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Nail Involvement (nail + involvement)

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Medical Sciences	100%

Selected Abstracts

Nail Changes in Childhood Psoriasis: A Study from Kuwait

PEDIATRIC DERMATOLOGY, Issue 1 2007
FRCPC, Nawaf Al-Mutairi M.D.
Childhood psoriasis is a distinct entity and the literature focused on nail changes associated with childhood psoriasis is scant. Our objectives were to evaluate the frequency of nail involvement in childhood psoriatic patients, assess the types of nail changes in childhood psoriasis, and compare our clinical findings with the few reports available in the literature. Two hundred and one consecutive new patients with childhood (age , 16 years) psoriasis of both sexes were selected for the study of nail changes. The diagnosis of psoriasis was made on clinical grounds. Each patient underwent a thorough dermatologic examination with special attention paid to the nail changes. If a clinical suspicion of fungal infection of the nails existed, further mycologic investigations were performed. We found the prevalence of nail changes to be 37.81% (boys > girls) in children who had psoriasis. Nail pitting was found to be the most common manifestation (61.84%) followed by onycholysis (30.26%), subungual hyperkeratosis (13.16%), and discoloration of the nail plate (7.90%). Nail involvement had no relationship to the type of psoriasis, patient's sex, or duration or extent of disease. [source]

The prevalence, aetiological agents and therapy of onychomycosis in patients with psoriasis: a prospective controlled trial

CLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 1 2007
N. Kaçar
Summary Background., Nail involvement morphologically resembling onychomycosis frequently accompanies psoriatic lesions. The role of psoriasis as a predisposing factor for onychomycosis and the possible influence of psoriasis on responsiveness of onychomycosis to treatment are controversial. Aim., To investigate the frequency of onychomycosis, the aetiological agents responsible for it, and the efficacy of terbinafine 250 mg/day in patients with psoriasis compared with controls in order to reveal the role of psoriatic process on fungal growth. Methods., Over a 1-year period, 168 patients with psoriasis and 164 nonpsoriatic controls were recruited. In the case of clinically suspected of fungal infection, further mycological investigations were performed. Systemic terbinafine therapy 250 mg daily for 12 weeks was administered to the patients with onychomycosis. Patients were followed up clinically and mycologically for 24 weeks. Results., Onychomycosis was diagnosed in 22 patients with psoriasis (13.1% of the psoriasis group, which constituted 28.6% of patients with suspicion of onychomycosis) and 13 controls (7.9% of control group; 40.6% of controls with suspicion of onychomycosis). The prevalence rates of onychomycosis were similar in both groups. The most commonly isolated fungi were dermatophytes in the psoriasis group and nondermatophytic moulds in controls. Dermatophytes were more common in psoriatic than control nails (P = 0.02). All patients in each group were cured at the end of the therapy. Conclusion., It seems that nail psoriasis constitutes a risk factor not for onychomycosis, but specifically for dermatophytic nail infections. Because of the similar therapeutic results in each group, different antifungal treatment protocols may not be needed in psoriasis. However, to confirm this, new comprehensive studies are necessary. [source]

Nail Biopsy: Assessment of Indications and Outcome

DERMATOLOGIC SURGERY, Issue 2 2005
Chander Grover MD, MNAMS
Background For years, nail biopsy has been shunned as a difficult and scarring procedure, which is seldom required in day-to-day practice. Only a few studies with a limited number of patients have been carried out to assess its utility in dermatology. Methods We studied 270 patients with nail disorders (both infectious and noninfectious). In 205 cases, the clinical diagnosis could be confirmed with the help of routine diagnostic aids, in the form of potassium hydroxide preparation, fungal culture, and biopsy of associated skin lesions. In the remaining 65 cases, various types of nail biopsies were carried out after ruling out contraindications to nail surgery. Results Overall, the histopathologic changes were found to be diagnostic in 63% of cases. Findings were more characteristic in infectious disorders of the nail unit. The diagnostic yield varied with the type of biopsy procedure. Side effects in the form of scarring and nail dystrophy were seen in 29.2% of the patients. Discussion Nail biopsy is useful, especially in cases with isolated nail involvement, an absence of skin lesions, and disorders such as twenty-nail dystrophy. It should be advocated in cases in which the routine diagnostic procedures fail to yield results. Proper selection of cases, choice of biopsy technique, and attention to the surgical procedure help in minimizing the side effects associated with the procedure. Conclusion Nail biopsy was found to be a simple, safe, and useful procedure, especially in cases in which the clinical diagnosis is otherwise obscure. CHANDER GROVER, MD, DNB, MNAMS, SONI NANDA, MD, B. S. N. REDDY, MD, MNAMS, AND KRISHNAMOORTHY UMA CHATURVEDI, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPPORTERS. [source]

