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SAGE Open Medical Case Reports 2019Hand, foot, and mouth disease is an enteroviral infection characterized by vesicles on the hands, feet, and oral mucosa. Given its rising incidence among adults, it is...
Hand, foot, and mouth disease is an enteroviral infection characterized by vesicles on the hands, feet, and oral mucosa. Given its rising incidence among adults, it is important to recognize its variable presentations and sequelae. These include onychomadesis, a complication of hand, foot, and mouth disease that is well described in children, with limited reports in adults. We present the unique case of a pregnant woman who developed onychomadesis following hand, foot, and mouth disease, with no adverse pregnancy outcomes. This case illustrates that (1) onychomadesis can occur in pregnant women with hand, foot, and mouth disease; (2) onychomadesis is typically a benign change that can occur following hand, foot, and mouth disease; and (3) onychomadesis is not necessarily associated with more severe disease or adverse pregnancy outcomes.
PubMed: 31080597
DOI: 10.1177/2050313X19845202 -
Case Reports in Pediatrics 2019Kawasaki disease is characterized by fever for ≥ five days, bilateral bulbar conjunctival injection without exudate, polymorphous rash changes in the extremities,...
Kawasaki disease is characterized by fever for ≥ five days, bilateral bulbar conjunctival injection without exudate, polymorphous rash changes in the extremities, oral mucosal changes, and cervical lymphadenopathy. We report a 20-month-old boy with Kawasaki disease who had onychomadesis affecting the fingernails and toenails bilaterally. To our knowledge, there were three reported cases of onychomadesis associated with Kawasaki disease, to which we add another one. We suggest keeping in mind the possibility of onychomadesis as a nail sequela of Kawasaki disease.
PubMed: 30944748
DOI: 10.1155/2019/3156736 -
Annals of Dermatology Apr 2019Nail dystrophy arises from various inflammatory dermatologic diseases. However, there have been few reports on the prevalence of nail abnormality in atopic dermatitis...
BACKGROUND
Nail dystrophy arises from various inflammatory dermatologic diseases. However, there have been few reports on the prevalence of nail abnormality in atopic dermatitis (AD) or on the relationship of this condition with the severity of the disease.
OBJECTIVE
This study was intended to determine the prevalence and types of nail abnormalities associated with AD and to evaluate the relation between nail abnormalities and the severity of AD.
METHODS
AD patients aged 2 to 19 who visited the outpatient clinic were thoroughly examined for nail abnormalities. Demographic information was collected and eczema area and severity index (EASI) score for severity of AD were checked.
RESULTS
A total of 235 AD patients (children and adolescents) were investigated. There were 24 (10.2%) patients with nail abnormalities: transverse groove (Beau's line) (25.0%), nail pitting (16.7%), koilonychia (16.7%), trachyonychia (12.5%), leukonychia (12.5%), brachyonychia (8.3%), melanonychia (8.3%), onychomadesis (8.3%), onychoschizia (8.3%), and onycholysis (8.3%). There was no statistically significant difference in the total EASI score associated with development of nail abnormalities (=0.236). However, when the EASI score was confined to the lower extremities, it showed a relation to the prevalence of toe nail dystrophy (odds ratio, 1.115; 95% confidence interval, 1.014~1.316; =0.030).
CONCLUSION
Nail abnormalities in AD are thought to be caused mainly by pathologic change in the nail matrix region, and the EASI score confined to lower limbs, might be used as a predictor of toe nail changes in patients with AD.
PubMed: 33911559
DOI: 10.5021/ad.2019.31.2.121 -
BMC Dermatology Jan 2019Mucous membrane pemphigoid (MMP) is an autoimmune blistering disease that is notoriously difficult to treat. Nail involvement in MMP is rare.
BACKGROUND
Mucous membrane pemphigoid (MMP) is an autoimmune blistering disease that is notoriously difficult to treat. Nail involvement in MMP is rare.
CASE PRESENTATION
We report on a 58 years old man with severe MMP who presented with onychomadesis.
CONCLUSION
To our knowledge, mucous membrane pemphigoid associated paronychia and onychomadesis have not been reported before. We believe it is important for dermatologists to be aware of this entity.
