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Indian Journal of Dermatology 2020Nail toxicity is a relatively uncommon cutaneous adverse effect of chemotherapeutic agents. Rapidly dividing cells of the nail matrix are perturbed by the antimitotic...
INTRODUCTION
Nail toxicity is a relatively uncommon cutaneous adverse effect of chemotherapeutic agents. Rapidly dividing cells of the nail matrix are perturbed by the antimitotic activity of these agents. Although most of these changes are cosmetic and regress once the therapy is completed, a few of these adverse effects are challenging to manage and require temporary or permanent suspension of chemotherapeutic agents.
MATERIALS AND METHODS
A total of 205 patients with various malignancies and under chemotherapy in oncology ward of the hospital over a period of 3 months were screened for nail involvement postchemotherapy. Relevant details, protocol of chemotherapeutic agents were assessed. Nail examination was carried out in daylight and the changes were analyzed.
RESULTS
A total of 124 (60.4%) patients had nail changes due to chemotherapeutic agents. The most common change was diffuse hyperpigmentation in 101 (81.4%) patients commonly due to a combination of cyclophosphamide and adriamycin in 43 (42.5%) patients. Longitudinal melanonychia was seen in 36 (29%), Beau's lines in 31 (25%), onychomadesis in 17 (13.7%), Mees' lines in 15 (12%), paronychia in 12 (9.6%), subungual hyperkeratosis in 10 (8%), and Muehrcke's lines in 4 (3.2%) patients. All the patients who developed Muehrcke's lines were on a combination of cyclophosphamide/doxorubicin/5 FU. Exudative onycholysis was observed in 2 (1.6%) patients; both these patients were on paclitaxel therapy. A total 2 (1.6%) patients who developed exudative onycholysis were advised discontinuation and another substitute chemotherapy was advised. Therapy for 2 (1.6%) patients who developed acute paronychia due to gefitinib was temporarily suspended. Unfortunately, most of the patients were on multiple chemotherapeutic agents hence, we could not pinpoint one drug as a cause. Therefore, a combination of agents was implicated in most cases.
CONCLUSION
Nail toxicities are common with chemotherapeutic agents, however less importance is given to nail involvement. Apart from being cosmetically significant, a few adverse effects may warrant modification of the chemotherapy.
PubMed: 32565559
DOI: 10.4103/ijd.IJD_37_19 -
The Journal of Experimental Medicine Aug 2024Coxsackievirus A10 (CV-A10) infection, a prominent cause of childhood hand-foot-and-mouth disease (HFMD), frequently manifests with the intriguing phenomenon of...
Coxsackievirus A10 (CV-A10) infection, a prominent cause of childhood hand-foot-and-mouth disease (HFMD), frequently manifests with the intriguing phenomenon of onychomadesis, characterized by nail shedding. However, the underlying mechanism is elusive. Here, we found that CV-A10 infection in mice could suppress Wnt/β-catenin signaling by restraining LDL receptor-related protein 6 (LRP6) phosphorylation and β-catenin accumulation and lead to onychomadesis. Mechanistically, CV-A10 mimics Dickkopf-related protein 1 (DKK1) to interact with Kringle-containing transmembrane protein 1 (KRM1), the CV-A10 cellular receptor. We further found that Wnt agonist (GSK3β inhibitor) CHIR99021 can restore nail stem cell differentiation and protect against nail shedding. These findings provide novel insights into the pathogenesis of CV-A10 and related viruses in onychomadesis and guide prognosis assessment and clinical treatment of the disease.
Topics: Animals; Wnt Signaling Pathway; Low Density Lipoprotein Receptor-Related Protein-6; Mice; Intercellular Signaling Peptides and Proteins; Humans; beta Catenin; Nail Diseases; Nails; Cell Differentiation; Mice, Inbred C57BL; Hand, Foot and Mouth Disease; Phosphorylation; Coxsackievirus Infections; Glycogen Synthase Kinase 3 beta; Pyridines; Pyrimidines
PubMed: 38836810
DOI: 10.1084/jem.20231512 -
Veterinary Dermatology Oct 2019Symmetrical lupoid onychomadesis (SLO) is a disease not infrequently seen in bearded collie dogs in Germany.
BACKGROUND
Symmetrical lupoid onychomadesis (SLO) is a disease not infrequently seen in bearded collie dogs in Germany.
