The Diagnosis and Treatment of Nail Disorders

Wollina, Uwe; Nenoff, P.; Haroske, G.; Haenssle, Holger A.

doi:10.3238/arztebl.2016.0509

Cited by 46 publications

(46 citation statements)

References 60 publications

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“…Other less common changes seen in patients with eczema were found to be pitting (25 %) and onycholysis (16.6%). Similar findings were reported in a study conducted by wollina U et al [17] In our study common nail changes seen in patients with lichen planus were found to be longitudinal ridging (75 %) and thinning of nail plate (75%) followed by Ptrygium (25 %). and Pigmentation (25 %).…”

Section: Discussionsupporting

confidence: 92%

A Prospective Study of Nail Changes in Dermatological and Systemic Illnesses

Rathi¹,

Mishra²,

Chaudhari³

2018

AIMDR

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Background: Some of the nail changes seen in certain dermatological or systemic pathologies may be unique to concerned condition. The knowledge of such nail changes may be immensely helpful in the diagnosis of some of these pathologies. Nail changes may precede other signs in some conditions and in these cases nail changes may help in early diagnosis. Various components of the nails which may get affected may include nail matrix, nail plate, nail bed and vasculature. We conducted this prospective study to know the prevalence of nail changes in various dermatological and systemic illnesses in patients attending dermatology outpatient department and patients admitted in different wards of our teaching institute. Aims and Objectives: (1) To study various nail changes in association with skin and systemic diseases. (2) To assess the diagnostic and prognostic significance of various nail changes. (3) To find our various etiological factors of the nail diseases. Methods: After approval from institutional ethical committee and obtaining informed consent from the patients nail changes were studied in patients attending dermatology OPD and those patients who were admitted in various wards of our institute. History, investigations and general and systemic examination was done in all the patients. Patients were included in this study on the basis of predefined inclusion and exclusion criteria. Nail and toes were examined for the changes such as dystrophy, ridging, thinning of nail plates, presence of Ptrygium, pigmentation and onycholysis. The changes were studied and their association with skin and systemic diseases was determined. Data analysis was carried out using SPSS16.0 version software. Results: In this prospective study of 225 patients there were 142 males (63.1 %) and 83 females (36.9 %) with a M: F ratio of 1:0.58. Most common age group to be affected was found to be 21-30 years and 31-40 years followed by 41-50 years and 51-60 years. The most common nail change was found to be onychomycosis (31.1 %) followed by paronychia (16%), psoriasis (11.5 %) and nail dystrophy (8.8 %). Longitudinal ridging, thinning of nail plates, pitting, Ptrygium and pigmentation were common changes seen in patients with lichen planus. Conclusion: Examining the patients for nail changes which may be seen in association with various dermatological and systemic conditions is an integral part of dermatology practice. These nail changes may precede the other signs and symptoms of the diseases and hence may be crucial in early diagnosis of such conditions.

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Section: Discussionsupporting

confidence: 92%

A Prospective Study of Nail Changes in Dermatological and Systemic Illnesses

Rathi¹,

Mishra²,

Chaudhari³

2018

AIMDR

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“…Subungual melanoma has a poor prognosis due to delayed diagnosis. Therefore, every unclear subungual pigmentation needs a histologic evaluation [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

“…The most common cause is subungual hematoma followed by infections of the nail apparatus. Vascular diseases including tumours and malformations represent important differential diagnoses [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Subungual Nail Pigmentation and Malalignment of the Great Toe Nail in a Cancer Patient - A Diagnostic Challenge

Wollina¹,

Tchernev²

2017

Open Access Maced J Med Sci

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Subungual pigmentation may have a variety of underlying pathologies, but clinicians should consider malignancies such as subungual melanoma or metastasis, even if they are not common. A delayed diagnosis can dramatically worsen the prognosis. Therefore, histologic examination is highly recommended. We present a 75-year-old female cancer patient presenting with subungual blackish pigmentation of the great toe nail for several years suspicious of a subungual melanoma even by dermoscopy. Nail avulsion and histological investigations excluded melanoma. The final diagnosis was subungual hematoma with growth malalignment of the great toe nail.

