Diseases of the Nail Unit

2012 ◽  
Author(s):  
Jennifer Nguyen ◽  
George Cotserelis
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Lichen Planus ◽  
Late Stage ◽  
Potassium Hydroxide ◽  
Nail Plate ◽  
Longitudinal Section ◽  
Antifungal Treatment ◽  
Nail Bed ◽  
Nail Psoriasis ◽  
Nail Matrix

The human nail is a complex unit that includes five major modified cutaneous structures: the nail matrix, nail bed, nail plate, nail folds, and cuticle (eponychium). This chapter discusses the function and structure of the five nail components and the pathophysiology affecting each. Also reviewed are nail findings associated with underlying systemic and dermatologic conditions: splinter hemorrhages, koilonychia, transverse nail-plate depressions (Beau’s lines), onycholysis, leukonychia, clubbing, nail-plate pitting, and longitudinal pigmented bands. Infections of the nail are discussed, which include bacterial paronychia, chronic paronychia, and onychomycosis. Figures illustrate the longitudinal section of the fingernail, multiple pigmented longitudinal bands, psoriasis involving the fingernail, late-stage lichen planus of the fingernail, transverse linear grooves, Pseudomonas aeruginosa causing a green nail, psoriasis of the nail, melanonychia striata, and a nail specimen for potassium hydroxide preparation. Tables describe antifungal treatment for toenail onychomycosis as well as selected dermatologic disorders that affect the nail unit. This chapter contains 50 references.

Diseases of the Nail Unit

2015 ◽  
Author(s):  
Jennifer Nguyen ◽  
George Cotserelis
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Lichen Planus ◽  
Late Stage ◽  
Potassium Hydroxide ◽  
Nail Plate ◽  
Longitudinal Section ◽  
Antifungal Treatment ◽  
Nail Bed ◽  
Nail Psoriasis ◽  
Nail Matrix

The human nail is a complex unit that includes five major modified cutaneous structures: the nail matrix, nail bed, nail plate, nail folds, and cuticle (eponychium). This chapter discusses the function and structure of the five nail components and the pathophysiology affecting each. Also reviewed are nail findings associated with underlying systemic and dermatologic conditions: splinter hemorrhages, koilonychia, transverse nail-plate depressions (Beau’s lines), onycholysis, leukonychia, clubbing, nail-plate pitting, and longitudinal pigmented bands. Infections of the nail are discussed, which include bacterial paronychia, chronic paronychia, and onychomycosis. Figures illustrate the longitudinal section of the fingernail, multiple pigmented longitudinal bands, psoriasis involving the fingernail, late-stage lichen planus of the fingernail, transverse linear grooves, Pseudomonas aeruginosa causing a green nail, psoriasis of the nail, melanonychia striata, and a nail specimen for potassium hydroxide preparation. Tables describe antifungal treatment for toenail onychomycosis as well as selected dermatologic disorders that affect the nail unit. This chapter contains 50 references.

scholarly journals Ultrasound Evaluation of the Effectiveness of the Use of Acitretin in the Treatment of Nail Psoriasis

2021 ◽  
Vol 10 (10) ◽  
pp. 2122
Author(s):  
Magdalena Krajewska-Włodarczyk ◽  
Zbigniew Żuber ◽  
Agnieszka Owczarczyk-Saczonek
Keyword(s):  
Morphological Changes ◽  
Nail Plate ◽  
Clinical Signs ◽  
Extensor Tendon ◽  
Control Group ◽  
Nail Bed ◽  
Nail Psoriasis ◽  
Ultrasound Evaluation ◽  
Tendon Thickness ◽  
Retinoid Treatment

The study aimed to evaluate the effect of retinoid treatment on the morphological changes in the nail apparatus in patients with nail psoriasis. Material and methods: 41 patients aged 32 to 64 with nail psoriasis, without clinical signs of psoriatic arthritis, started on acitretin 0.6 to 0.8 mg kg b.w./d, for six months and 28 people in the control group were included in the study. Both groups had ultrasound examination of fingernails and digital extensor tendon in the distal interphalangeal joints. In psoriatic patients, US examination was conducted before starting the treatment and after six months. A total of 685 nails were examined. Results: After six months of treatment, there was a reduction in the thickness of the nail bed and nail matrix (p = 0.046 and p = 0.031, respectively). The thickness of the nail plates decreased, although it was statistically insignificant (p = 0.059) and it was higher than in the control group (p = 0.034). The reduced severity of clinical nail changes after six months of retinoid treatment did not correlate with the reduction in extensor tendon thickness in any group of patients. Conclusions: In patients with nail psoriasis, acitretin treatment resulted in a rapid decrease in the thickness of the nail bed and matrix, but it did not affect the thickness of the nail plate after six months. There was no effect of acitretin on the digital extensor tendon thickness or the increased blood supply to the tendon area. The results of the study may indicate the usefulness of ultrasound nail examinations in patients with nail psoriasis not only to assess the advancement of morphological changes and response to treatment, but also to choose the potential treatment.

