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Annals of Medicine Dec 2022Nail conditions are not only aesthetic concerns, and nail changes may be a clue to an underlying systemic diseases or infection. Without timely treatment, nail diseases... (Review)
Review
Nail conditions are not only aesthetic concerns, and nail changes may be a clue to an underlying systemic diseases or infection. Without timely treatment, nail diseases can continue to worsen and significantly impair performance of daily activities and reduce quality of life. Examination of the nails is essential at every medical visit, and may uncover important findings. Brittle nail syndrome, onychomycosis, paronychia, nail psoriasis, longitudinal melanonychia, Beau's lines, onychomadesis and retronychia are common nail disorders seen in clinical practice. These conditions stem from infectious, inflammatory, neoplastic and traumatic aetiologies. Though each nail condition presents with its own distinct characteristics, the clinical findings may overlap between different conditions, resulting in misdiagnosis and treatment delays. Patients can present with nail plate changes (e.g. hyperkeratosis, onycholysis, pitting), discolouration, pain and inflammation. The diagnostic work-up of nail disease should include a detailed history and clinical examination of all 20 nail units. Dermoscopy, diagnostic imaging and histopathologic and mycological analyses may be necessary for diagnosis. Nail findings concerning for malignancy should be promptly referred to a dermatologist for evaluation and biopsy. Nail disease management requires a targeted treatment approach. Treatments include topical and/or systemic medications, discontinuation of offending drugs or surgical intervention, depending on the condition. Patient education on proper nail care and techniques to minimize further damage to the affected nails is also important. This article serves to enhance familiarity of the most common nail disorders seen in clinical practice. It will highlight the key clinical manifestations, systematic approaches to diagnosis and treatment options for each nail condition to improve diagnosis and management of nail diseases, as well as patient outcomes.Key messagesNail disease is not only a cosmetic issue, as nail changes can indicate the presence of a serious underlying systemic disease, infection or malignancy.Nail pain and changes associated with NP are physically and emotionally distressing and may contribute to functional impairment and diminished quality of life.LM is a hallmark sign of subungual melanoma and this finding warrants further investigation to rule out malignancy.
Topics: Humans; Nail Diseases; Nails; Neoplasms; Psoriasis; Quality of Life
PubMed: 35238267
DOI: 10.1080/07853890.2022.2044511 -
Recent Advances in Inflammation &... 2022Hand, foot, and mouth disease is a common viral disease in childhood. Because the disease has the potential to reach epidemic levels and mortality is high in some... (Review)
Review
BACKGROUND
Hand, foot, and mouth disease is a common viral disease in childhood. Because the disease has the potential to reach epidemic levels and mortality is high in some countries, early recognition of this disease is of paramount importance.
OBJECTIVE
This purpose of this article is to familiarize pediatricians with the clinical manifestations and management of hand, foot, and mouth disease.
METHODS
A search was conducted in February 2022 in PubMed Clinical Queries using the key term "hand, foot, and mouth disease". The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in English were included in this review.
RESULTS
Hand, foot, and mouth disease is characterized by a painful oral enanthem and asymptomatic exanthem on the palms and soles. Children younger than 5 years are most commonly affected. Hand, foot, and mouth disease caused by enterovirus A71 is more severe and has a higher rate of complications than that attributed to other viruses such as coxsackievirus A16. Circulatory failure secondary to myocardial impairment and neurogenic pulmonary edema secondary to brainstem damage are the main causes of death. Fortunately, the disease is usually benign and resolves in 7 to10 days without sequelae. Given the self-limited nature of most cases, treatment is mainly symptomatic and supportive. Intravenous immunoglobulin should be considered for the treatment of severe/complicated hand, foot, and mouth disease and has been recommended by several national and international guideline committees. Currently, there are no specific antiviral agents approved for the treatment of the disease. Drugs such as ribavirin, suramin, mulberroside C, aminothiazole analogs, and sertraline have emerged as potential candidates for the treatment of hand, foot, and mouth disease. Vaccination of susceptible individuals in high-risk areas and good personal hygiene are important preventative measures to combat the disease.
CONCLUSION
Familiarity of the disease including its atypical manifestations is crucial so that a correct diagnosis can be made, and appropriate treatment initiated. A timely diagnosis can help avoid contact with the affected individual and decrease the risk of an outbreak.