OBJECTIVES
The aim of this study was to compare historical and clinical data, as well as the mineral content of the hair and claws of bearded collies with SLO with that of normal control dogs.
ANIMALS
Twenty-eight affected bearded collie dogs and 39 control dogs.
METHODS AND MATERIALS
Owners completed an extensive questionnaire regarding upbringing, environmental conditions and diets. Claw specimens were obtained by claw trimming or gathering lost claws; hairs were obtained by plucking samples from several areas of the body; samples were converted to ash and evaluated in an atomic absorption spectrophotometer.
RESULTS
Clinical signs in affected dogs eventually involved all claws on all paws. In twelve dogs recurrence of onychomadesis was observed. There was no relevant association between gender, housing, diet and health management, physical stress and the development of SLO with exception of the age at which more intense exercise began. The most commonly used treatment combination was fatty acids, pentoxifylline and tetracycline; improvement occurred in 17 animals. Calcium, sodium and phosphorus concentrations were higher in the claws of affected dogs, whereas zinc concentrations were lower. The mineral content of hair samples of the affected dogs was not significantly different than controls.
CONCLUSION AND CLINICAL IMPORTANCE
Symmetrical lupoid onychomadesis in bearded collies is clinically similar to what has been described in other breeds with regard to clinical signs and response to treatment. Early strenuous activity may increase the risk for disease occurrence in this breed.
Topics: Animals; Dog Diseases; Dogs; Female; Male; Nail Diseases; Nails, Malformed
PubMed: 31328335
DOI: 10.1111/vde.12779 -
Journal of Medical Virology Dec 2023An increasing number of studies have reported that atypical hand, foot, and mouth disease (HFMD) is becoming a new concern for children's health. At present, there is no...
An increasing number of studies have reported that atypical hand, foot, and mouth disease (HFMD) is becoming a new concern for children's health. At present, there is no official definition for atypical HFMD, but some studies have defined that it occurs at anatomic sites not listed in the definition of HFMD issued by the World Health Organization. Several pathogens have been reported to cause atypical HFMD, such as Coxsackievirus (CV)A6. As one of the most prevalent enteroviruses in the world, CVA6 seems to affect a wider range of children and causes more severe and prolonged illness than other enteroviruses. The early lesions of atypical HFMD are very similar to the clinical presentations of other diseases, such as eczema, which poses a challenge for clinicians aiming to identify and diagnose HFMD in a timely manner. Here, we report on six atypical HFMD patients caused by recombinant CVA6 variants, and the atypical manifestations include eczema coxsackium, large herpes, rice-like red papules and herpes, purpuric rash, and onychomadesis, as well as and large red herpes on scalp, perianal, testicles, shoulders and neck, and other atypical eruption sites, hoping to draw the attention of other pediatricians. This study will provide scientific guidance for timely diagnosis of HFMD to prevent serious complications.
Topics: Child; Humans; Hand, Foot and Mouth Disease; Phylogeny; Enterovirus; China; Eczema; Antibodies, Viral; Exanthema
PubMed: 38103032
DOI: 10.1002/jmv.29316 -
BMC Infectious Diseases Nov 2019In 2017, an outbreak of onychomadesis occurred in kindergarten H, Hubei province, China. We investigated the field to learn about the magnitude and reason of the...
BACKGROUND
In 2017, an outbreak of onychomadesis occurred in kindergarten H, Hubei province, China. We investigated the field to learn about the magnitude and reason of the outbreak.
METHODS
The case definition was that a child with onychomadesis or transverse ridging (Beau's line) in fingernails and toenails without previous traumatic or systemic disease in kindergarten H from Sep. 1st to Nov. 30th, 2017. A retrospective cohort study was carried out to analyze the epidemiological relationship between onychomadesis and the hand-foot-mouth disease (HFMD) in Primary Class #2, kindergarten H. We also performed a serological survey for neutralizing antibodies against coxsackie virus A6 (CVA6), coxsackie virus A10 (CVA10) among 15 cases and six healthy children in the kindergarten. Meanwhile, some children were carried out with routine blood, fungal microscopic and microelement tests. Indoor environment examinations had been done for all classes.
