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Actas Dermo-sifiliograficas May 2022Nail involvement in psoriasis is common. It is seen in up to 80% of patients with psoriatic lesions and may be the only manifestation in 6% of cases. Nail psoriasis is... (Review)
Review
Nail involvement in psoriasis is common. It is seen in up to 80% of patients with psoriatic lesions and may be the only manifestation in 6% of cases. Nail psoriasis is correlated with more severe disease, characterized by earlier onset and a higher risk of psoriatic arthritis. Accordingly, it can also result in significant functional impairment and reduced quality of life. Psoriasis involving the nail matrix causes pitting, leukonychia, red lunula and nail dystrophy, while nail bed involvement causes splinter hemorrhages, onycholysis, oil spots (salmon patches), and subungual hyperkeratosis. Common evaluation tools are the Nail Psoriasis Severity Index (NAPSI), the modified NAPSI, and the f-PGA (Physician's Global Assessment of Fingernail Psoriasis). Treatment options include topical therapy, intralesional injections, and systemic and biologic agents. Treatment should therefore be assessed on an individualized basis according to the number of nails involved, the part of the nail or nails affected, and the presence of concomitant nail and/or joint involvement.
Topics: Arthritis, Psoriatic; Humans; Nail Diseases; Nails; Psoriasis; Quality of Life; Severity of Illness Index
PubMed: 35697407
DOI: 10.1016/j.ad.2022.01.006 -
Recent Patents on Inflammation &... 2020Onychomycosis is a common fungal infection of the nail. (Review)
Review
BACKGROUND
Onychomycosis is a common fungal infection of the nail.
OBJECTIVE
The study aimed to provide an update on the evaluation, diagnosis, and treatment of onychomycosis.
METHODS
A PubMed search was completed in Clinical Queries using the key term "onychomycosis". The search was conducted in May 2019. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews published within the past 20 years. The search was restricted to English literature. Patents were searched using the key term "onychomycosis" in www.freepatentsonline.com.
RESULTS
Onychomycosis is a fungal infection of the nail unit. Approximately 90% of toenail and 75% of fingernail onychomycosis are caused by dermatophytes, notably Trichophyton mentagrophytes and Trichophyton rubrum. Clinical manifestations include discoloration of the nail, subungual hyperkeratosis, onycholysis, and onychauxis. The diagnosis can be confirmed by direct microscopic examination with a potassium hydroxide wet-mount preparation, histopathologic examination of the trimmed affected nail plate with a periodic-acid-Schiff stain, fungal culture, or polymerase chain reaction assays. Laboratory confirmation of onychomycosis before beginning a treatment regimen should be considered. Currently, oral terbinafine is the treatment of choice, followed by oral itraconazole. In general, topical monotherapy can be considered for mild to moderate onychomycosis and is a therapeutic option when oral antifungal agents are contraindicated or cannot be tolerated. Recent patents related to the management of onychomycosis are also discussed.
CONCLUSION
Oral antifungal therapies are effective, but significant adverse effects limit their use. Although topical antifungal therapies have minimal adverse events, they are less effective than oral antifungal therapies, due to poor nail penetration. Therefore, there is a need for exploring more effective and/or alternative treatment modalities for the treatment of onychomycosis which are safer and more effective.
Topics: Administration, Oral; Administration, Topical; Antifungal Agents; Foot Dermatoses; Hand Dermatoses; Humans; Onychomycosis; Patents as Topic; Randomized Controlled Trials as Topic
PubMed: 31738146
DOI: 10.2174/1872213X13666191026090713 -
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 -
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 -
International Journal of Environmental... Jun 2022Tetracyclines are a group of antibiotics whose first representative was discovered over 70 years ago. Since then, they have been of great interest in dermatology. In... (Review)
Review
Tetracyclines are a group of antibiotics whose first representative was discovered over 70 years ago. Since then, they have been of great interest in dermatology. In addition to their antibacterial activity, they are able to inhibit metalloproteinases and exhibit anti-inflammatory, anti-apoptotic and antioxidant effects. The side effects have been thoroughly studied over the years, the most characteristic and important ones in daily dermatological practice being: phototoxicity, hyperpigmentation, onycholysis, photoonycholysis, induced lupus erythematosus, and idiopathic intracranial hypertension. In this article, we summarize the use of tetracyclines in infectious diseases and inflammatory dermatoses, and further discuss the instances where the efficacy and safety of tetracyclines have been highlighted over the past few years.
