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Acta Dermatovenerologica Alpina,... Dec 2004Photo-onycholysis is a phototoxic reaction, which is usually drug-induced. It consists of the separation of the nail from the nail bed due to ultraviolet radiation. We...
Photo-onycholysis is a phototoxic reaction, which is usually drug-induced. It consists of the separation of the nail from the nail bed due to ultraviolet radiation. We report two cases of female patients who developed distal onycholysis while receiving doxycycline. Among the drugs that cause photo-onycholysis, the most frequently cited are tetracyclines, psoralens and fluoroquinolones. Photo-onycholysis is often distal, half-moon shaped and can be surrounded by pigmentation. Spontaneous recovery follows within a few months of discontinuing the drug.
PubMed: 15818449
DOI: No ID Found -
SAGE Open Medical Case Reports 2023Paclitaxel is a drug frequently used in the treatment of gynecological cancers. Its cutaneous side effects are fairly well documented. A subtype of hand-foot syndrome,...
Paclitaxel is a drug frequently used in the treatment of gynecological cancers. Its cutaneous side effects are fairly well documented. A subtype of hand-foot syndrome, periarticular erythema of the thenar eminences with onycholysis, is rarer. Here, we present a case of a woman treated with paclitaxel for recurrent ovarian cancer who developed periarticular thenar eminence erythema with onycholysis syndrome. Involvement presented as an erythematous rash on the top of the left hand progressing up the arm. A lesion was also present on the right lower limb and on the dorsal surface of the right foot with onycholysis. Edema was present in the fingers, hands, forearms, and feet. A punch biopsy and pathological analysis confirmed the diagnosis of periarticular thenar eminence erythema with onycholysis syndrome. Rapid identification and treatment with topical corticosteroids limited irreversible damage.
PubMed: 38022865
DOI: 10.1177/2050313X231213930 -
Postepy Dermatologii I Alergologii Jun 2020There are very few studies investigating the dermoscopic aspect of nail involvement in lichen planus and these studies described dermoscopic features of only clinically...
INTRODUCTION
There are very few studies investigating the dermoscopic aspect of nail involvement in lichen planus and these studies described dermoscopic features of only clinically visible nail involvement in lichen planus.
AIM
To reveal subtle dermoscopic nail findings in patients with lichen planus.
MATERIAL AND METHODS
The study included 40 patients with lichen planus and 40 healthy volunteers. All fingernails of the patients and healthy volunteers were examined by a handheld dermoscope and the findings detected were recorded. The patients were grouped by age, gender, disease duration and extent of the disease. The statistical analysis was performed using Chi square test.
RESULTS
82.5% of the patients and 17.5% of the healthy volunteers showed at least one dermoscopic nail finding. The frequency of multiple splinter haemorrhage ( < 0.05), multiple leukonychia ( < 0.05), longitudinal erythronychia ( < 0.05), prominent hyponychial vascular structures ( < 0.05) and onycholysis ( < 0.05) observed in the patients group was statistically significant. The other findings included distal short longitudinal lines, onychorrhexis, solitary splinter haemorrhage and solitary punctate leukonychia and showed no statistically significant differences between the two groups.
CONCLUSIONS
To the best of our knowledge, this is the first study focusing on uncovering subtle nail involvement in lichen planus. The presence of dilated hyponychial vascular structures in lichen planus was first described in the present study. It can be concluded that the frequency of nail involvement in lichen planus is more than known. Dermoscopic imaging of the nails of all patients with lichen planus may help establish early diagnosis and treatment to avoid permanent nail damage.
PubMed: 32792882
DOI: 10.5114/ada.2020.96298 -
Heliyon Apr 2024Dermoscopy has emerged as a useful diagnostic tool to evaluate skin lesions, including psoriasis. We aimed to compare the clinical examination and digital dermoscopy...
BACKGROUND
Dermoscopy has emerged as a useful diagnostic tool to evaluate skin lesions, including psoriasis. We aimed to compare the clinical examination and digital dermoscopy findings of nail involvement in patients with psoriatic nails.
METHODS
This study included 60 patients with clinically diagnosed psoriasis. The nail findings and NAPSI were evaluated clinically and via dermoscopy, and then the severity of the disease was calculated using PASI criteria.
RESULTS
About 32 patients were males, with a median PASI score of 4.4, and pitting and subungual hyperkeratosis were the most common findings. The clinical and dermoscopic examination had a moderate diagnostic resemblance regarding onycholysis, subungual hyperkeratosis, and leukonychia. The resemblance between the two methods for the diagnosis of leukonychia in patients with a duration of disease <2 years (Kappa = 0.59) and 2-6 years was moderate (Kappa = 0.48), and for 6 years< was perfect (Kappa = 0.62). The resemblance for the diagnosis of subungual hyperkeratosis and onycholysis in subjects with a duration of disease <2 years was slight, and for 2-6 years and 6 years< were moderate. The resemblance between the NAPSI score by the two methods was also moderate (95%CI -0.89-0.81, < 0.001).