Topics: Humans; Male; Middle Aged; Paronychia; Pemphigoid, Benign Mucous Membrane
PubMed: 30674299
DOI: 10.1186/s12895-019-0083-7 -
Skin Appendage Disorders Aug 2018Onychomadesis occurs when the proximal nail plate becomes unattached to the underlying structures. When only one or a few nails are involved, the cause is usually...
Onychomadesis occurs when the proximal nail plate becomes unattached to the underlying structures. When only one or a few nails are involved, the cause is usually physical trauma. A 23-year-old female presented with a 4-year history of recurrent onychomadesis involving her bilateral great toes that occurred during the springtime. While recurrent trauma from winter shoes or athletic activities may be a contributing factor, our patient was convinced that wearing tight-fitting socks during winter nights was the primary pathophysiologic process. By wearing socks only during the days and decreasing the amount of time the nails spent traumatized due to pressure, the patient's recurrent condition was eliminated.
PubMed: 30197898
DOI: 10.1159/000484328 -
Frontiers in Medicine 2018Pemphigus vulgaris lesions have a tendency to localize around natural body orifices. The aim here was to analyze the involvement of nail apparatus in pemphigus vulgaris....
Pemphigus vulgaris lesions have a tendency to localize around natural body orifices. The aim here was to analyze the involvement of nail apparatus in pemphigus vulgaris. Sixty seven ethnic Poles suffering from pemphigus vulgaris on photographic files archiving initial presentation were retrospectively evaluated. Pemphigus vulgaris was diagnosed using combination of clinical data, H+E histology, direct immunofluorescence of plucked scalp hair and/or perilesional tissue also for IgG1 and IgG4 deposits evaluation, indirect immunofluorescence on mosaic substrate and/or monkey esophagus, mono-analyte ELISA with desmoglein 1/3 or multi-analyte ELISA. The nail apparatus involvement was found in 9 of 67 patients (13.4%; 3 females and 6 males). Periungual fingernail lesions were found in 6 patients (2 females, 4 males), whereas periungual toenail lesions in just 3 patients (1 female, 2 males). Our patients nail apparatus changes included, by order of frequency, paronychia, nail discoloration, onychorrhexis, Beau lines, periungual hemorrhages, onychomadesis, cross-ridging, onycholysis, and trachyonychia. The average time between the onset, as recalled by patients, and the diagnosis of pemphigus vulgaris with direct immunofluorescence was not statistically different in PV patients with and without nail apparatus lesions. In this article the molecular and immunological rationale for of periungual involvement is discussed. Our single-center study suggests that nail apparatus involvement is infrequent in pemphigus vulgaris in ethnic Poles. Due to the fact that nail apparatus lesions in pemphigus vulgaris may clinically resemble onychomycosis, giving the proper diagnosis can be difficult particularly when other lesions are overlooked or misinterpreted.
PubMed: 30155468
DOI: 10.3389/fmed.2018.00227 -
BMC Pediatrics Aug 2018Coxsackievirus A6 (CVA6) is one of the major agents to cause hand, foot and mouth disease (HFMD) outbreaks globally. The objective of this study is to investigate the...
BACKGROUND
Coxsackievirus A6 (CVA6) is one of the major agents to cause hand, foot and mouth disease (HFMD) outbreaks globally. The objective of this study is to investigate the epidemiologic and clinical manifestations of CVA6 outbreak, and thus guide the diagnosis and treatment of the disease, as well as disease prevention.
METHODS
An HFMD outbreak in a kindergarten was reported to Shijingshan District Center for Disease Control and Prevention (SCDC) on November 2, 2015 in Beijing, China. Epidemiological investigation was conducted. We performed a nine-week follow-up study to collect and analyze the clinical manifestations of HFMD cases.
RESULTS
The outbreak yield 56 (15.7%) clinical diagnosed HFMD cases out of 357 registered children in the kindergarten with the mean age of 3.5 years old. This outbreak lasted for three days and ceased after initiating infectious disease controlling procedures, including periodical suspension of the kindergarten activities, environmental disinfection, and family health education. Fifty-one cases were followed for nine weeks. The positive rate of clinical manifestations of rash, fever, desquamation, pigmentation and onychomadesis were 100.0%, 84.3%, 68.6%, 17.6% and 43.1%, respectively. Children developed desquamation within the first 4 weeks after disease onset and developed onychomadesis between the 3th and 8th week after disease onset. Children with desquamation had 9.3 (95%CI: 1.836-47.437) times higher odds of developing onychomadesis compared to those without this manifestation. Ten out of 14 collected samples were CVA6 positive, and five positive samples shared a high degree of similarity in the VP1 nucleotide and amino acid sequences (99.9-100.0% and 100%).
