UV-A and UV-B Penetration of Normal Human Cadaveric Fingernail Plate

Stern, Dana; Creasey, Alia; Quijije, John; Lebwohl, Mark

doi:10.1001/archdermatol.2010.375

Cited by 62 publications

(46 citation statements)

References 13 publications

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“…Examining of human cadaveric nails has previously showed that all of UVB and the vast majority of UVA light is blocked by the nail plate. 14 The fact that two of the cases we reported in the thumb and a previous case report in the toe 28 of subungual melanoma with a dominant UVR signature appears to refute these findings. It would therefore appear that in some patients sufficient UVR can penetrate the nail plate to cause mutation effects in the melanocytes in the underlying subungual tissue.…”

Section: Acral and Subungual Melanomas With A Dominant Uvr Signaturementioning

confidence: 57%

“…12 Furthermore, acral melanomas are thought to be protected from UVR by a thick strata corneum 13 or nail plate. 14 Therefore, it has been hypothesized that acral and sun-shielded mucosal melanomas have different genetic causal pathways unrelated to UVR exposure. This is typically reflected in low mutation burden, which is offset by numerous focused gene amplifications and deletions or structural abnormalities.…”

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confidence: 99%

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Unexpected UVR and non-UVR mutation burden in some acral and cutaneous melanomas

Rawson

Johansson

Hayward

et al. 2017

Laboratory Investigation

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Ultraviolet radiation (UVR) mutagenesis causes nearly all cutaneous melanomas, however, since UVR signatures are largely absent in acral melanoma, as well as melanoma in sun-protected sites, the cause of these melanomas is unknown. Wholegenome sequencing data generated as part of the Australian Melanoma Genome Project was supplemented with a detailed histopathological assessment with the melanomas then classified as UVR or non-UVR related, based on their mutation signatures. The clinicopathological characteristics of melanomas with mutation signatures for their subtype were compared. Three (of 35 = 8.6%) acral melanomas, all clinically and pathologically verified as arising from acral or subungual locations, had predominant UVR mutation burden, whereas four (of 140 = 2.9%) cutaneous melanomas showed predominant non-UVR mutations. Among the acral melanomas, the few that were UVR dominant occurred in younger patients, had a higher mutation load and a proportion of mutation burden due to UVR, which was similar to that in melanomas from intermittently UVR-exposed skin. Acral melanomas with a UVR signature occurred most frequently in subungual sites and included tumors harboring BRAF or NF1 mutations. Cutaneous melanomas dominated by non-UVR signatures had lower mutation burdens counts and their primary tumors were thicker and had more mitoses than in other cutaneous melanomas. No histopathological features predicted UVR dominance in acral melanomas or non-UVR dominance in cutaneous melanomas. Our finding of acral/subungual melanomas with predominant UVR mutagenesis suggests that the nail plate and acral skin do not provide complete protection from UVR. Our data also confirm that cutaneous melanomas not caused by UVR are infrequent. Identifying where mutation burden is discordant with primary tumor anatomical site is likely to be clinically significant when determining treatment options for metastatic acral and cutaneous melanoma patients.

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Section: Acral and Subungual Melanomas With A Dominant Uvr Signaturementioning

confidence: 57%

mentioning

confidence: 99%

Unexpected UVR and non-UVR mutation burden in some acral and cutaneous melanomas

Rawson

Johansson

Hayward

et al. 2017

Laboratory Investigation

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“…Additionally, based on current evidence, there appears to be minimal differences in therapeutic efficacy in using PDL with long or short pulse durations (6 ms pulse 9 J/cm 2 compared to 0.45 ms pulse 6 J/cm 2 ) . Furthermore, there was no difference in efficacy between PDT with PDL groups compared to PDL alone, indicating that there is no role for PDT in the treatment for nail psoriasis …”

Section: Discussionmentioning

confidence: 97%

“…Psoralen plus ultraviolet A (PUVA) and broadband or narrowband ultraviolet B (UVB) light have been used as monotherapy or in combination with other drugs to enhance treatment effectiveness. However, a recent study does suggest that the nail plate completely blocks UVB light and the majority of ultraviolet A (UVA) light …”

Section: Introductionmentioning

confidence: 99%

Laser and light therapies for the treatment of nail psoriasis

Maranda

Nguyen

Lim

et al. 2016

Acad Dermatol Venereol

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Psoriatic involvement of the nail is notoriously refractory to conventional therapy. Nail psoriasis has a high incidence amongst patients with psoriasis. It remains a significant cosmetic problem and thus, has a significant impact on quality of life. More recently, light and laser therapies have emerged as modalities for treatment of nail psoriasis. In this study, the efficacies of light and laser therapies are systematically reviewed. Light therapies involve ultraviolet light (with or without photosensitizers) or intense pulsed light. Alternatively, laser therapy in nail psoriasis is primarily administered using a 595-nm pulsed dye laser. These modalities have demonstrated significant improvement in psoriatic nail lesions, and even complete resolution in some cases. Both laser and light modalities have also been tested in combination with other systemic or topical therapeutics, with variable improvement in efficacy. Both laser and light therapies are generally well tolerated. Side-effects of light therapies include hyperpigmentation, itching and erythema; whereas, side-effects of laser therapy are more frequent and include pain, purpura/petechiae and hyperpigmentation. Patterns of response to therapy were also seen based on presenting characteristics of the nail lesions: subungual hyperkeratosis and onycholysis appeared to be the most responsive to therapy, while nail pitting was the most resistant. Light or laser therapies have the potential to be an efficient and cost-effective in-office based treatment for nail psoriasis. However, more large-scale clinical trials are needed to assess their efficacy, particularly in combination with other therapeutic modalities.

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“…The pitting and onycholysis have demonstrated poor response to PUVA treatment [38]. A recent study on the penetration of UV lights in normal human cadaveric fingernail plate showed that the nail plate completely blocks UVB light but only a minimal amount of UVA penetrates the nail [39]. This may explain the limited effect of PUVA in nail psoriasis.…”

Section: Phototherapy Radiation Therapy and Laser Therapymentioning

confidence: 99%

Treatment of Nail Psoriasis: Common Concepts and New Trends

Oram

Akkaya

2013

Dermatology Research and Practice

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The lifetime incidence of nail involvement in psoriatic patients is estimated to be 80–90%, and the nails can be affected in 10% to 55% of psoriatic patients. Psoriasis may also solely involve the nails, without any other skin findings, in which the treatment can be more challenging. Nail psoriasis may lead to considerable impairment in quality of life due to aesthetic concerns and more importantly limitations in daily activities resulting from the associated pain, which may be overlooked by the physicians. Several topical and systemic treatment modalities, as well as radiation and light systems, have been used in the treatment of nail psoriasis. In the last decade, the introduction of biologic agents and the utilization of laser systems have brought a new insight into the treatment of nail psoriasis. This paper focuses on the recent advances, as well as the conventional methods, in treating nail psoriasis in adults and children, in reference to an extensive literature search.

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UV-A and UV-B Penetration of Normal Human Cadaveric Fingernail Plate

Cited by 62 publications

References 13 publications

Unexpected UVR and non-UVR mutation burden in some acral and cutaneous melanomas

Unexpected UVR and non-UVR mutation burden in some acral and cutaneous melanomas

Laser and light therapies for the treatment of nail psoriasis

Treatment of Nail Psoriasis: Common Concepts and New Trends

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