CONCLUSION
Dermoscopy is an efficient, supportive, and non-invasive method providing a better diagnosis of nail psoriasis.
PubMed: 38655347
DOI: 10.1016/j.heliyon.2024.e29608 -
Skin Appendage Disorders Sep 2015Acrylic nails, including sculptured nails and the new ultraviolet-curable gel polish lacquers, have been associated with allergic contact dermatitis (ACD). We report 2...
Acrylic nails, including sculptured nails and the new ultraviolet-curable gel polish lacquers, have been associated with allergic contact dermatitis (ACD). We report 2 cases of ACD to acrylic nails with severe onychodystrophy and psoriasiform changes including onycholysis and subungual hyperkeratosis. In both cases, the patients did not realize the association between the use of acrylate-based manicures and nail changes. One patient had been previously misdiagnosed and treated unsuccessfully for nail psoriasis. The informed clinician should elicit a history of acrylic manicure in patients with these nail changes, especially in cases of suspected nail psoriasis refractory to treatment. Patch testing is a useful tool in confirming diagnosis.
PubMed: 27170940
DOI: 10.1159/000434686 -
Indian Journal of Dermatology,... 2023Background Nail involvement in psoriasis is common and may be an indicator not only of disease severity, but also of the presence of psoriatic arthritis. However, the...
Background Nail involvement in psoriasis is common and may be an indicator not only of disease severity, but also of the presence of psoriatic arthritis. However, the relationship of nail psoriasis with enthesitis remains under-explored. Aims This study was conducted to evaluate the clinical, onychoscopic (nail dermatoscopic) and ultrasonographic features in patients with nail psoriasis. Materials and Methods All nails of twenty adult patients with nail psoriasis were examined clinically and onychoscopically. Patients were evaluated for psoriatic arthritis (Classification Criteria for Psoriatic Arthritis), the severity of cutaneous disease (Psoriasis Area Severity Index) and nail disease (Nail Psoriasis Severity Index). Ultrasonography of the clinically involved digits was performed for evidence of distal interphalangeal joint enthesitis. Results Out of 20 patients, 18 patients had cutaneous psoriasis and 2 had isolated nail involvement. Among the 18 patients with skin psoriasis, 4 had associated psoriatic arthritis. The most commonly observed clinical and onychoscopic features were pitting (31.2% and 42.2%), onycholysis (36% and 36.5%) and subungual hyperkeratosis (30.2% and 30.5%), respectively. Ultrasonographic evidence of distal interphalangeal joint enthesitis was seen in 57% (175/307) of the digits with clinical nail involvement. Enthesitis was more common in patients with psoriatic arthritis (77% vs 50.6%). Nail thickening, crumbling and onychorrhexis (all features of nail matrix involvement) were significantly associated with enthesitis (P < 0.005). Limitation The major limitation was the small sample size and lack of controls. Only the clinically involved digits were evaluated for enthesitis. Conclusion Enthesitis was frequently detected on ultrasonography in patients with nail psoriasis, even in clinically asymptomatic individuals. Nail features of thickening, crumbling and onychorrhexis may predict underlying enthesitis and the potential development of arthritis. A comprehensive evaluation could help identify patients with psoriasis at risk for arthritis, helping improve long-term outcomes.
Topics: Adult; Humans; Arthritis, Psoriatic; Enthesopathy; Cross-Sectional Studies; Severity of Illness Index; Psoriasis; Nail Diseases
PubMed: 37317728
DOI: 10.25259/IJDVL_894_2022 -
American Journal of Human Genetics Jun 2011Inherited and isolated nail malformations are rare and heterogeneous conditions. We identified two consanguineous pedigrees in which some family members were affected by...
Inherited and isolated nail malformations are rare and heterogeneous conditions. We identified two consanguineous pedigrees in which some family members were affected by isolated nail dysplasia that suggested an autosomal-recessive inheritance pattern and was characterized by claw-shaped nails, onychauxis, and onycholysis. Genome-wide SNP array analysis of affected individuals from both families showed an overlapping and homozygous region of 800 kb on the long arm of chromosome 8. The candidate region spans eight genes, and DNA sequence analysis revealed homozygous nonsense and missense mutations in FZD(6), the gene encoding Frizzled 6. FZD(6) belongs to a family of highly conserved membrane-bound WNT receptors involved in developmental processes and differentiation through several signaling pathways. We expressed the FZD(6) missense mutation and observed a quantitative shift in subcellular distribution from the plasma membrane to the lysosomes, where the receptor is inaccessible for signaling and presumably degraded. Analysis of human fibroblasts homozygous for the nonsense mutation showed an aberrant response to both WNT-3A and WNT-5A stimulation; this response was consistent with an effect on both canonical and noncanonical WNT-FZD signaling. A detailed analysis of the Fzd(6)(-/-) mice, previously shown to have an altered hair pattern, showed malformed claws predominantly of the hind limbs. Furthermore, a transient Fdz6 mRNA expression was observed in the epidermis of the digital tips at embryonic day 16.5 during early claw morphogenesis. Thus, our combined results show that FZD6 mutations can result in severe defects in nail and claw formation through reduced or abolished membranous FZD(6) levels and several nonfunctional WNT-FZD pathways.
