Multiple melanonychia striata as a sign of connective tissue disorders

Edamitsu, Tomohiro; Uhara, Hisashi; Minagawa, Akane; Okuyama, Ryuhei

doi:10.1016/j.jaad.2018.01.008

Cited by 4 publications

(5 citation statements)

References 5 publications

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“…Thus, ischemia increasing the melanin in the nail matrix may be the cause of longitudinal melanonychia. 12 In this case, the onset of chronic longitudinal melanonychia was after 38 months of treatment with HQ and the diagnosis of SLE. The symptoms in the nails remained stable over a period of 15 years and have not changed with the severity of SLE, which suggests longitudinal melanonychia is more likely to be caused by HQ.…”

Section: Discussionmentioning

confidence: 77%

Longitudinal melanonychia and subungual hemorrhage in a patient with systemic lupus erythematosus treated with hydroxychloroquine

Zhang

Liu

Cai

et al. 2018

Lupus

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Hydroxychloroquine is an antimalarial agent, most commonly prescribed in the treatment of several rheumatic diseases. Although generally well tolerated, a variety of mucocutaneous adverse effects have been reported. Besides the familiar adverse effects, longitudinal melanonychia is rarely seen. Although the incidence is extremely low, systemic lupus erythematosus may also cause nail pigmentation in its own right. We report the case of a 55-year-old woman who was diagnosed with systemic lupus erythematosus and presented with longitudinal melanonychia of all 10 fingernails after 3 years of treatment with hydroxychloroquine, without mucocutaneous hyperpigmentation. The pigment of the nail lasted for more than 15 years. To the best of our knowledge, this is first published report of hydroxychloroquine-induced melanonychia without mucocutaneous hyperpigmentation. This case demonstrates that hydroxychloroquine treatment and the primary disease should be considered in the case of multiple nail changes in patients with systemic lupus erythematosus.

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Section: Discussionmentioning

confidence: 77%

Longitudinal melanonychia and subungual hemorrhage in a patient with systemic lupus erythematosus treated with hydroxychloroquine

Zhang

Liu

Cai

et al. 2018

Lupus

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“…Melanonychia striata is more common in the thumb. Involvement of multiple digits is less common and is most commonly seen in dark-skinned individuals and individuals with connective tissue disorders [5,18,19]. Our case is unique that all the fingernails and toenails were affected.…”

Section: Discussionmentioning

confidence: 87%

Laugier–Hunziker Syndrome in an 8-Year-Old Boy with Scleral Melanocytosis, Lingual Pigmentation, Labial Pigmentation, and Melanonychia Striata

Leung

Leong

Barankin³

et al. 2020

Case Reports in Pediatrics

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Laugier–Hunziker syndrome is a rare, acquired disorder characterized by mucocutaneous hyperpigmentation and melanonychia striata with no underlying systemic abnormalities. We report an 8-year-old boy with Laugier–Hunziker syndrome who presented with melanonychia striata affecting all the fingernails and toenails, macular pigmentation on the tongue and the lower lip, and scleral melanocytosis. Melanonychia striata rarely affect all the twenty nails, and scleral melanocytosis has rarely been reported in association with Laugier–Hunziker syndrome. Laugier–Hunziker syndrome occurs predominately in adults. Our patient is the youngest reported patient with Laugier–Hunziker syndrome.

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“…Melanonychia striata may result from melanocytic activation or melanocytic hyperplasia (Tables and ) . In most of the cases, melanonychia striata results from melanocytic activation in the nail matrix (an increase in activity of melanocytes with the subsequent increased synthesis of melanin in the nail matrix and subsequent deposition of melanin in the nail plate without a concurrent increase in the number of melanocytes) .…”

Section: Etiologymentioning

confidence: 99%

“…The involvement of multiple digits is less common and is most commonly seen in dark‐skinned individuals and individuals with connective tissue disorders (Fig. ) . A recent study showed that of the 97 Japanese patients (27 males, 70 females; mean age 45.3 years) with melanonychia striata, 18 patients had melanonychia striata involving more than two fingers .…”

Section: Clinical Manifestationsmentioning

confidence: 99%

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Melanonychia striata: clarifying behind the Black Curtain. A review on clinical evaluation and management of the 21st century

et al. 2019

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Melanonychia striata is characterized by a tan, brown, or black longitudinal streak within the nail plate that runs from the proximal nail fold to the distal part of the nail plate.Melanonychia striata is due to increased activity of melanocytes or melanocytic hyperplasia in the nail matrix with subsequently increased melanin deposition in the nail plate. The most common cause of melanonychia striata associated with melanocytic activation is ethnic melanonychia which occurs in dark-skinned individuals. Other causes of melanonychia striata related to melanocytic activation include pregnancy, chronic local trauma, infections, medications, dermatological disorders, endocrine disorders, alkaptonuria, hemochromatosis, porphyria, graft-vs-host disease, Peutz-Jeghers syndrome, and Laugier-Hunziker syndrome. Causes of melanonychia striata associated with melanocytic hyperplasia include nail matrix melanocytic nevus, nail lentigo, and nail apparatus/subungual in situ and invasive melanoma. In most cases, melanonychia striata is a benign condition, especially in children. Consequently, most investigators advocate a wait-and-see approach. Nail apparatus/subungual melanoma should be suspected if there is an abrupt onset after middle age, personal or family history of melanoma, rapid growth, darkening of a melanonychia band, pigment variegation, blurry lateral borders, irregular elevation of the surface, a bandwidth >3 mm, proximal widening, associated nail plate dystrophy, single rather than multiple digit involvement, and periungual spread of pigmentation onto the adjacent cuticle and/or proximal and/or lateral nail folds (Hutchinson sign). Prolonged follow-up is mandatory for early detection of possible malignant changes.

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Multiple melanonychia striata as a sign of connective tissue disorders

Cited by 4 publications

References 5 publications

Longitudinal melanonychia and subungual hemorrhage in a patient with systemic lupus erythematosus treated with hydroxychloroquine

Longitudinal melanonychia and subungual hemorrhage in a patient with systemic lupus erythematosus treated with hydroxychloroquine

Laugier–Hunziker Syndrome in an 8-Year-Old Boy with Scleral Melanocytosis, Lingual Pigmentation, Labial Pigmentation, and Melanonychia Striata

Melanonychia striata: clarifying behind the Black Curtain. A review on clinical evaluation and management of the 21st century

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