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Ugeskrift For Laeger Dec 2018Melanonychia is seen, when melanin is incorporated in the nail, which gives a band of dark discolouration of the nail. Nail discolouration is a common cause for patients...
Melanonychia is seen, when melanin is incorporated in the nail, which gives a band of dark discolouration of the nail. Nail discolouration is a common cause for patients to seek medical attention, and it is often benign. Melanonychia can be seen due to melanocytic proliferation (ungual naevi), benign hyperplasia (lentigo) and hypermelanosis (infections, traumas). However, subungual melanoma also commonly presents with melanonychia and is often overseen, leading to a worse prognosis. It is therefore important systematically to examine all nail discolourations to find the cause and rule out malignancy.
Topics: Humans; Melanoma; Nail Diseases; Nails; Nevus, Pigmented; Skin Neoplasms
PubMed: 30547873
DOI: No ID Found -
Ugeskrift For Laeger Nov 2023Disturbances of the nail apparatus are common and mainly benign. This review aims to investigate the aetiology of these disturbances, which range from more common benign... (Review)
Review
Disturbances of the nail apparatus are common and mainly benign. This review aims to investigate the aetiology of these disturbances, which range from more common benign causes to less common melanomas. Melanonychia may be the most prominent concern and is characterised by brown or black nail plate discoloration. Hence, understanding the most common nail changes, their epidemiology, pathophysiology, and clinical features are imperative to diagnosis and may prevent unnecessary surgical procedures in cases where it is not warranted.
Topics: Humans; Skin Neoplasms; Dermoscopy; Melanoma; Nails; Nail Diseases
PubMed: 38018740
DOI: No ID Found -
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 -
American Family Physician Oct 2021Onychomycosis is a chronic fungal infection of the fingernail or toenail bed leading to brittle, discolored, and thickened nails. Onychomycosis is not just a cosmetic... (Review)
Review
Onychomycosis is a chronic fungal infection of the fingernail or toenail bed leading to brittle, discolored, and thickened nails. Onychomycosis is not just a cosmetic problem. Untreated onychomycosis can cause pain, discomfort, and physical impairment, negatively impacting quality of life. Onychomycosis should be suspected in patients with discolored nails, nail plate thickening, nail separation, and foul-smelling nails. Accurate diagnosis is important before initiating treatment because therapy is lengthy and can cause adverse effects. A potassium hydroxide preparation with confirmatory fungal culture, periodic acid-Schiff stain, or polymerase chain reaction is the preferred diagnostic approach if confirmative testing is cost prohibitive or not available. Treatment decisions should be based on severity, comorbidities, and patient preference. Oral terbinafine is preferred over topical therapy because of better effectiveness and shorter treatment duration. Patients taking terbinafine in combination with tricyclic antidepressants, selective serotonin reuptake inhibitors, atypical antipsychotics, beta blockers, or tamoxifen should be monitored for drug-drug interactions. Topical therapy, including ciclopirox 8%, efinaconazole 10%, and tavaborole 5%, is less effective than oral agents but can be used to treat mild to moderate onychomycosis, with fewer adverse effects and drug-drug interactions. Nail trimming and debridement used concurrently with pharmacologic therapy improve treatment response. Although photodynamic and plasma therapies are newer treatment options that have been explored for the treatment of onychomycosis, larger randomized trials are needed. Preventive measures such as avoiding walking barefoot in public places and disinfecting shoes and socks are thought to reduce the 25% relapse rate.
Topics: Administration, Oral; Administration, Topical; Antifungal Agents; Diagnosis, Differential; Humans; Onychomycosis; Terbinafine
PubMed: 34652111
DOI: No ID Found -
Journal of Fungi (Basel, Switzerland) Mar 2022Onychomycosis is a nail fungal infection that produces nail discolouration, thickness, and separation from the nail bed. The species of the genus that cause... (Review)
Review
Onychomycosis is a nail fungal infection that produces nail discolouration, thickness, and separation from the nail bed. The species of the genus that cause onychomycosis are emerging and the number of cases has increased throughout the years. Microscopic examination, as well as cultures, are required for the accurate diagnosis of onychomycosis. The goal of treatment is to eliminate the organism that causes the disease and restore the nail's normal appearance. Here, we provide an overview of the onychomycosis cases that have been reported in literature over the last 24 years, which have been caused by the species. We performed a review on the onychomycosis cases caused by the species from January 1997 to January 2021. Patients aged between 40 and 49 years made up 30.23% of the cases. The most common aetiologic species was species complex (FSSC), which accounted for 44.11% of the cases, followed by species complex (FFSC), which accounted for 17.64%; 14.70% of the cases were due to species complex (FDSC) and 14.70% of the cases were due species complex (FOSC). Europe accounted for 29.06% of the cases caused by FOSC, whereas Africa accounted for 46.67% of the cases due to FSSC. The clinical presentation of onychomycosis due to spp. is commonly the distal-lateral pattern of onychomycosis. Identification of the infectious agent in onychomycosis cases due to is crucial in deciding the proper treatment. Although antifungal susceptibility tests have only been performed in a few cases, susceptibility testing can help with patient management.