Clinical Study of various Nail Disorders presenting to Dermatology Outpatient Department

2017 ◽  
Vol 2 (3) ◽  
pp. 125-129
Author(s):  
Praveen K Rathore ◽  
Sapna Goyal ◽  
Anuj Kumar ◽  
Parul Garg
Keyword(s):  
Clinical Study ◽  
Potassium Hydroxide ◽  
Outpatient Department ◽  
Fungal Culture ◽  
Nail Bed ◽  
Nail Psoriasis ◽  
Medical College ◽  
Gram Staining ◽  
Nail Discoloration ◽  
Pachyonychia Congenita

ABSTRACT Aims and objectives To study the clinical spectrum of nail disorders including congenital, developmental, infectious, neoplastic, degenerative, dermatological, and systemic diseases affecting the nail unit. Materials and methods A total of 100 consecutive cases of nail disorders reporting to the dermatology outpatient department in Rohilkhand Medical College & Hospital were examined. Complete dermatological, systemic, hematological examinations, Gram staining, scraping for fungus, nail clipping for potassium hydroxide mount, fungal culture, biopsy from nail bed were undertaken in doubtful cases. Observations and results Among 100 cases, the most common was onychomycosis — 28 cases, followed by nail psoriasis — 13 cases, pitting — 10 cases, paronychia — 9 cases, trachyonychia — 5 cases, onycholysis — 4 cases, clubbing — 3 cases, koilonychia — 3 cases, ingrow toenail — 3 cases, pterygium — 3 cases, onychogryphosis — 2 cases, subungual wart — 2 cases, half and half nail — 2 cases, anonychia — 2 cases, longitudinal grooves — 2 cases, clubbing with resorption of fingers — 2 cases, onychomadesis — 1 case, nail discoloration — 1 case, melanonychia — 1 case, pachyonychia congenita — 1 case, beau's line — 1 case, racket nail — 1 case, transverse groove — 1 case. Conclusion Among examined cases, onychomycosis was most common followed by another nail disorders. How to cite this article Garg P, Kumar A, Rathore PK, Goyal S. Clinical Study of various Nail Disorders presenting to Dermatology Outpatient Department. Int J Adv Integ Med Sci 2017;2(3):125-129.

Squamous cell carcinoma arising from lichen planus of nail matrix and nail bed

2005 ◽  
Vol 53 (5) ◽  
pp. 908-909 ◽  
Author(s):  
Naoko Okiyama ◽  
Takahiro Satoh ◽  
Hiroo Yokozeki ◽  
Kiyoshi Nishioka
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Lichen Planus ◽  
Squamous Cell ◽  
Nail Bed ◽  
Nail Matrix

scholarly journals Ultrasonographic and resistance index evaluation of nails in psoriatic arthritis, psoriasis, and control groups: a cross-sectional study

2021 ◽  
Vol 61 (1) ◽  
Author(s):  
Samanta Daiana De Rossi ◽  
José Alexandre Mendonça ◽  
Penelope Ester Palominos ◽  
Charles Lubianca Kohem ◽  
Tania Ferreira Cestari ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Plate Thickness ◽  
Nail Plate ◽  
Resistance Index ◽  
Cross Sectional Study ◽  
Type I ◽  
Sectional Study ◽  
Cross Sectional ◽  
Nail Bed ◽  
Nail Matrix

Abstract Background Nail psoriasis occurs frequently in patients with psoriatic disease, it can lead to functional impairment, pain, discomfort, decreased quality of life and can also be a predictor for the development of arthritis. Early recognition of this condition can provide early and effective treatment and prevent structural impairment. This study aims to identify nail ultrasonographic characteristics in three groups: psoriasis (PsO), psoriatic arthritis (PsA) and controls patients, to determine if the ultrasonography (US) can identify early signs of nail psoriatic impairment or local inflammation. We conducted nail US to determine nail matrix resistance index (NMRI), nail bed resistance index (NBRI), and power Doppler (PD) and grayscale (GS) parameters in these 3 groups. Methods Single-center, cross-sectional study. GS, PD, and spectral doppler images of bilateral 2nd and 3rd fingernails were acquired from 35 PsO, 31 PsA, and 35 controls patients. An US equipment with an 18 MHz linear transducer for GS and 8.0 MHz for PD was used. PD, NMRI, NBRI, nail plate thickness (NPT), nail bed thickness (NBT), nail matrix thickness (NMT), and morphostructural characteristics of the trilaminar structure (TS) were evaluated in saved images, blind. Results Mean NMRI and NBRI did not differ between groups. Linear regression analysis detected no relationships between PsO or PsA and NMRI or NBRI. Nail PD grade did not differ between groups. Type I and IV TS changes were more frequent in PsO; types II and III changes were more frequent in PsA (p < 0.001). NPT was greater in PsA and PsO groups than controls: PsA 0.73 ± 0.14 mm, PsO 0.72 ± 0.15 mm, Controls 0.67 ± 0.10 mm (p = 0.001). Conclusion Echographic TS characteristics of the nail plate and NPT evaluated by GS are useful and can distinguish PsO and PsA nails from controls. NMRI, NBRI, and US nail microcirculation parameters could not distinguish psoriatic nails. Trial registration 72762317.4.0000.5327 (Certificate of Presentation of Ethical Appreciation – CAAE - Plataforma Brasil) Avaiable in https://plataformabrasil.saude.gov.br/login.jsf.

