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Cureus Nov 2020Methyl ethyl ketone is an organic solvent commonly used in adhesives and paints. Overexposure to methyl ethyl ketone can irritate the central nervous system, eyes, and...
Methyl ethyl ketone is an organic solvent commonly used in adhesives and paints. Overexposure to methyl ethyl ketone can irritate the central nervous system, eyes, and respiratory system. When in direct contact with skin, methyl ethyl ketone can lead to dryness and cracking of the skin. Forty years ago, methyl ethyl ketone was used in the Navy to degrease and remove paint from planes and naval equipment. A 57-year-old Navy veteran presented with an absence of all fingernails and thumbnails as well as pterygium formation on his digits; however, his toenails were normal. Additional history revealed that his unprotected hands were regularly exposed to methyl ethyl ketone for three years. His nails shed and stopped growing after one year of this work; subsequently, pterygiums developed. We postulate that exposure to methyl ethyl ketone may result in chemical destruction of the nail matrix in a similar manner to phenol or sodium hydroxide. We introduce the following acronym that describes not only the etiology but also the manifestations of Methyl Ethyl Ketone-related Loss of Matrix with Nail Onycholysis and Pterygium (ME KLMNOP).
PubMed: 33364118
DOI: 10.7759/cureus.11597 -
Anais Brasileiros de Dermatologia 2016Vitiligo is an acquired pigmentary skin disorder affecting 0.1-4% of the general population. The nails may be affected in patients with an autoimmune disease such as...
BACKGROUND
Vitiligo is an acquired pigmentary skin disorder affecting 0.1-4% of the general population. The nails may be affected in patients with an autoimmune disease such as psoriasis, and in those with alopecia areata. It has been suggested that nail abnormalities should be apparent in vitiligo patients.
OBJECTIVE
We sought to document the frequency and clinical presentation of nail abnormalities in vitiligo patients compared to healthy volunteers. We also examined the correlations between nail abnormalities and various clinical parameters.
METHODS
This study included 100 vitiligo patients and 100 healthy subjects. Full medical histories were collected from the subjects, who underwent thorough general and nail examinations. All nail changes were noted. In the event of clinical suspicion of a fungal infection, additional mycological investigations were performed.
RESULTS
Nail abnormalities were more prevalent in the patients (78%) than in the controls (55%) (p=0.001). Longitudinal ridging was the most common finding (42%), followed by (in descending order): leukonychia, an absent lunula, onycholysis, nail bed pallor, onychomycosis, splinter hemorrhage and nail plate thinning. The frequency of longitudinal ridging was significantly higher in patients than in controls (p<0.001).
CONCLUSIONS
Nail abnormalities were more prevalent in vitiligo patients than in controls. Systematic examination of the nails in such patients is useful because nail abnormalities are frequent. However, the causes of such abnormalities require further study. Longitudinal ridging and leukonychia were the most common abnormalities observed in this study.
Topics: Adolescent; Adult; Aged; Case-Control Studies; Child; Child, Preschool; Female; Humans; Hypopigmentation; Male; Middle Aged; Nail Diseases; Nails, Malformed; Prevalence; Statistics, Nonparametric; Turkey; Vitiligo; Young Adult
PubMed: 27579738
DOI: 10.1590/abd1806-4841.20164620 -
Skin Appendage Disorders Nov 2022Symptoms of pemphigus vulgaris (PV) rarely include nail findings. When ungual involvement does occur, the most common manifestations are paronychia and onychomadesis....
INTRODUCTION
Symptoms of pemphigus vulgaris (PV) rarely include nail findings. When ungual involvement does occur, the most common manifestations are paronychia and onychomadesis. Onycholysis is very uncommon, and complete nail loss has not been reported in the literature. Ungual involvement is thought to be closely correlated with disease severity, with only severe PV cases demonstrating nail symptoms.
CASE PRESENTATION
We report a case of a 34-year-old female presenting with mild to moderate PV yet severe onycholysis of her first toe leading to secondary nail loss in conjunction with paronychia of her bilateral thumbs. Oral tofacitinib and rituximab infusions led to strikingly rapid improvement in her nail symptoms.
DISCUSSION/CONCLUSION
This case illustrates the importance of a thorough history and physical exam, as a primary complaint of nail symptoms in these patients may lead to unrecognized PV by even the most skilled practitioners. Tofacitinib and rituximab in combination may rapidly improve nail involvement.