Lichenoid nail changes as sole external manifestation of graft vs. host disease

INTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 1 2002
Sara Isabel Palencia MD
A 56-year-old-man who had refractory anemia with an excess of blasts underwent an allogeneic peripheral blood stem cell transplantation (PBSCT) from his brother after preparation with melphalan and fludarabin. He received GvHD (graft-vs.-host disease) prophylaxis with cyclosporine from day ,1 at a daily dose of 5 mg/kg of body weight. The daily dosage was tapered gradually from day +20. On post-PBSCT day 68 he developed acute cutaneous GvHD grade 3 and acute gastrointestinal GvHD grade 2,3, which was resolved with a daily dose of 1 mg/kg of body weight of prednisone. The patient was discharged in good clinical condition and without signs of GvHD, and he started tapering his immunosuppressive treatment. By day 160 he developed oral lichen planus-like changes, with several reticulate white lesions on the oral mucosa. A biopsy specimen was microscopically consistent with lichenoid GvHD (Fig. 1). By day 150 after PBSCT, when he was being treated with CsA 100 mg once daily and prednisone 10 mg once daily, his fingernails started to grow abnormally and gradually became dystrophic and painful. Two months later his toenails became similarly affected. Although affecting all finger and toe nails, the lesions were especially important in both thumbs. Physical examination revealed multiple findings on his nails (Fig. 2): thickening, fragility, onycholysis, longitudinal striations, and even pterygium. The micological cultures were negative. A biopsy specimen showed an sparse papillary dermis lymphoid infiltrate with focal exocytosis and presence of isolated multiple necrotic keratinocytes (Fig. 3). These findings were interpreted as a lichenoid GvHD with oral and nail involvement. The patient did not have other associated cutaneous lesions. He did not develop signs or symptoms consistent with hepatic GvHD. In May 2000 thalidomide was added to the immunosuppressive therapy, at a daily dose from 100 to 300 mg according to tolerance (constipation, sedation, ,). The lesions on the oral mucous showed a substantial improvement, but the nail changes remained more or less stable. Thalidomide was discontinued after 7 months because the patient displayed numbness and tingling in the hands and feet consistent with a peripheral neuropathy. Twenty days later he stopped taking thalidomide and the oral lichenoid lesions worsened, resulting in difficulty in eating. He also developed periungueal erythema, swelling and intense pain after minimal trauma. The daily dose of prednisone increased to 20,30 mg with moderate improvement. However, the dose could not be increased because of the secondary immunosuppressive effects. Twenty-three months post-PBSCT the patient remains with intense oral and nail lichenoid lesions. Figure Figure 1 . Oral mucosa with a lichenoid hiperplasia and a band-like lymphoid infiltrate. Note the basal lymphocytosis with isolated necrotic keratinocytes Figure 2. Lichenoid graft-vs.-host disease showing marked nail involvement with a ridge in the midline Figure 3. Panoramic view of the nail epithelium. Dermal lymphocytes with basal exocytosis and apoptotic keratinocytes (arrow) are evident [source]

Juvenile psoriatic arthritis with nail psoriasis in the absence of cutaneous lesions

INTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 1 2000
Carola Duran-McKinster MD
A 4-year-old white boy without a significant family history had morning stiffness and painful swelling of his left knee and ankle, right elbow, and dorsolumbar region of 2 months' evolution. The following laboratory studies were within normal limits: complete blood cell count, C-reactive protein (CRP), latex, antistreptolysin, and antinuclear antibodies. Rheumatoid factor was negative and an increase in the erythrocyte sedimentation rate (ESR) was detected (56 mm/h). The pediatric department made an initial diagnosis of juvenile rheumatoid arthritis, and treatment with acetylsalicylic acid at 100 mg/kg/day and naproxen at 10 mg/kg/day was started. A thick, yellowish toenail was diagnosed as onychomycosis. No mycologic investigations were performed. Intermittent episodes of painful arthritis of different joints were present. The radiographic features of the peripheral joints included: narrow joint spaces, articular erosions, soft tissue swelling, and diffuse bony demineralization. Characteristic bilateral sacroiliitis and a swollen tendon sheath on the left ankle were detected. At 11 years of age the nail changes had extended to five other toenails and to four fingernails, were yellow,brown in color, and showed marked subungual hyperkeratosis ( Figs 1, 2). The rest of the nails showed significant nail pitting. Trials of griseofulvin alternated with itraconazole in an irregular form for five consecutive years resulted in no clinical improvement, which prompted a consultation to our dermatology department. On three different occasions, KOH nail specimens were negative for fungus, but the presence of parakeratotic cells aroused the suspicion of psoriasis. A complete physical examination was negative for psoriatic skin lesions. A nail bed biopsy specimen was characteristic of nail psoriasis ( Fig. 3). Figure 1. Thickened nails with severe subungual hyperkeratosis in five fingernails Figure 2. Secondary deformity of nail plate. No "sausage" fingers were observed Figure 3. Light microscopic appearance of a nail biopsy specimen showing parakeratotic hyperkeratosis, elongation of interpapillary processes, and Munroe abscess (arrow) (hematoxylin and eosin stain, ×40) The following human leukocyte antigens (HLAs) were positive: A9, A10, B12, B27, Cw1, Bw4, DR6, DR7, DQ1, DQ2, and DR53. A diagnosis of juvenile psoriatic arthritis associated with nail psoriasis was made. Toenail involvement became so painful that walking became very difficult. Occlusive 40% urea in vaseline applied to the affected toenails for 48 h resulted in significant improvement. Currently, the patient is 20 years old with nail involvement, but no psoriatic skin lesions have ever been observed. [source]