Topics: Child; Humans; Hand, Foot and Mouth Disease; Enterovirus; Enterovirus Infections; Exanthema; Mouth Diseases
PubMed: 36284392
DOI: 10.2174/1570180820666221024095837 -
The British Journal of Dermatology Mar 2015Onychomadesis is characterized by separation of the nail plate from the matrix with persistent attachment to the nail bed and often, but not always, eventual shedding.... (Review)
Review
Onychomadesis is characterized by separation of the nail plate from the matrix with persistent attachment to the nail bed and often, but not always, eventual shedding. Onychomadesis has been associated with infection, autoimmune disease, critical illness and medications. To our knowledge a literature review of all associations with onychomadesis has not been completed previously. Most commonly, onychomadesis has been reported in association with pemphigus vulgaris and hand-foot-mouth disease, and following chemotherapy or antiepileptic medications. This article summarizes these key culprit associations, postulates the pathogenesis of nail matrix arrest and summarizes the clinical outcomes. We conducted a retrospective review of cases of onychomadesis reported from January 1960 to March 2013. Using the PubMed database, the literature was searched using the following terms: 'onychomadesis' and 'proximal nail shedding'. Also, an Ovid search was carried out using the same terms. In total 56 articles have been published, including our previously reported series of idiopathic onychomadesis. Articles pertaining only to Beau's lines and not true onychomadesis were excluded. Onychomadesis has been associated with autoimmune disease, other major medical illness, neonatal illness, medication and infection.
Topics: Autoimmune Diseases; Chronic Disease; Drug Eruptions; Hand, Foot and Mouth Disease; Humans; Onycholysis
PubMed: 25132198
DOI: 10.1111/bjd.13339 -
Skin Appendage Disorders Sep 2022Irritant contact dermatitis affecting the nail unit may lead to nail matrix damage and onychomadesis, which may initially be subclinical, becoming overt later. We...
INTRODUCTION
Irritant contact dermatitis affecting the nail unit may lead to nail matrix damage and onychomadesis, which may initially be subclinical, becoming overt later. We describe a patient who developed these changes after using a chemical pesticide.
CASE PRESENTATION
A 52-year-old woman presented with discoloration of the nails of both hands of two days' duration, associated with mild digital pain. She had used an over-the-counter insecticide product containing thiamethoxam (a broad-spectrum systemic insecticide) for her houseplants, preceding the nail changes. Examination revealed onycholysis and subclinical onychomadesis involving multiple fingernails as well as toenails. Onychoscopic examination showed proximal nail plate separation with an erythematous regular border. Histopathology showed an essentially normal nail plate with spongiosis, epidermal cell necrosis, and hypergranulosis. However, there was no evidence of bacterial or fungal infection, and dermal inflammation was mild. The patient was diagnosed with thiamethoxam-induced irritant dermatitis with subclinical onychomadesis and was advised to take general precautions with avoidance of any further contact with the insecticide. She was managed with topical steroids and emollient; however, on follow-up, she developed green nails, with progression to overt onychomadesis in some nails. Additionally, onychomycosis was observed in few nails in the long-term, which needed to be treated.
CONCLUSION
Thiamethoxam is an over-the-counter broad-spectrum insecticide used for houseplants, but its safety data does not mention acute adverse effects on nails, which was a novel finding in our patient. The safety data does mention the use of gloves for preparing and administering the product. Secondary bacterial and fungal infections, which can occur after the initial insult, further worsen the prognosis.
PubMed: 36161079
DOI: 10.1159/000523978 -
BMJ Case Reports Dec 2023
Topics: Humans; Nail Diseases; Nails, Malformed
PubMed: 38056926
DOI: 10.1136/bcr-2023-257235 -
Dermatologic Clinics Apr 2021Many pediatric nail findings are normal variants and are no cause for alarm. Others represent congenital abnormalities or genetic syndromes for which there is no cure.... (Review)
Review
Many pediatric nail findings are normal variants and are no cause for alarm. Others represent congenital abnormalities or genetic syndromes for which there is no cure. Still others are inflammatory or infectious entities that require treatment. Pediatric nail disorders are reviewed, along with management.
