-
Current Opinion in Pediatrics Aug 2020Nail disorders represent an uncommon subset of complaints seen in pediatric dermatology. There is a wide array of disorders that can affect the nail unit in children,... (Review)
Review
PURPOSE OF REVIEW
Nail disorders represent an uncommon subset of complaints seen in pediatric dermatology. There is a wide array of disorders that can affect the nail unit in children, including infectious, inflammatory, neoplastic, congenital, and traumatic processes. In order to enhance familiarity with pediatric nail conditions, we review the background and treatment of the more common entities seen in pediatric onychology, including onychomycosis, onychomadesis, nail psoriasis, trachyonychia, longitudinal melanonychia, onychophagia, and onychocryptosis.
RECENT FINDINGS
Nail involvement in pediatric patients with psoriasis may indicate increased risk for both overall disease severity and the development psoriatic arthritis. In the evaluation of longitudinal melanonychia, the clinical findings that raise concern for subungual melanoma in adults are often found in benign nail unit nevi in children. In the systemic treatment of pediatric onychomycosis, new data raises the possibility that laboratory monitoring may be approached differently. In the approach to onychophagia, emerging pharmacotherapies include N-acetylcysteine.
SUMMARY
Most nail disorders in pediatric patients have an overall favorable prognosis. However, nail abnormalities can lead to patient and parental anxiety, decreased quality of life, pain, and functional impairment. Clinicians should be aware of these more common diverse entities in order to identify them and apply state of the art management for these issues. Additionally, the reader will learn factors related to these nail disorders, which may require systemic work-up and/or specialist referral.
Topics: Adult; Animals; Child; Humans; Melanoma; Nail Diseases; Onycholysis; Onychomycosis; Presbytini; Psoriasis; Quality of Life
PubMed: 32692049
DOI: 10.1097/MOP.0000000000000921 -
Cureus Apr 2022Hand-foot-and-mouth disease (HFMD) is a viral infection frequently encountered in the pediatric age group. Common culprits in such manifestations are coxsackievirus A16...
Hand-foot-and-mouth disease (HFMD) is a viral infection frequently encountered in the pediatric age group. Common culprits in such manifestations are coxsackievirus A16 and human enterovirus 71. The patient presents febrile with erythematous papulovesicular exanthems in the mouth, palms, and soles. HFMD is self-limiting in nature with a rare-complication rate. Onychomadesis is proximal nail separation while Beau's lines are whitish transverse lines and considered a rare complication of HFMD. Both allude to halted nail-matrix proliferation, and the pathophysiology behind such manifestations is still not yet understood. It is hypothesized that the virus elicits an inflammatory process, inhibiting nail-matrix proliferation or immune-complexes depositing on nails creating an embolism. Onychomadesis and Beau's lines appear after four to eight weeks of HFMD disease resolution and persist for approximately 35 days. There are no serious sequelae of those manifestations, as the nail basement is still intact. We present a case of a seven-year-old Saudi male presenting with nail changes, mainly onychomadesis and Beau's lines, after 35 days of HFMD disease resolution. All causes of nail changes have been ruled out and diagnosis of onychomycosis and Beau's lines secondary to HFDM has been established.
PubMed: 35530819
DOI: 10.7759/cureus.23832 -
Acta Dermatovenerologica Croatica : ADC Apr 2017Beau lines are transverse, band-like depressions extending from one lateral edge of the nail to the other and affecting all nails at corresponding levels (1)....
Beau lines are transverse, band-like depressions extending from one lateral edge of the nail to the other and affecting all nails at corresponding levels (1). Onychomadesis is considered an extreme form of Beau line with subsequent separation of the proximal nail plate from the nail bed. Both fall along a spectrum of nail plate abnormalities that occur secondary to temporary nail matrix arrest (NMA). Various systemic and dermatologic conditions have been reported in association with onychomadesis (2-7) (Table 1). Nail changes can affect all or some of the nails and both the fingernails and toenails; however, fingernails are more frequently affected. The severity of the nail changes varies depending on the underlying cause, its duration, and environmental factors (8). We present a case of onychomadesis following cutaneous leukocytoclastic vasculitis (CLCV). A 61-year-old woman presented to the Dermatology Clinic complaining of a purpuric rash that began on her lower extremities and rapidly progressed to her abdomen and upper extremities over the previous five days. Her medical history was remarkable for hypertension and diet-controlled diabetes mellitus. Her medications included enalapril, which she had been taking for the past four years. On three consecutive days before the skin eruption, the patient took oral diclofenac sodium for hip pain. A clinical examination revealed non-blanching petechial rash on the legs, abdomen, and upper limbs up to the elbow (Figure 1, A) with leukocytoclastic vasculitis on biopsy (Figure 1, B). Direct immunofluorescence was negative. Laboratory investigations revealed a white blood cell count of 14.5 × 109/L