Topics: Anti-Bacterial Agents; Dermatologists; Humans; Tetracyclines
PubMed: 35742496
DOI: 10.3390/ijerph19127246 -
Frontiers in Pediatrics 2022Juvenile psoriatic arthritis (JPsA) is a relatively rare condition in childhood as it represents approximately 5% of the whole Juvenile Idiopathic Arthritis (JIA)... (Review)
Review
Juvenile psoriatic arthritis (JPsA) is a relatively rare condition in childhood as it represents approximately 5% of the whole Juvenile Idiopathic Arthritis (JIA) population. According to International League of Associations of Rheumatology (ILAR) classification, JPsA is defined by the association of arthritis and psoriasis or, in the absence of typical psoriatic lesions, with at least two of the following: dactylitis, nail pitting, onycholysis or family history of psoriasis in a first-degree relative. However, recent studies have shown that this classification system could conceal more homogeneous subgroups of patients differing by age of onset, clinical characteristics and prognosis. Little is known about genetic factors and pathogenetic mechanisms which distinguish JPsA from other JIA subtypes or from isolated psoriasis without joint involvement, especially in the pediatric population. Specific clinical trials testing the efficacy of biological agents are lacking for JPsA, while in recent years novel therapeutic agents are emerging in adults. In this review, we summarize the clinical features and the current evidence on pathogenesis and therapeutic options for JPsA in order to provide a comprehensive overview on the clinical management of this complex and overlapping entity in childhood.
PubMed: 35722498
DOI: 10.3389/fped.2022.884727 -
Taiwanese Journal of Obstetrics &... Sep 2019Nail change after chemotherapy is relatively unfamiliar with gynecological oncologist. It often occurs after docetaxel treatment. For gynecological tract cancers,...
OBJECTIVE
Nail change after chemotherapy is relatively unfamiliar with gynecological oncologist. It often occurs after docetaxel treatment. For gynecological tract cancers, paclitaxel might be most frequently used but nail change after paclitaxel treatment is seldom reported before.
CASE REPORT
Two patients treated with the postoperative dose-dense weekly schedule of paclitaxel 80 mg/m plus cisplatin 20 mg/m every three weeks were complicated with nail problems during the treatment. They included onycholysis, subungual hemorrhage, proximal white subungual collections of pus obscuring the lunula (onychophosis), dystrophy, Beau's lines, pigmentation, and melanonychia. Topical use of anti-fugal cream and oral antibiotics stopped the nail disease progression and both patients had completed their chemotherapy without interruption.
CONCLUSION
Clinicians should be aware of paclitaxel-induced nail toxicities. Adequate information, detailed preventive intervention, and early use of prophylactic and/or therapeutic agents to minimize the occurrence of severe morbidity, such as cellulitis and subsequent sepsis is important for women who need the continuous dose-dense paclitaxel chemotherapy.
Topics: Adult; Antineoplastic Agents, Phytogenic; Carcinoma; Female; Humans; Middle Aged; Nail Diseases; Ovarian Neoplasms; Paclitaxel
PubMed: 31542098
DOI: 10.1016/j.tjog.2019.07.023 -
Journal of Fungi (Basel, Switzerland) Feb 2022The relationship between psoriasis and onychomycosis is controversial, and the exact nature of this association remains to be clearly elucidated. In healthy nails, the... (Review)
Review
The relationship between psoriasis and onychomycosis is controversial, and the exact nature of this association remains to be clearly elucidated. In healthy nails, the compact nail plate acts as a barrier, preventing any infection. In psoriatic nails, the nail plate involvement, together with abnormalities in the blood capillaries, may lead to decreased natural defenses against microorganisms. Moreover, onycholysis (detachment of the nail plate) induces a humid environment that may favor fungal proliferation. Treatment with immunosuppressive drugs may additionally enhance onychomycosis. In this comprehensive review, we present data regarding the incidence and pathogenic action of dermatophytes and other fungi in the development of fungal infection in psoriatic nails.
PubMed: 35205908
DOI: 10.3390/jof8020154 -
Deutsches Arzteblatt International Mar 2020
Topics: Antimalarials; Dermatitis, Phototoxic; Doxycycline; Female; Humans; Young Adult
PubMed: 32343652
DOI: 10.3238/arztebl.2020.0196