RESULTS
A total of 20 cases were identified in Kindergarten H. Seventy-five percent (15/20) cases occurred in Primary Class #2. Fifty-five percent of the cases (11/20) had suffered from HFMD within two months. The median time between onychomadesis and HFMD was 45 days (ranging from 31 to 58 days). A retrospective cohort study in Primary Class #2 showed the attack rate was 90.0% among 10 children who suffered from HFMD in the past two months compared to 30.0% among 20 children who didn't (Rate Ratio [RR] =3.0, 95% Confidence Interval [CI] =1.5-6.0). The positive rates of neutralizing antibodies were 66.7% for CVA6 and 26.7% for CVA10 in tested cases. The result of routine blood, fungal microscopic, microelements tests were normal in cases. The indicators of environment were within the normal range.
CONCLUSION
The results of this study suggested that the outbreak of onychomadesis in Hubei province was probably associated with HFMD epidemic within two months.
Topics: Antibodies, Neutralizing; Antibodies, Viral; Child, Preschool; China; Disease Outbreaks; Enterovirus A, Human; Female; Hand, Foot and Mouth Disease; Humans; Incidence; Male; Nail Diseases; Retrospective Studies; Schools
PubMed: 31771520
DOI: 10.1186/s12879-019-4560-8 -
Clinical and Experimental Dermatology Dec 2021Cutaneous findings are well known in atopic dermatitis (AD), but nail changes have not received as much attention.
BACKGROUND
Cutaneous findings are well known in atopic dermatitis (AD), but nail changes have not received as much attention.
AIM
To determine the clinical and disease-related capillaroscopic findings of nail findings in paediatric patients with AD.
METHODS
In total, 100 participants aged 2-16 years were sourced from the dermatology outpatient clinic: 50 of these had been diagnosed with AD according to the Hanifin-Rajka criteria, and the others were 50 healthy controls (HCs) without AD. The AD severity score (SCORing Atopic Dermatitis; SCORAD) was calculated for all patients with AD. A digital epiluminescence device was used for nailfold capillaroscopy.
RESULTS
The nail findings detected in patients with AD were pitting, punctate leuconychia, trachyonychia, onycholysis and onychomadesis. Pitting was significantly (P < 0.01) more frequent in the patient group (26%) than in the HC group (6%). Similarly, the patient group had significantly higher rates for capillary density decrease (P < 0.01), capillary array irregularity (P < 0.001), capillary dilatation increase (P < 0.001), tortuosity (P = 0.04), ramification increase (P = 0.02), bush-like appearance (P = 0.02) and avascular areas (P < 0.01). Significant correlations were determined between pitting and trachyonychia (P < 0.05, r = 0.21), capillary density decrease (P < 0.05, r = 0.25), avascular areas (P < 0.001; r = 0.29) and SCORAD (P < 0.05, r = 0.35).
CONCLUSION
The nailfold capillaroscopic images of children with AD were similar to those of scleroderma spectrum disorder. Thus, we believe it would be beneficial to support detailed clinical examination of patients with a capillaroscopic examination.
Topics: Adolescent; Case-Control Studies; Child; Child, Preschool; Dermatitis, Atopic; Female; Humans; Male; Microcirculation; Microscopic Angioscopy; Nails; Vasodilation
PubMed: 34089190
DOI: 10.1111/ced.14783 -
The Journal of Dermatology Feb 2022Kawasaki disease (KD) is vasculitis of unknown etiology in infants and young children. The diagnostic criteria for KD include major and minor symptoms, but various nail... (Review)
Review
Kawasaki disease (KD) is vasculitis of unknown etiology in infants and young children. The diagnostic criteria for KD include major and minor symptoms, but various nail lesions are not described in detail. The aim of this study was to identify symptoms that are relatively found in nail of KD as diagnostic markers. After literature review, various nail lesions are classified as Beau's lines, leukonychia, onychomadesis, orange-brown chromonychia, and pincer nail deformity. The orange-brown chromonychia is the most common nail lesion in KD. In this study, the authors found three cases of KD with orange-brown chromonychia; two of these cases included rare dotted or splinter hemorrhages in the nail bed that were found on dermoscopic examination. The authors propose that these nail lesions, including hemorrhage of the nail bed, could be included as a helpful diagnosis of KD.