PubMed: 35448591
DOI: 10.3390/jof8040360 -
Reumatologia 2017Nail psoriasis is considered a significant psychological and social problem causing functional impairment in affected patients. Nail changes hamper their daily and... (Review)
Review
Nail psoriasis is considered a significant psychological and social problem causing functional impairment in affected patients. Nail changes hamper their daily and occupational activities and contribute to a worse quality of life. Almost 50% of patients with psoriasis vulgaris and up to 80% of patients with psoriatic arthritis are afflicted with nail lesions. The important correlation between psoriatic arthritis and nail changes is well established - the presence of the latter is a strong predictor of the development of arthritis. There is a broad spectrum of nail dystrophies associated with psoriasis, ranging from the common pitting, subungual hyperkeratosis and loosening of the nail plate to less frequent discolouration and splinter haemorrhages. Some of these symptoms are also observed in other nail diseases, and further diagnostics should be performed. The assessment tools NAPSI (Nail Psoriasis Severity Index), mNAPSI (Modified Nail Psoriasis Severity Index), and PNSS (Psoriasis Nail Severity Score) are most commonly used to grade the severity of nail involvement in psoriasis and enable the evaluation of therapy effectiveness. The treatment of nail psoriasis is a major clinical challenge. It should be adjusted to the extent of dermal, articular and ungual lesions. Systemic therapies of psoriasis, especially biological agents, are most likely to be effective in treating nail psoriasis. However, as their use is limited in scope and safety, topical therapy remains a mainstay, and the combination of corticosteroids and vitamin D analogues is considered to be most helpful.
PubMed: 28769136
DOI: 10.5114/reum.2017.68912 -
Orphanet Journal of Rare Diseases Feb 2017Yellow nail syndrome (YNS; OMIM 153300, ORPHA662) is a very rare disorder that almost always occurs after 50 years of age but a juvenile or familial form has also been... (Review)
Review
Yellow nail syndrome (YNS; OMIM 153300, ORPHA662) is a very rare disorder that almost always occurs after 50 years of age but a juvenile or familial form has also been observed. YNS is diagnosed based on a triad associating yellow nail discoloration, pulmonary manifestations (chronic cough, bronchiectasia, pleural effusion) and lower limb lymphedema. Chronic sinusitis is frequently associated with the triad. YNS etiology remains unknown but a role of lymphatic impairment is usually evoked. YNS is more frequently isolated but may be associated in rare cases with autoimmune diseases, other clinical manifestations implicating lymphatic functions or cancer and, hence, is also considered a paraneoplastic syndrome. YNS management is symptomatic and not codified. YNS can resolve spontaneously. Oral vitamin E alone or even better when associated with triazole antifungals may achieve partial or total disappearance of nail discoloration. Pleural effusion can be treated surgically, with decortication/pleurectomy or pleurodesis. Antibiotic prophylaxis is prescribed for bronchiectasia with chronic sputum production. Lymphedema treatment is based on low-stretch bandages and the wearing of elastic compression garments combined with skin care, exercises and, as needed, manual lymph drainage.
Topics: Humans; Lung Diseases; Lymphedema; Sinusitis; Yellow Nail Syndrome
PubMed: 28241848
DOI: 10.1186/s13023-017-0594-4 -
Indian Dermatology Online Journal 2020Melanonychia is a very worrisome entity for most patients. It is characterized by brownish black discoloration of nail plate and is a common cause of nail plate... (Review)
Review
Melanonychia is a very worrisome entity for most patients. It is characterized by brownish black discoloration of nail plate and is a common cause of nail plate pigmentation. The aetiology of melanonychia ranges from more common benign causes to less common invasive and in situ melanomas. Melanonychia especially in a longitudinal band form can be due to both local and systemic causes. An understanding of the epidemiology, pathophysiology and clinical details is necessary for adequate patient care and counseling. It not only helps in the early recognition of melanoma but also prevents unnecessary invasive work up in cases with benign etiology. An early diagnosis of malignant lesion is the key to favourable outcome. Though there are no established guidelines or algorithms for evaluating melanonychia, a systematic stepwise approach has been suggested to arrive at a probable etiology. We, hereby, review the aetiology, clinical features, diagnostic modalities and management protocol for melanonychia.
PubMed: 32055501
DOI: 10.4103/idoj.IDOJ_167_19