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Actas Dermo-sifiliograficas Nov 2020
Topics: Conjunctiva; Humans; Onycholysis; Pemphigoid, Bullous; Pterygium; Skin Abnormalities
PubMed: 32663446
DOI: 10.1016/j.ad.2018.09.030 -
Actas Dermo-sifiliograficas Sep 2007Capecitabine is an antineoplastic agent used for the treatment of patients with metastatic solid tumors (breast and colon). Different adverse effects have been...
Capecitabine is an antineoplastic agent used for the treatment of patients with metastatic solid tumors (breast and colon). Different adverse effects have been recognized, among which we find the muco-cutaneous ones and, specifically, hyperpigmentation. We report a case of localized cutaneous hyperpigmentation secondary to capecitabine in a woman that underwent surgery for breast cancer and was receiving this drug for a month. The start of therapy was associated with dysesthesias and hyperpigmentation of the hands and feet. The pathogenesis of such manifestations is unknown. Other reported cutaneous adverse effects associated with this drug involve the nails producing onycholysis, fragility, discoloration and dystrophy.
Topics: Antimetabolites, Antineoplastic; Breast Neoplasms; Capecitabine; Carcinoma; Deoxycytidine; Female; Fluorouracil; Foot Dermatoses; Hand Dermatoses; Humans; Hyperpigmentation; Mastectomy, Radical; Middle Aged; Paresthesia
PubMed: 17669305
DOI: No ID Found -
Indian Journal of Dermatology 2023Nail disorders account for about 10% of all dermatological conditions. Onychoscopy is useful not only for their diagnosis but also for assessing severity/progression and...
BACKGROUND
Nail disorders account for about 10% of all dermatological conditions. Onychoscopy is useful not only for their diagnosis but also for assessing severity/progression and monitoring the response to therapy.
AIMS AND OBJECTIVES
Describing dermoscopic features of nail disorders in patients reporting to the dermatology OPD of our tertiary care hospital and recording the sociodemographic profiles thereof.
MATERIALS AND METHODS
This cross-sectional observational study was carried out on 176 patients with effect from August 2019 to August 2021.
RESULTS
Males (99; 56.25%) outnumbered females (77; 43.75%); males: female: 1.28: 1; their mean age was 35.8 years. Fingernails were affected more oftener (84.09%) than toenails (38.64%). Onychomycosis, the commonest (58;32.95%) condition, revealed findings of aurora borealis pattern (75.86%), subungual hyperkeratosis (72.41%), and onycholysis with jagged edges and spikes (68.97%). The next frequent (32;18.18%) condition was nail psoriasis which revealed pits (81.25%); onycholysis (62.5%) and dilated globose nail fold vessels on capillaroscopy (25%).
LIMITATIONS
The small sample size proved inadequate for the evaluation of statistical significance in the less common conditions and the correlation of disease severity of many. Ideally, confirmatory diagnostic tests should have been done in every patient, as indicated. The magnification of our dermoscopy was 10X; 20- and 40X permit better capillaroscopy.
CONCLUSIONS
Onychocopy can minimize the need for biopsy by highlighting subtle changes and helps narrow down the differentials. It is potentially a diagnostic test of choice in younger children. Our study helped to grade the severity of connective tissue disorders and establish the benignity of melanonychia. Photographic documentation facilitates record-keeping.
PubMed: 37151277
DOI: 10.4103/ijd.ijd_215_22 -
Skin Appendage Disorders Jun 2021Bullous pemphigoid (BP) is the most frequent autoimmune blistering disorder. The immune reaction targets BP180 and BP230 antigens, 2 components of junctional adhesion...
Bullous pemphigoid (BP) is the most frequent autoimmune blistering disorder. The immune reaction targets BP180 and BP230 antigens, 2 components of junctional adhesion complexes at the basement membrane zone. Clinical aspect includes multiple tense bullae on urticarial plaques of the skin. Although the nail apparatus may be affected by the immune process, nail changes have been rarely reported during BP. We report a case of a 72-year-old woman diagnosed with BP who subsequently developed a secondary nail loss of the 2 thumbs and the left middle finger. Also, she presented onycholysis of the fourth left finger with the aspect of roller-coaster of the proximal border at dermoscopy. Steroid therapy at high doses was ineffective and the nail atrophy was permanent.
PubMed: 34307481
DOI: 10.1159/000514362 -
Skin Appendage Disorders Feb 2016Yeasts cause only 5-10% of onychomycosis; the most common yeast is Candida albicans, and rarely Trichosporon spp. is found. Recently, it has become an important cause of...
Yeasts cause only 5-10% of onychomycosis; the most common yeast is Candida albicans, and rarely Trichosporon spp. is found. Recently, it has become an important cause of fungemia with a high mortality rate in immunocompromised patients. Superficial infections caused by Trichosporon spp., including piedra and onychomycosis, occur in immunocompetent patients. Herein, we report a case of a fungal nail infection characterized by onycholysis and chromonychia caused by Trichosporon inkin.
PubMed: 27171745
DOI: 10.1159/000441065 -
Dermatology Practical & Conceptual Jul 2018Squamous cell carcinoma (SCC) of the nail apparatus is a rare malignant tumor that usually originates underneath the nail plate and grows slowly with possible bone...
