy presented to clinic with a 6-month history of a friable papule on the lateral periungual region of the left third finger. He was first seen at an outside clinic where the lesion was thought to be an abscess and treated with incision and drainage. He had also been treated with amoxicillin/clavulanic acid, ciprofloxacin, and topical mupirocin. The lesion did not heal, remaining painful, friable, and occasionally purulent. He underwent a biopsy, which was consistent with pyogenic granuloma, followed by surgical resection, with subsequent complete recurrence.On examination at our clinic, pincer nails were noted, as well as an eroded, crusted papule of the lateral nail fold of the left third finger (Figure 1). The patient was started on imiquimod 5% cream once daily. After 3 weeks of treatment, his finger appeared more edematous and erythematous, and he had begun to develop a similar lesion on the fourth finger, which he was also treating with imiquimod. At that time, because of concern for superinfection, imiquimod was discontinued, and the patient was started on a 7-day course of levofloxacin along with topical econazole and triple antibiotic ointment. Fungal and bacterial cultures were negative. Another biopsy was performed showing vascular proliferation with a dense lymphoid infiltrate. At this time, we debrided the serosanguineous crust from the lesions, along with the offending portion of the nail plates (Figure 2), and treated the lesions with pulsed dye laser (PDL; 595 nm, 7-mm spot size, 8 J/cm 2 , 0.45-ms pulse width) in two sessions 1 week apart. These aggressive laser settings were chosen to maximize the therapeutic response by delivering the greatest amount of energy in the least amount of time. Prior experience in treating these lesions with longer pulse widths, specifically, had not proven to be successful. Pulses were stacked two to three times, with purpura being the point at which a therapeutically meaningful dose of energy was thought to be delivered ( Figure 3A). The patient was then counseled to cut his nails straight across and allow them to grow out slightly and he was shown how to tape the nail fold back to alleviate pressure. He was also

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Treatment of Multiple Periungual Pyogenic Granulomata from Pincer Nails with Pulsed Dye Laser

Miller

Levitt

2011

Dermatologic Surgery

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“…A 9‐year‐old boy developed PGs in the proximal nail folds of three fingers 2 months after several episodes of oxygen desaturation 45 . The development of periungual PGs has also been reported after Guillain–Barré syndrome 46 and in patients with hemiplegia 47 …”

Section: Discussionmentioning

confidence: 94%

Periungual and subungual pyogenic granuloma

Piraccini

Bellavista

Misciali

et al. 2010

British Journal of Dermatology

115

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“…The authors related these lesions to a mild peripheral nerve injury, although they did not find any pathologic sign in neurophysiologic studies. Mazereeuw‐Hautier et al (3) reported another patient who developed bilateral Beau's lines and pyogenic granulomas following Guillain‐Barré syndrome. Two patients have been reported presenting with subungueal pyogenic granulomas after repetitive friction provoked by long walks.…”

Section: Discussionmentioning

confidence: 99%

Beau's Lines and Multiple Periungueal Pyogenic Granulomas After Long Stay in an Intensive Care Unit

Guhl

Torrelo

Hernández

et al. 2008

Pediatric Dermatology

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Bilateral Beau’s Lines and Pyogenic Granulomas following Guillain-Barré Syndrome

Cited by 17 publications

References 5 publications

Treatment of Multiple Periungual Pyogenic Granulomata from Pincer Nails with Pulsed Dye Laser

Treatment of Multiple Periungual Pyogenic Granulomata from Pincer Nails with Pulsed Dye Laser

Periungual and subungual pyogenic granuloma

Beau's Lines and Multiple Periungueal Pyogenic Granulomas After Long Stay in an Intensive Care Unit

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