Topics: Child; Child, Preschool; Humans; Mucocutaneous Lymph Node Syndrome; Nail Diseases; Nails
PubMed: 34918369
DOI: 10.1111/1346-8138.16276 -
Journal of the American Academy of... Dec 2020Carpal tunnel syndrome (CTS) is commonly seen by general practitioners and often presents with neurologic symptoms of nocturnal pain and paresthesia along the median... (Review)
Review
Carpal tunnel syndrome (CTS) is commonly seen by general practitioners and often presents with neurologic symptoms of nocturnal pain and paresthesia along the median nerve distribution. Approximately 20% of patients also present with cutaneous findings (ulcerations, blistering, sclerodactyly, nail dystrophy) characterizing a severe form called necrotic CTS. Necrotic CTS can also be associated with bone changes (acro-osteolysis). In the author's practice, combined nail and skin findings are not an uncommon presentation of CTS, although this form remains overlooked and underreported in the dermatological textbooks and studies. This manuscript aims to review the literature on CTS cases, with a specific focus on using associated nail findings as diagnostic clues. The literature review along with a few additional recent cases from the author's practice demonstrate that CTS is frequently accompanied by a variety of nail changes including koilonychia, longitudinal fissuring, Beau's lines, onychomadesis, melanonychia, nail thickening, hyperkeratosis, and ischemic ulcerations with paronychia. Furthermore, when these changes are limited to the second and third fingernails, they should prompt the diagnosis of CTS. Once suspected, diagnostic evaluation is not difficult and surgical management can resolve cutaneous findings and prevent irreversible changes such as acro-osteolysis.
Topics: Administration, Topical; Carpal Tunnel Syndrome; Decompression, Surgical; Fingers; Glucocorticoids; Humans; Injections, Intralesional; Median Nerve; Nails; Nails, Malformed; Necrosis; Nitroglycerin; Severity of Illness Index; Splints; Treatment Outcome
PubMed: 32199899
DOI: 10.1016/j.jaad.2020.03.023 -
Case Reports in Dermatological Medicine 2016Onychomadesis is a clinical sign of nail plate separation due to transient or permanent arrest of nail matrix activities. Onychomadesis can be considered as a severe...
Onychomadesis is a clinical sign of nail plate separation due to transient or permanent arrest of nail matrix activities. Onychomadesis can be considered as a severe form of Beau's line. This condition usually occurs after trauma, causal diseases, or medications, yet it rarely occurs as an idiopathic condition. We report a case of a 38-year-old Thai female who developed recurrence onychomadesis in several toenails in the absence of predisposing factors or associated conditions. To the best of our knowledge, our patient is the first reported case of idiopathic onychomadesis limited to toenails.
PubMed: 27437152
DOI: 10.1155/2016/6451327 -
Skin Appendage Disorders Jan 2018Mycosis fungoides (MF) has a wide range of clinical presentations and it has been reported rarely to involve the nail apparatus.
BACKGROUND
Mycosis fungoides (MF) has a wide range of clinical presentations and it has been reported rarely to involve the nail apparatus.
OBJECTIVE
We intended to evaluate the frequency and characteristics of nail changes in patients with biopsy-proven MF.
METHODS
A retrospective analysis of 60 patients with MF who were evaluated at our cancer center from 2013 to 2014 was performed to identify patients with nail changes. Histological examinations of the skin around the nail apparatus were obtained from 10 patients with periungual skin erythema and scaling.
RESULTS
In 45 patients out of 60 cases, the skin around the nail apparatus was normal, and only in 5 patients of these 45 cases, nail changes were detected. These changes included leukonychia, longitudinal ridging, nail thickening, and opacity. In the remaining 15 patients, erythema and scaling was observed in periungual skin, and 13 of them demonstrated nail changes including longitudinal ridging, nail thickening, fragility of the nail plate, subungual hyperkeratosis, pigmented nail band, Beau's lines, onychomadesis, koilonychia, nail thinning, distal notching, subungual debris, leukonychia, and pitting. In biopsies of periungual skin, none of 10 cases revealed histological findings consistent with MF.
CONCLUSIONS
Evidence of nail changes was observed in 18 cases (30%). The most common nail changes detected in MF patients included longitudinal ridging, nail thickening, nail fragility, and leukonychia.
PubMed: 29457018
DOI: 10.1159/000478946