PubMed: 36407650
DOI: 10.1159/000525462 -
Indian Journal of Dermatology,... 2020
Topics: Chronic Disease; Fingers; Hemorrhage; Histiocytosis, Langerhans-Cell; Humans; Male; Onycholysis; Paronychia; Purpura; Young Adult
PubMed: 30829296
DOI: 10.4103/ijdvl.IJDVL_762_17 -
Skin Appendage Disorders Jul 2020Nail involvement in psoriasis occurs in up to 30-50% of patients, and 5-10% may have isolated nail disease. Onychoscopy, a noninvasive tool, might obviate the need for...
INTRODUCTION
Nail involvement in psoriasis occurs in up to 30-50% of patients, and 5-10% may have isolated nail disease. Onychoscopy, a noninvasive tool, might obviate the need for nail biopsy, which is a diagnostic gold standard.
OBJECTIVE
The aim of this study was to evaluate onychoscopic features of nail unit in patients with nail psoriasis.
METHODS
Fifty-five patients with clinically diagnosed and histologically documented nail psoriasis were recruited. Onychoscopy was performed for each nail (excluding the 5th toenail). Clinically, 443/550 fingernails and 101/440 toenails were involved. The frequency distributions of various onychoscopic features was assessed and compared using the χ test ( value <0.05 was considered significant).
RESULTS
With onychoscopy, additional 52 fingernails and 64 toenails showed psoriatic involvement. Pitting was the commonest finding in fingernails (60.5%) followed by subungual hyperkeratosis (SUH) (52.8%), onycholysis (40.8%), and dotted capillaries in hyponychium, proximal, and lateral nail folds (38.6 vs. 35.8 vs. 35.8%). In toenails, we observed SUH (85.1%), nail plate thickening (82.1%), onycholysis (77.2%), and dotted capillaries in hyponychium and nail folds (59.4 vs. 53.4 vs. 45.5%). Fuzzy lunula was a novel onychoscopic finding noted in 33.6% fingernails and 4.95% toenails ( < 0.00001).
LIMITATIONS
Small sample size.
CONCLUSIONS
Onychoscopy may aid in diagnosing nail lesions even before the clinical signs are apparent.
PubMed: 32903967
DOI: 10.1159/000508165 -
Clinical Case Reports May 2021A 34-year-old woman presented due to progressive painful swelling around the nail of the right index finger. Onychectomy and drainage of the abscess of the affected...
A 34-year-old woman presented due to progressive painful swelling around the nail of the right index finger. Onychectomy and drainage of the abscess of the affected finger were performed as the inflammation was progressive despite the previous antibiotic therapy. The microbiological culture revealed a ciprofloxacin-susceptible Citrobacter braakii.
PubMed: 34084511
DOI: 10.1002/ccr3.4203 -
Dermatology and Therapy Apr 2022Onychomycosis is the most common nail disorder in adults, with high recurrence and relapse rates. Its diagnosis may be difficult by non-experts because the clinical...
INTRODUCTION
Onychomycosis is the most common nail disorder in adults, with high recurrence and relapse rates. Its diagnosis may be difficult by non-experts because the clinical signs may overlap with other dermatoses. The treatment may be challenging, as it should be patient-tailored.
METHODS
An online survey was conducted among European Nail Society (ENS) members to provide recommendations on the diagnosis and assessment of distal lateral subungual onychomycosis (DLSO) in non-specialized clinical environments, as well as recommendations for patient referral.
RESULTS
DLSO diagnosis is predominantly based on clinical aspects, and microscopy and fungal culture are commonly employed to establish the diagnosis. Assessment of clinical features is the main method for DLSO follow-up, and the main criterion to define cure is a combination of mycologic cure and clinical cure. The most commonly selected treatments for onychomycosis include oral antifungals, topical antifungals, and nail debridement. According to the nail experts, predisposing factors of DLSO to be evaluated include concurrent tinea pedis diagnosis, immunocompromised status, and diabetes. The minimum clinical aspects to be evaluated for DLSO diagnosis should include subungual hyperkeratosis, white-yellow-orange subungual scales, and absence of salmon-pink coloration. Recommendations for clinical signs that should be evaluated to confirm treatment effectiveness include normal appearance and color of the nail, reduction or absence of scales under the nail, and absence of onycholysis. Recommendations for specialist referral include lack of treatment effectiveness, need of additional therapies, concurrent presence of other diseases or comorbidities, severe DLSO, and presence of a dermatophytoma or involvement of the nail matrix.