scholarly journals A novel surgical method for total nail ablation: Use of triple flap technique

2017 ◽  
Vol 3 (1) ◽  
Author(s):  
Berna Aksoy ◽  
Hasan Mete Aksoy
Keyword(s):  
Nail Plate ◽  
Dorsal Surface ◽  
Treatment Method ◽  
Advancement Flap ◽  
Nail Bed ◽  
Cosmetic Appearance ◽  
Flap Technique ◽  
Nail Matrix ◽  
Skin Coverage ◽  
Transverse Strip

<p>Total nail ablation for the treatment of onychodystrophies can be performed by using chemicals, surgical resection or laser ablation of nail matrix.<strong> </strong>A female patient with bilateral severe onychodystrophy as a result of inadvertent previous nail surgeries was treated surgically. Proximal complete nail matrix resection and distal 10 mm wide transverse strip partial nail bed resection were performed. A 5 mm wide transverse strip of nail bed was left intact proximally. Proximal nail matrix defect was closed by using the skin of proximal nail fold. The distal nail bed defect was reconstructed by using triple flap technique which was composed of a main central advancement flap containing ventral toe skin and two side flaps containing nail fold skin. The patient healed without any problem and her nail problem was treated successfully. The cosmetic appearance of her first toes was acceptable. Surgical nail ablation followed by volar skin coverage of dorsal surface of the distal phalanx bone by using triple flap technique is an effective surgical treatment method for the correction of advanced nail plate deformities requiring total nail ablation. </p>

scholarly journals Comparing the Efficacy of Triamcinolone Acetonide Iontophoresis versus Topical Calcipotriol/Betamethasone Dipropionate in Treating Nail Psoriasis: A Bilateral Controlled Clinical Trial

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Nasrin Saki ◽  
Shahla Hosseinpoor ◽  
Alireza Heiran ◽  
Ali Mohammadi ◽  
Mehdi Zeraatpishe
Keyword(s):  
Clinical Trial ◽  
Triamcinolone Acetonide ◽  
Repeated Measures ◽  
Betamethasone Dipropionate ◽  
Rank Test ◽  
Therapeutic Effects ◽  
Nail Bed ◽  
Nail Psoriasis ◽  
Nail Matrix ◽  
Calcipotriol Betamethasone

Background and Objective. Psoriasis is a common chronic inflammatory skin disorder affecting any age and gender. The clinical presentation of the nail disease depends on the location of the pathology: nail bed or nail matrix. We aimed to compare the therapeutic effects of triamcinolone acetonide iontophoresis (TI) and topical calcipotriol/betamethasone dipropionate in the nail bed and nail matrix involvements of psoriasis using Nail Psoriasis Severity Index (NAPSI). Materials and Methods. In the present bilateral comparison clinical trial, sixteen patients with clinical diagnosis of nail psoriasis were enrolled and randomized to receive six monthly TI treatment sessions either on their right or on the left hand target nails and daily application of topical calcipotriol/betamethasone dipropionate for six months on their other hand. Clinical efficacy was evaluated according to target nails NAPSI before and after the treatment. Wilcoxon sign-rank test and repeated measures ANOVA were used to compare the efficacy of the treatments. Results. The results did not show any difference between the therapeutic effects of TI and topical calcipotriol/betamethasone dipropionate regarding the nail bed score (P value =  .356), matrix score (P value =  .137), and total NAPSI (P-value =  .098). Conclusion. Monthly TI has an equal efficacy compared to daily topical calcipotriol/betamethasone dipropionate. It can be used as a safe, easy, and compliant treatment for nail psoriasis. This study is registered under IRCT2017050233778N1.

Dermoscopy of the Nail Plate, Nail Matrix, and Nail Bed

Melanonychias ◽  
2017 ◽  
pp. 25-43
Author(s):  
Nilton Di Chiacchio ◽  
Diego L. Bet ◽  
Nilton Gioia Di Chiacchio
Keyword(s):  
Nail Plate ◽  
Nail Bed ◽  
Nail Matrix
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