Squamous cell carcinoma (SCC) of the nail apparatus is a rare malignant tumor that usually originates underneath the nail plate and grows slowly with possible bone invasion. The etiology remains unknown, although a strong association with different conditions, such as high-risk human papillomavirus (HPVs), trauma, or radiation exposure has been demonstrated. Nail SCC is called "the great mimicker nail tumor" because different clinical presentations may coexist, resembling benign or malignant nail lesions. For this reason, there is often a significant delay between the onset of nail SCC and the diagnosis. Clinical manifestation includes onycholysis and erythema, while in the advanced stages nail ulceration can be observed. The association with pain, swelling, and inflammation usually indicates an invasive SCC with involvement of the underlying bone. Metastasis is rare but possible with involvement of lymph nodes. A multidisciplinary approach to assessment, management, and follow-up is advised. Using careful examination and modern diagnostic methods, including onychoscopy, biopsy, and histopathology, will help identify SCC and prevent the invasive progression. X-ray is important to investigate the bone invasion to determine the best surgical approach that will have satisfying cosmetic and functional outcomes. Nevertheless, local excision with sufficient surgical margins, best if using Mohs surgery, is usually sufficient and superior to amputation of the distal phalanx. This review aims to highlight the correct approach in suspected SCC of the nail unit.
PubMed: 30116671
DOI: 10.5826/dpc.0803a17 -
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 -
American Family Physician Mar 2004The visual appearance of the fingernails and toenails may suggest an underlying systemic disease. Clubbing of the nails often suggests pulmonary disease or inflammatory... (Review)
Review
The visual appearance of the fingernails and toenails may suggest an underlying systemic disease. Clubbing of the nails often suggests pulmonary disease or inflammatory bowel disease. Koilonychia, or "spoon-shaped" nails, may stimulate a work-up for hemochromatosis or anemia. In the absence of trauma or psoriasis, onycholysis should prompt a search for symptoms of hyperthyroidism. The finding of Beau's lines may indicate previous severe illness, trauma, or exposure to cold temperatures in patients with Raynaud's disease. In patients with Muehrcke's lines, albumin levels should be checked, and a work-up done if the level is low. Splinter hemorrhage in patients with heart murmur and unexplained fever can herald endocarditis. Patients with telangiectasia, koilonychia, or pitting of the nails may have connective tissue disorders.
Topics: Humans; Nail Diseases; Nails
PubMed: 15053406
DOI: No ID Found -
The Oncologist Feb 2021Fibroblast growth factor receptor (FGFR) tyrosine kinases, which are expressed on the cell membrane, are involved in a wide range of biological functions such as cell... (Review)
Review
Fibroblast growth factor receptor (FGFR) tyrosine kinases, which are expressed on the cell membrane, are involved in a wide range of biological functions such as cell proliferation, survival, migration, and differentiation. The identification of FGFR fusions and other alterations in a wide range of solid tumors, including cholangiocarcinoma and bladder cancer, has resulted in the development of several selective FGFR inhibitors for use in these indications, for example, infigratinib, erdafitinib, derazantinib, pemigatinib, and futibatinib. In addition to the typical adverse events associated with tyrosine kinases, the FGFR inhibitors appear to give rise to a number of adverse events affecting the skin. Here we describe these skin events, which include the more common nail adverse events (e.g., onycholysis), palmar-plantar erythrodysesthesia syndrome, and stomatitis, as well as less common reactions such as calciphylaxis. This review aims to provide oncologists with an understanding of these dermatologic events and proposes guidelines for the management of treatment-emergent dermatologic adverse events. Awareness of possible adverse events associated with specific drugs should allow physicians to educate patients as to what to expect and implement effective management plans at the earliest possible opportunity, thereby preventing premature discontinuation while maintaining patient quality of life. IMPLICATIONS FOR PRACTICE: Identification of fibroblast growth factor receptor (FGFR) aberrations in cholangiocarcinoma and bladder cancer led to development of selective FGFR inhibitors for these indications, based on clinical benefit and safety profiles. The most frequent adverse events (AEs) include those affecting skin, hair, and nails, a unique class effect of these agents. These are usually mild to moderate in severity. This work reviewed skin AEs reported with FGFR inhibitors and provides management guidelines for physicians, aiming to increase awareness of skin events and provide effective treatment strategies. Early intervention and effective management may improve treatment adherence, optimize outcomes, and improve quality of life.
Topics: Antineoplastic Agents; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Humans; Morpholines; Pyrimidines; Pyrroles; Quality of Life; Receptors, Fibroblast Growth Factor
PubMed: 33021006
DOI: 10.1002/onco.13552 -
Dermatology Research and Practice 2023Nail psoriasis is a challenging chronic condition affecting patients functionally and psychologically. Nail involvement is observed in 15-80% of psoriatic patients with...
BACKGROUND
Nail psoriasis is a challenging chronic condition affecting patients functionally and psychologically. Nail involvement is observed in 15-80% of psoriatic patients with occasional presence of isolated nail psoriasis.
OBJECTIVES
To evaluate dermoscopic features of nail psoriasis and correlate them clinically.
METHODS
The study included fifty subjects with nail psoriasis. Psoriasis skin and nail severity was evaluated using psoriasis area severity index (PASI) and nail psoriasis severity index (NAPSI). Dermoscopy of the nails (onychoscopy) was performed, and features were recorded and analyzed.
RESULTS
The most common clinical and dermoscopic findings were pitting (86%) and onycholysis (82%). Among all dermoscopic features of nail psoriasis, only longitudinal striations and subungual hyperkeratosis were significantly higher in patients with moderate to severe psoriasis than in patients with mild psoriasis (=0.028; =0.042, respectively). PASI scores correlated positively but none significantly with NAPSI scores ( = 0.132, =0.360), and similarly, no significant correlation was observed between the duration of psoriasis and the dermoscopic NAPSI ( = 0.022, =0.879).
CONCLUSION
Dermoscopy can serve as a useful tool for early diagnosis of psoriatic nail changes not always visible to the naked eye and is a non-invasive easy-to-use confirmatory tool for nail changes in psoriatic disease or in isolated nail involvement.
PubMed: 37223320
DOI: 10.1155/2023/4653177