CONCLUSION
This HFMD outbreak was caused by CVA6, featured with delayed symptoms. Emerging CVA6-associated HFMD and its delayed symptoms should be paid more attention to reduce outbreaks and provide more information to doctors and parents.
Topics: Beijing; Child; Child, Preschool; Disease Outbreaks; Disease Transmission, Infectious; Enterovirus; Female; Hand, Foot and Mouth Disease; Humans; Infection Control; Male; Nail Diseases; Phylogeny
PubMed: 30131060
DOI: 10.1186/s12887-018-1253-1 -
Revista Chilena de Pediatria Jun 2018Nail alterations in children are an important cause of parent anxiety and derive in multiple and unnecessary consultations. The onychomadesis corresponds to the complete...
INTRODUCTION
Nail alterations in children are an important cause of parent anxiety and derive in multiple and unnecessary consultations. The onychomadesis corresponds to the complete and pain less detachment of the nail plate from the proximal fold. This self-resolving nail finding has been described as a late complication of hand-foot-mouth disease, a frequent viral exanthema in the pedia tric age.
OBJECTIVE
To describe a classic pediatric case of hand-foot-mouth disease with subsequent onychomadesis.
CLINICAL CASE
A 3-years-old male patient with an acute presentation of acute erythe matous perioral papulovesicles, which extend to upper extremities and hands, buttocks, thighs and feet, asymptomatic, and without compromising general condition. Skin lesions resolve completely, but after one month, he develops detachment of the nails, with subsequent complete recovery. Con clusions: The recognition of this association will allow primary care physicians to guide the parents about a benign and self-resolving process that may occur as part of the evolution of hand-foot-mouth disease, thus avoiding unnecessary anxiety, referral and treatments.
Topics: Child, Preschool; Hand, Foot and Mouth Disease; Humans; Male; Nail Diseases
PubMed: 29999145
DOI: 10.4067/S0370-41062018005000203 -
Indian Journal of Dermatology 2018
PubMed: 29937569
DOI: 10.4103/ijd.IJD_429_17 -
Medicine May 2018Thromboangiitis obliterans (TAOs, or Buerger's disease) present as a non-atherosclerotic segmental occlusive vasculitis within medium- and small-sized blood vessels. TAO...
RATIONALE
Thromboangiitis obliterans (TAOs, or Buerger's disease) present as a non-atherosclerotic segmental occlusive vasculitis within medium- and small-sized blood vessels. TAO frequently occurs in young adults and is associated with cigarette smoking. At present, there are no accurately defined treatments for TAO.
PATIENT CONCERNS
A 34-year-old Asian woman with a 20-year history of heavy cigarette smoking and recurrent, small, and self-limited lower limb ulcerations since adolescence, presented with persisting unhealed ulcerations on both ankles for 6 months. Her wound healing response was poor following the 2-month administration of colchicine, prednisolone, hydroxychloroquine, and mycophenolic acid.
DIAGNOSIS
The patient was diagnosed with TAO with hyperimmunoglobulin E and refractory ulcerations on her ankles.
INTERVENTIONS
The patient received monthly omalizumab (300 mg) and previous medications for 2 months and shifted to omalizumab and colchicine without mycophenolic acid and hydroxychloroquine because of onychomadesis, which was considered to be a possible adverse drug reaction.
OUTCOMES
The wounds healed almost completely. The administration of omalizumab and colchicine will be continued until they the wounds are fully healed.
LESSONS
Mycophenolic acid has a limited function in TAO treatment, especially in cases of refractory skin ulcerations. Omalizumab can be a valuable treatment option for patients with TAO and hyperimmunoglobulin E.
Topics: Adult; Ankle; Colchicine; Dermatologic Agents; Female; Humans; Immunoglobulin E; Omalizumab; Skin Ulcer; Smoking; Thromboangiitis Obliterans; Wound Healing
PubMed: 29768374
DOI: 10.1097/MD.0000000000010798