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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 -
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 -
Acta Dermato-venereologica Aug 2022
Topics: Alopecia; Humans; Hypohidrosis; Nail Diseases; Nails, Malformed; Propylthiouracil
PubMed: 35971830
DOI: 10.2340/actadv.v102.2690 -
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 -
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 -
Mayo Clinic Proceedings Nov 2023
Topics: Humans; Nail Diseases
PubMed: 37923530
DOI: 10.1016/j.mayocp.2023.06.006