with a normal differential count, and a platelet count of 380 × 109/L. Westergren erythrocyte sedimentation rate was 65 mm/1st h, and C reactive protein was at 8.5 mg/dL. Antinuclear antibodies, rheumatoid factor, immune complexes, and cryoglobulinemia were negative, as were B and C hepatitis virus serological tests. Her renal, cardiac, pulmonary, and abdominal exams were normal. Diclofenac was discontinued due to a clinical suspicion of drug-induced cutaneous vasculitis. The rash resolved in 2 weeks without treatment, leaving post-inflammatory hyperpigmentation. Four weeks later, she presented with painless, palpable grooves on all 10 fingernails (Figure 2). The grooves were 3 to 4 mm in width, at a similar distance from the proximal nail fold. There were no signs of periungual inflammation. The patient denied any recent history of trauma, unusual activities, or chemical exposure. Routine serum biochemistry and hematology results were normal. Repeated potassium hydroxide preparations and fungal cultures of the nail clippings were negative. A diagnosis of Beau lines and onychomadesis was made. Nail changes were tolerable and did not require any specific treatment. During the follow up, the Beau lines advanced with the linear growth of the nails and disappeared (Figure 3 and 4). Four fingernails developed complete nail shedding (onychomadesis). No toenail alterations were observed in this period. A complete recovery of the nail plate surface was observed after 4 months. The nail matrix epithelium is formed by highly proliferating cells that differentiate and keratinize to produce the nail plate. The nail matrix epithelium is very susceptible to toxic noxae, and acute damage results in a defective nail plate formation. Nail matrix arrest is a term used to describe a temporary inhibition of the nail matrix proliferation that can present as Beau lines and onychomadesis (8). The width of Beau lines relates to the duration of the etiological agent. As the nail adheres firmly to the nail bed, the onychomadesis remains latent for several weeks before leading to temporary shedding (8,9). There are several proposed etiological mechanisms for NMA. NMA associated with fever, severe infection, and major medical illnesses can be explained by an inflammation of the matrix, periungual tissues, or digital blood vessels (8); chemotherapy agents temporary inhibit the mitotic activity in nail matrix (10); the detection of Coxackie virus in the shedding nail particle, following hand, foot, and mouth disease, suggests that the viral replication itself may directly damage the nail matrix (11). However, as nail changes are not unique, it may be difficult to incriminate a single etiological agent. Our patient presented with an onset of Beau lines seven weeks after the initial CLCV lesions, which suggests that vasculitis might have acted as a trigger for NMA. As the fingers were not affected by CLCV, an indirect effect of vasculitis is more plausible. Leukocytoclastic vasculitis is a small-vessel inflammatory disease mediated by a deposition of immune complexes. Thus, the circulating immune complexes may be involved in the damage of nail bed microvasculature. Considering that the patient had been receiving enalapril and diclofenac, it is less likely that those drugs were involved in the pathogenesis of NMA. Enalapril was continued, and the nail changes were resolved while patient was still on enalapril. Furthermore, diclofenac is a widely prescribed drug and its association with NMA is yet to be described in literature. We described a patient who developed Beau lines and onychomadesis following cutaneous leukocytoclastic vasculitis. This clinical observation can expand the spectrum of possible causes of nail matrix arrest.
PubMed: 28511755
DOI: No ID Found -
FP Essentials Jun 2022A thorough understanding of nail anatomy can help physicians identify the causes of nail conditions. Observation of changes to the nail can help establish a diagnosis....
A thorough understanding of nail anatomy can help physicians identify the causes of nail conditions. Observation of changes to the nail can help establish a diagnosis. Patient evaluation should include a physical examination, dermoscopy, and, in some cases, nail biopsy. Onychomycosis is the most common nail condition worldwide, and should be distinguished from other nail conditions with similar manifestations. Empiric onychomycosis treatment without confirmatory tests has been proposed, but studies have shown the cost-effectiveness of testing to prevent inappropriate therapy. Systemic drugs for management include terbinafine and itraconazole. Longitudinal melanonychia is a brown band through the length of the nail. Nail melanoma should be suspected if the band is dark brown-black, is located on a single digit, and occupies 40% or more of the nail plate width. Biopsy with local anesthesia should be performed in patients with suspected nail melanoma or other neoplastic nail conditions. Identification of warning signs of nail melanoma can result in earlier diagnosis and limit potential morbidity and mortality. Nail psoriasis often is overlooked but can affect up to 50% of patients with psoriasis. Nail lichen planus can cause permanent scarring with loss of normal nail anatomy. Other common nail conditions include acute and chronic paronychia, onychocryptosis, onycholysis, infection (ie, green nails), onychogryphosis, subungual hematoma, and onychomadesis.