CONCLUSIONS
According to the surveyed nail experts, after evaluating clinical signs and predisposing factors for DLSO, the diagnosis should include subungual hyperkeratosis, nail color (yellow-orange), and onycholysis and thickening. In cases of severe DLSO, when there is treatment failure, concomitant diseases/comorbidities, presence of a dermatophytoma or involvement of the nail matrix, or involvement of several/all nails, referral should be considered.
PubMed: 35262878
DOI: 10.1007/s13555-022-00698-x -
Clinical Case Reports Mar 2018The symptoms of infection can be minimal or absent in patients with febrile neutropenia at first. The focal site of infection, which may be the main cause of a fever or...
The symptoms of infection can be minimal or absent in patients with febrile neutropenia at first. The focal site of infection, which may be the main cause of a fever or be a complication of neutropenia, can develop as neutrophils increase during the clinical course of febrile neutropenia.
PubMed: 29531738
DOI: 10.1002/ccr3.1399 -
Skin Pharmacology and Physiology 2017One of the most important dermatologic side effects of doxycycline is photosensitivity. As doxycycline is important for malaria prophylaxis and malaria is mainly spread... (Review)
Review
BACKGROUND
One of the most important dermatologic side effects of doxycycline is photosensitivity. As doxycycline is important for malaria prophylaxis and malaria is mainly spread in countries with high sun radiation, special attention should be paid to this adverse effect. While there are many publications on the phototoxicity of tetracyclines in general, only a few exist focusing on doxycycline. The objective of this systematic review was to summarize all available reports on clinical manifestations, influencing factors like UV dose or dose of medication, and the possibilities of prevention by sun protection.
METHODS
This review is based on a systematic search in PubMed for articles in English and German and a manual search between 1990 and 2015.
RESULTS
The number of publications is low. Clinical symptoms vary from light sunburn-like sensation (burning, erythema) to large-area photodermatitis. Also, onycholysis is possible. The triggering UV spectrum seems to consist mainly of UVA1 (340-400 nm), so UV-protective products should be used that cover this range. Travelers to tropical countries taking doxycycline for malaria prophylaxis need thorough medical counseling to avoid possibly severe phototoxic reactions.
CONCLUSION
Evidence base must be improved for giving advice on appropriate prevention measures to travelers taking doxycycline and having a risk of significant sun exposure.
Topics: Anti-Bacterial Agents; Doxycycline; Humans; Malaria; Onycholysis; Photosensitivity Disorders; Sunlight; Ultraviolet Rays
PubMed: 28291967
DOI: 10.1159/000458761 -
Actas Dermo-sifiliograficas May 2012Leprosy, a disease caused by Mycobacterium leprae, primarily affects the skin and nerves, but the nails are also involved in as many as 3 out of 4 patients .The factors... (Review)
Review
Leprosy, a disease caused by Mycobacterium leprae, primarily affects the skin and nerves, but the nails are also involved in as many as 3 out of 4 patients .The factors that trigger nail changes in leprosy are numerous and include repeated trauma, neuropathy, vascular impairment, infections, lepra reactions, and the drugs used to manage the disease. The changes most often reported include subungual hematomas, onycholysis, onychauxis, onychogryphosis, pterygium unguis, and onychoheterotopia, most of which can be attributed to nerve damage and trauma. Furthermore, the acro-osteolysis that occurs in the advanced stages of the disease may present with brachyonychia, racquet nails, or even anonychia. Infections of the nail bed leading to paronychia and onychomycosis should also be taken into account in leprosy. Other typical changes include longitudinal striae, pitting, macrolunula, Terry nails, leukonychia, hapalonychia, and Beau lines. In this review, we describe the principal nail changes associated with leprosy. These changes, which are highly varied and diverse in origin, are in fact a reflection of the significant morbidity caused by M. leprae infection.
Topics: Humans; Leprosy; Nail Diseases
PubMed: 22056258
DOI: 10.1016/j.ad.2011.07.011