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“…Onychomadesis appears as a whole thickness sulcus that separates the nail into two parts and is caused by a temporary nail matrix arrest (NMA). The common causes of onychomadesis include local traumas, local cutaneous diseases, medications, viral infections, pemphigus, Kawasaki disease, rare idiopathic or familial diseases . Common medications which would induce onychomadesis include indinavir, retinoids, and chemotherapeutic drugs …”

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confidence: 99%

Mycophenolic acid‐induced onychomadesis: An easily ignorable adverse effect in patients with rheumatic diseases

Feng

2019

Int J of Rheum Dis

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We had great interest in reading the published paper fromBoulous and colleagues, who demonstrated mycophenolate mofetil (MMF) contributes to the treatment of diffuse scleroderma. 1 Dr Tang and Dr Joo respectively mentioned that MMF is effective for induction of membranous glomerulonephritis and lupus nephritis. 2,3 MMF and mycophenolic acid (MPA) have been widely prescribed for rheumatic diseases, including lupus nephritis, cutaneous diseases and for preventing rejection after organ transplantation. Gastrointestinal symptoms and bone marrow suppression are the most commonly noticed adverse effects. 4 Nonetheless, nail disorder is rarely reported to be an adverse effect of MPA. Here, we reported the first case of MPA-induced onychomadesis. A 34-year-old woman presented at our clinic with unhealed cutaneous ulcers that had persisted for 6 months bilaterally on her lower legs. The patient did not have medical problems but used to smoke two packs of cigarettes per day. Physical examinations showed normal bilateral palpable dorsalis pedis pulsation. Contrast computed tomography revealed a bilateral occlusion of her posterior tibialis arteries with collateral circulation in the lower limbs. Laboratory evaluations showed normal white cell count, erythrocyte sedimentation rate, and C-reactive protein level, and did not show the presence of autoantibodies. Culture of the unhealed wound revealed no microorganism growth. Histological examination of her unhealed wounds indicated mixed acute and chronic inflammation with granulation tissue formation, and focal neutrophilic infiltration of the vascular wall. Thromboangiitis obliterans (TAO) was diagnosed. She received a silver-containing foam dressing, daily medications with colchicine 0.5 mg, and MPA 360 mg. Onychomadesis developed bilaterally in all 20 proximal nails of phalanges 1 month after MPA (Figure 1A).Nail lesions went into remission gradually 1 month after withdrawing MPA ( Figure 1B), and total remission three month after, whereas she was still taking colchicine ( Figure 1C).Thromboangiitis obliterans, a nonatherosclerotic segmental occlusive vasculitis, is often noted in young adults and diagnosed based on unhealed cutaneous ulcers on distal lower limbs, tobacco use, and exclusion of autoimmune diseases. 5 The histological findings of TAO reveal that T lymphocytes outnumber B lymphocyte infiltration in the thrombi and intima. 6 Thus, MPA was prescribed for these refractory cutaneous ulcers in this TAO woman.

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The Diagnosis and Treatment of Nail Disorders

Abstract: Evaluation of the nail organ is an important diagnostic instrument. Aside from onychomycosis, which is a common nail disorder, important differential diagnoses such as malignant diseases, drug side effects, and bacterial infections must be considered.

Cited by 46 publications

References 60 publications

A Prospective Study of Nail Changes in Dermatological and Systemic Illnesses

A Prospective Study of Nail Changes in Dermatological and Systemic Illnesses

Subungual Nail Pigmentation and Malalignment of the Great Toe Nail in a Cancer Patient - A Diagnostic Challenge

Mycophenolic acid‐induced onychomadesis: An easily ignorable adverse effect in patients with rheumatic diseases

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