Topics: Hair; Humans; Melanoma; Nail Diseases; Nails; Onychomycosis; Psoriasis
PubMed: 35679470
DOI: No ID Found -
The Lancet. Oncology Apr 2015Patients treated with systemic anticancer drugs often show changes to their nails, which are usually well tolerated and disappear on cessation of treatment. However,... (Review)
Review
Patients treated with systemic anticancer drugs often show changes to their nails, which are usually well tolerated and disappear on cessation of treatment. However, some nail toxicities can cause pain and functional impairment and thus substantially affect a patient's quality of life, especially if they are given taxanes or EGFR inhibitors. These nail toxicities can affect both the nail plate and bed, and might present as melanonychia, leukonychia, onycholysis, onychomadesis, Beau's lines, or onychorrhexis, as frequently noted with conventional chemotherapies. Additionally, the periungual area (perionychium) of the nail might be affected by paronychia or pyogenic granuloma, especially in patients treated with drugs targeting EGFR or MEK. We review the nail changes induced by conventional chemotherapies and those associated with the use of targeted anticancer drugs and discuss preventive or curative options.
Topics: ErbB Receptors; Humans; Nail Diseases; Nails; Neoplasms; Protein Kinase Inhibitors; Taxoids
PubMed: 25846098
DOI: 10.1016/S1470-2045(14)71133-7 -
Mayo Clinic Proceedings Nov 2023
Topics: Humans; Nail Diseases
PubMed: 37923530
DOI: 10.1016/j.mayocp.2023.06.006 -
Wiener Medizinische Wochenschrift (1946) Sep 2023We report the case of a 67-year-old woman who developed onychomadesis on 9 of her fingers 2 months after recovering from COVID-19, with subsequent full nail regrowth...
We report the case of a 67-year-old woman who developed onychomadesis on 9 of her fingers 2 months after recovering from COVID-19, with subsequent full nail regrowth after 4 months. The development of onychomadesis in COVID-19 is probably related to inhibition of nail proliferation due to fever, direct viral damage, or an inflammatory process associated with endothelial damage and obliterative microangiopathy in the nail matrix area. Clinicians should be aware of nail changes and actively seek them out in patients with COVID-19.
Topics: Humans; Female; Aged; COVID-19; Nail Diseases; Fingers; Fever
PubMed: 36441360
DOI: 10.1007/s10354-022-00988-1 -
Canine Genetics and Epidemiology 2015Hypothyroidism is one of the most common endocrine disorders, whereas symmetrical onychomadesis is a rare claw disease in the general dog population. The aims of this...
BACKGROUND
Hypothyroidism is one of the most common endocrine disorders, whereas symmetrical onychomadesis is a rare claw disease in the general dog population. The aims of this study were to estimate the prevalence of hypothyroidism and symmetrical onychomadesis in a birth cohort of 291 Gordon setters at eight years of age. Further, to describe the age at diagnosis of hypothyroidism in the 68 Gordon setters and 51 English setters included in the DLA study. Finally, to elucidate potential associations between dog leukocyte antigen (DLA) class II and hypothyroidism and/or symmetrical onychomadesis in the Gordon setter and the English setter.
RESULTS
In the birth cohort of eight years old Gordon setters, 2.7 % had hypothyroidism and 8.9 % had symmetrical onychomadesis, but only one out of these 291 dogs (0.3 %) had both diseases. Mean age at diagnosis of hypothyroidism for dogs included in the DLA study was 6.4 years (95 % CI: 5.6-7.2 years) in the Gordon setters and 7.7 years (95 % CI: 7.2-8.2 years) in the English setters. The DLA alleles most associated with hypothyroidism in the Gordon setter and English setter were DLA-DQB1*00201 (OR = 3.6, 95 % CI: 2.1-6.4, p < 0.001) and DLA-DQA1*00101 (OR = 2.9, 95 % CI: 1.3-6.6, p < 0.001), respectively. In the Gordon setter, the haplotype DLA-DRB1*01801/DQA1*00101/DQB1*00802 was significantly associated with both symmetrical onychomadesis (OR = 2.9, 95 % CI: 1.7-5.2, p < 0.001) and with protection against hypothyroidism (OR = 0.3, 95 % CI: 0.2-0.5, p < 0.001).
CONCLUSION
Hypothyroidism is a complex disease where DLA genes together with other genes may be involved in the pathogenesis of the disease. In the Gordon setter, one DLA haplotype that was associated with protection against hypothyroidism was also associated with symmetrical onychomadesis. These findings indicate that closely linked genes, instead of or together with the DLA genes themselves, may be associated with hypothyroidism and symmetrical onychomadesis. In a breed where several autoimmune diseases are prevalent all possible associations between DLA genes and actual diseases need to be investigated before DLA is considered used as a tool for marker-assisted selection.
PubMed: 26401340
DOI: 10.1186/s40575-015-0025-6 -
Indian Pediatrics Aug 2014
Topics: Child, Preschool; Female; Fingers; Hand, Foot and Mouth Disease; Humans; Nail Diseases; Nails
PubMed: 25129012
DOI: 10.1007/s13312-014-0481-1 -
Acta Dermato-venereologica Oct 2023
Topics: Humans; Nail Diseases; Nails, Malformed
PubMed: 37902467
DOI: 10.2340/actadv.v103.18251