Topics: Child; Humans; Nail Diseases
PubMed: 33745636
DOI: 10.1016/j.det.2020.12.005 -
Cutis Jan 2017Onychomadesis is the proximal separation of the nail plate from the nail matrix due to a temporary cessation of nail growth. It can occur in children of all ages...
Onychomadesis is the proximal separation of the nail plate from the nail matrix due to a temporary cessation of nail growth. It can occur in children of all ages including neonates. Diagnosis is made clinically through palpation and inspection of the nail plate. Physicians should consider underlying associations. A review of the patient's history for any viral illnesses 1 to 2 months prior to nail changes often will help identify the causative disease. Onychomadesis typically is mild and self-limited. There is no specific treatment, but a conservative approach to management is recommended with treatment of any underlying causes and supportive care. Spontaneous nail regrowth usually occurs within 12 weeks and may occur faster in children. In this article, causes of onychomadesis are described, including the connection between hand-foot-and-mouth disease (HFMD) and onychomadesis. We also explore several theories of possible mechanisms for onychomadesis; however, the precise mechanism remains unclear and further investigation is needed.
Topics: Child; Child, Preschool; Hand, Foot and Mouth Disease; Humans; Infant; Infant, Newborn; Nail Diseases; Time Factors
PubMed: 28207011
DOI: No ID Found -
International Journal of Dermatology Sep 2015Nail abnormalities in childhood are generally uncommon. Recently, onychomadesis was described as a late complication of hand-foot-and-mouth disease (HFMD). Onychomadesis... (Review)
Review
BACKGROUND
Nail abnormalities in childhood are generally uncommon. Recently, onychomadesis was described as a late complication of hand-foot-and-mouth disease (HFMD). Onychomadesis outbreaks following HFMD have been reported in many countries worldwide.
AIM
To present a case series of onychomadesis in children, following HFMD outbreak in Northern Greece, and review literature data.
METHODS
Children with evident onychomadesis attending the outpatient clinic between November 2012 and January 2013 were included in the study. A questionnaire including demographic personal and family history information of the children was completed by the parents. Patients were clinically examined, and their pediatric and dermatological records were studied to confirm precedent HFMD. Direct microscopic examination and cultures for fungi were performed. Exposure of participants to coxsackievirus, based on serology testing during infection, was also recorded.
RESULTS
Sixty-eight children with onychomadesis were included. The mean number of affected nails was 8.82. Fingernails were more often involved. Previous clinical diagnosis of HFMD was confirmed in 67/68 cases. The mean time from HFMD diagnosis to onychomadesis development was 39.6 days (range: 28-56 days, STD: 7.33). Direct microscopic examination, as well as cultures for fungal species, was negative for the whole sample size. All the nail changes were transient with spontaneous regrowth after 1-4 months.
CONCLUSION
Our data indicate that onychomadesis outbreak in the region of Thessaloniki during fall-winter 2012-13 was highly related to the outbreak of HFMD. Our study reinforces existing evidence for the association between onychomadesis and HFMD.
Topics: Adolescent; Age Distribution; Animals; Chi-Square Distribution; Child; Child, Preschool; Cohort Studies; Disease Outbreaks; Female; Fingers; Foot-and-Mouth Disease; Greece; Humans; Incidence; Male; Nails, Malformed; Prognosis; Retrospective Studies; Risk Assessment; Severity of Illness Index; Sex Distribution; Toes
PubMed: 25772385
DOI: 10.1111/ijd.12592 -
Journal of the American Academy of... Nov 2015Beau lines, onychomadesis, and retronychia are nail dystrophies with distinctive clinical findings. Trauma has been reported as the initiating factor in each of these... (Review)
Review
Beau lines, onychomadesis, and retronychia are nail dystrophies with distinctive clinical findings. Trauma has been reported as the initiating factor in each of these entities. Infections, severe medical illnesses, major surgery/anesthesia, medication side effects, and autoimmune disease can produce Beau lines and onychomadesis. This article illustrates the common underlying pathophysiological mechanism that produces each of these nail dystrophies.
Topics: Humans; Nail Diseases
PubMed: 26475537
DOI: 10.1016/j.jaad.2015.08.003 -
Acta Dermato-venereologica Aug 2022
Topics: Alopecia; Humans; Hypohidrosis; Nail Diseases; Nails, Malformed; Propylthiouracil
PubMed: 35971830
DOI: 10.2340/actadv.v102.2690