Abstract:Diabetes is a metabolic disorder caused by abnormal release of or sensitivity to the insulin hormone, with loss of blood glucose control. Un controlled diabetes can have devastating effects on many organ systems including cardiovascular, neurologic, ocular, and renal, with its impact on skin, hair, and nail. diabetes mellitus is a predisposing factor for onychomycosis (OM),paronychia and ingrowing toe nail defects. In the present study evaluation of the prevalence and types of nail changes was done. Materials … Show more
“…In another study involving adult patients with psoriasis, metabolic syndrome was identified with an increased prevalence in those with nail pitting [29]. Additionally, in a publication evaluating the spectrum of nail changes in diabetes mellitus patients, about 8.3% of such patients presented with nail pitting, having a previously diagnosis of psoriasis [30]. Hence, future studies with different, more suitable designs (i.e., case-control) and proper patient samples should consider exploring the potential link between insulin resistance and nail involvement in pediatric psoriasis patients.…”
Psoriasis is a chronic inflammatory disease with specific cutaneous and nail lesions. Recent data has emphasized its systemic nature, highlighting metabolic conditions found in patients. Insulin resistance was identified in adult psoriasis, sometimes related to psoriasis severity. Data regarding this relationship in children are limited. Consequently, we tested the association between the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and Psoriasis Area and Severity Index (PASI) using a retrospective dataset of 43 children with various types of psoriasis. First, we attempted to replicate the relationship between the HOMA-IR and PASI. Second, we explored potential associations between these variables and others in the dataset. The results illustrated no association between HOMA-IR and PASI (p-value = 0.512). The exploratory findings hinted at a connection between nail pitting and insulin resistance (p-value = 0.038), yet Bonferroni adjustments suggested the risk of a false-positive finding. Noteworthy associations were found between the HOMA-IR and body mass index (BMI) (p-value = 0.001), the PASI and quality of life impairment (p-value = 0.005), and psoriasis severity and type (p-value = 0.001). The null hypothesis that insulin resistance in children is not positively associated with psoriasis severity cannot be rejected. Pilot estimates of variables and covariates of interest are provided for further confirmatory studies assessing this hypothesis.
“…In another study involving adult patients with psoriasis, metabolic syndrome was identified with an increased prevalence in those with nail pitting [29]. Additionally, in a publication evaluating the spectrum of nail changes in diabetes mellitus patients, about 8.3% of such patients presented with nail pitting, having a previously diagnosis of psoriasis [30]. Hence, future studies with different, more suitable designs (i.e., case-control) and proper patient samples should consider exploring the potential link between insulin resistance and nail involvement in pediatric psoriasis patients.…”
Psoriasis is a chronic inflammatory disease with specific cutaneous and nail lesions. Recent data has emphasized its systemic nature, highlighting metabolic conditions found in patients. Insulin resistance was identified in adult psoriasis, sometimes related to psoriasis severity. Data regarding this relationship in children are limited. Consequently, we tested the association between the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and Psoriasis Area and Severity Index (PASI) using a retrospective dataset of 43 children with various types of psoriasis. First, we attempted to replicate the relationship between the HOMA-IR and PASI. Second, we explored potential associations between these variables and others in the dataset. The results illustrated no association between HOMA-IR and PASI (p-value = 0.512). The exploratory findings hinted at a connection between nail pitting and insulin resistance (p-value = 0.038), yet Bonferroni adjustments suggested the risk of a false-positive finding. Noteworthy associations were found between the HOMA-IR and body mass index (BMI) (p-value = 0.001), the PASI and quality of life impairment (p-value = 0.005), and psoriasis severity and type (p-value = 0.001). The null hypothesis that insulin resistance in children is not positively associated with psoriasis severity cannot be rejected. Pilot estimates of variables and covariates of interest are provided for further confirmatory studies assessing this hypothesis.
“…The pathological processes of diabetes that occur systemically are reflected in the nail (just as in the skin), which helps physicians understand the progress of this condition. General measures such as appropriate footwear, education about nail care and avoiding breaks in the skin barrier are important, along with treatment of secondary factors such as fungal infections 29 . Further research on the nail changes in diabetes will help our optimal management of the systemic features of diabetes.The nail changes in diabetes are related to hyperglycaemia and formation of AGEs.Fungal nail infections occur more commonly in patients with diabetes than in the general population and correlate with blood sugar levels.Bacterial infections can cause acute paronychia, resulting in Beau lines and onycholysis.Treatment of bacterial nail infection with general measures that address trauma, inflammation and cold may need to be continued in the long term.Fingernail periungual telangiectasia occurs in up to 50% of patients with diabetes.Diabetic neuropathic changes in the extremities can manifest with dystrophic nails.Ingrown toenails (onychocryptosis) can occur with T2DM.…”
Section: Discussionmentioning
confidence: 99%
“…General measures such as appropriate footwear, education about nail care and avoiding breaks in the skin barrier are important, along with treatment of secondary factors such as fungal infections. 29 Further research on the nail changes in diabetes will help our optimal management of the systemic features of diabetes.…”
Diabetes is a common condition that is increasing in incidence worldwide. Although the skin manifestations of this condition are well described, there is scant literature on the associated nail changes. In this review, we describe the various clinical features of nail changes associated with diabetes, which can be broadly divided into infections, vascular changes, neuropathic manifestations and miscellaneous changes, although there is overlap between them. There is no pathognomonic nail alteration, but it is important for clinicians to be aware of the potential nail manifestations in diabetes as they can facilitate investigations and thereby early diagnosis of diabetes, resulting in holistic management of the patient.
PathogenesisNail and skin changes in DM are significantly associated with hyperglycaemia and the formation of advanced glycation end-products (AGE) due to
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