Topics: Amino Acid Sequence; Animals; Chromosomes, Human, Pair 8; Codon, Nonsense; Frizzled Receptors; Genome-Wide Association Study; HEK293 Cells; Hindlimb; Hoof and Claw; Humans; Mice; Mice, Mutant Strains; Molecular Sequence Data; Mutation, Missense; Nail Diseases; Pedigree; Polymorphism, Single Nucleotide; Proto-Oncogene Proteins; Receptors, G-Protein-Coupled; Wnt Proteins; Wnt-5a Protein; Wnt3 Protein; Wnt3A Protein
PubMed: 21665003
DOI: 10.1016/j.ajhg.2011.05.013 -
Skin Appendage Disorders Aug 2019Nail changes are a common side effect of taxane chemotherapy, although their correct management is poorly standardized.
BACKGROUND
Nail changes are a common side effect of taxane chemotherapy, although their correct management is poorly standardized.
OBJECTIVE
To evaluate incidence, clinical aspects, and response to treatment of taxane-induced nail side effects in patients treated with taxanes for malignancies.
PATIENTS AND METHODS
We performed a retrospective clinical study of 79 patients with taxane-induced nail changes from January 2015 to July 2018.
RESULTS
Paclitaxel was the most responsible drug and both hands and feet were often affected (46.8%). Grade 2 nail toxicity was seen in 63.3% of the patients, including painful subungual hematoma, hemorrhagic onycholysis, and paronychia. Grade 3 nail toxicity was seen only in 2.5% of the patients, including hemorrhagic onycholysis and pyogenic granuloma. Removal of the detached nail plate with application of topical antibiotics and steroids induced regression of symptoms within 2 weeks.
CONCLUSIONS
Nail toxicity develops mostly at the end of therapy, and total drug dosage is the only known factor that predisposes to these side effects. Trauma possibly plays a role as the most severe signs are located on the great toenails. Although it is impossible to prevent taxane-induced nail side effects, a careful patient monitoring permits to immediately recognize and manage the symptoms in order to induce their remission and improvement of the patient's quality of life.
PubMed: 31559250
DOI: 10.1159/000497824 -
Case Reports in Oncology 2021Onychomycosis has been shown to have a higher incidence in cancer patients. Nail toxicity is a quite common side effect of anticancer agents. Taxotere is a...
Onychomycosis has been shown to have a higher incidence in cancer patients. Nail toxicity is a quite common side effect of anticancer agents. Taxotere is a chemotherapeutic known to cause great incidence of nail change and has a role in subungual suppuration. We report on a 52-year-old woman with breast cancer admitted in our institution for onycholysis. Because of the stage and histology of breast cancer, neoadjuvant chemotherapy was initiated. The patient received 8 cycles of Taxotere and Adriamycin (AT), and she underwent a modified radical mastectomy. Three months later, the patient developed evidence of onycholysis, involving all the fingernails. We observed the following changes in nails of all the digits in both hands: onycholysis, dystrophy, oedema, and exudate. Nail scraping and purulent discharge were collected and cultured on Sabouraud medium. Physical features of the colonies and biochemical tests (Auxacolor) revealed as the sole etiologic agent of onychomycosis. This case details an onycholysis in a breast cancer case successfully managed solely with amorolfine lacquer. This clinical and mycological presentation should alert the clinician to the possibility of onychomycosis induced by docetaxel chemotherapy.
PubMed: 34899247
DOI: 10.1159/000519695 -
Annals of Dermatology Apr 2020Solitary fibrous tumor (SFT) is a relatively uncommon mesenchymal neoplasm that usually arises in the pleura, but also has been reported in numerous extrapleural...
Solitary fibrous tumor (SFT) is a relatively uncommon mesenchymal neoplasm that usually arises in the pleura, but also has been reported in numerous extrapleural locations, including cutaneous site. The skin lesion presents as a circumscribed nodule or tumor, mainly on the head and neck. A 41-year-old male presented with 6 months history of nail lesion without symptom on the left third finger. The lesion is slightly yellowish discoloration with subungual erythematous nodule and distal onycholysis. Biopsy specimen from the nail lesion showed the spindle cells form patternless pattern with hypercellular and hypocellular area. And small blood vessels and dilated vascular spaces were present. The result of special stain for specimen showed that positive for CD34, Bcl-2, and CD99 but negative for S-100, FactorXIIIa, and smooth muscle action. Recognition of this uncommon location of SFT is important because of possible confusion with other subungual tumors, including glomus tumor, fibroma and other fibrohistiocytic tumors like dermatofibrosarcoma protuberans, superficial acral fibromyxoma and cellular digital fibroma. Here in, we report a case of SFT of subungual region. We think this case is interesting because of uncommon location and may be helpful to more understand the character of this disease.
PubMed: 33911726
DOI: 10.5021/ad.2020.32.2.146