Epidemiology and clinical classification of onychomycosis

JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 2005
I Effendy
ABSTRACT Objectives, To review recent data , what is new in the epidemiology of onychomycoses? To identify the most relevant diagnostic criteria for effective therapy. Methods, The preliminary results of the European Onychomycosis Observatory (EUROO) study were analysed. In this international study, physicians completed questionnaires concerning patient profile and the disease. Results, One of the most interesting novel findings was that sampling requests were often not made [only 3.4% of general physicians (GPs) and 39.6% of dermatologists]. This means that no information about causative agent(s) was available, hindering appropriate treatment choice. Furthermore, contrary to previous findings, 70.7% of participants did not practice sports. Lastly, these preliminary findings showed that treatment strategy depends largely on the type of treating physician, with GPs preferring monotherapy and dermatologists preferring combination therapy. Conclusions, A consensus was reached that treatment strategy should depend on the severity of nail involvement and the causative fungus. It is thus important to promote the importance of sampling. To simplify the choice of an appropriate treatment, onychomycosis may be divided into just two clinical groups: onychomycosis with and without nail matrix area involvement. However, the distinct clinical findings (number and type of affected nails, multimorbidity, drug interaction, etc.) in each individual case must be taken into account to ensure an appropriate treatment decision. [source]

Nail Changes in Childhood Psoriasis: A Study from Kuwait

Lichen Planus in 24 Children with Review of the Literature

PEDIATRIC DERMATOLOGY, Issue 4 2005
Pilar Luis-Montoya M.D.
Our objective was to obtain epidemiologic data retrospectively and determine the clinical characteristics of lichen planus in Mexican children seen in our dermatology department. We found 235 patients with the clinical and histologic diagnosis of lichen planus seen over a period of 22 years and 7 months. Twenty-four (10.2%) of these patients were children (15 years of age or younger). The ratio of male to female was 1 : 1.2. The main clinical pattern was classic lichen planus (43.5%). Mucous membrane and nail involvement were uncommon. No family history of lichen planus or systemic disease was noted. In the international literature, the frequency of lichen planus varied from 2.1% to 11.2% of the pediatric population. In the majority of studies no significant gender predominance was identified. Most patients had the classic variety of lichen planus. Reported mucosal involvement was rare, except in India and Kuwait. Frequency of nail involvement ranged from 0% to 16.6%. Little evidence of systemic disease or family history was found. [source]

Development and pilot-testing of a psoriasis screening tool

BRITISH JOURNAL OF DERMATOLOGY, Issue 4 2009
P.L. Dominguez
Summary Background, There is a need to validate psoriasis self-reports in epidemiological studies, where individuals may not be seeing dermatologists or other health care providers. Objectives, To develop and pilot test the Psoriasis Screening Tool (PST) in an ambulatory setting. Patients and methods, The PST was designed with eight closed-ended questions requiring a ,yes' or ,no' response. Typical images of skin, nail and scalp changes in psoriasis were included with respective questions. We administered the PST to 222 consecutive individuals being seen at a dermatology clinic. All English-speaking subjects completed the PST without assistance. A board-certified dermatologist established the diagnosis of psoriasis or excluded psoriasis in all participants. Results, A total of 222 completed PST questionnaires were included for analysis. There were 111 individuals in the psoriasis group and 111 individuals in the nonpsoriasis group. A combination of three questions resulted in a sensitivity of 96·4% [95% confidence interval (CI) 93·2,98·0] and specificity of 97·3% (95% CI 94·1,98·9) for psoriasis. Adding a pictorial question increased the sensitivity of the screening tool to 98·2% (95% CI 95·0,99·5). Of the 111 individuals with psoriasis, 69% answered yes to having plaque-type psoriasis, 50% answered yes to having nail involvement, 66% answered yes to having scalp involvement, and 59% answered yes to having inverse-type psoriasis. Conclusions, This pilot study suggests that the PST can distinguish individuals with psoriasis from individuals without psoriasis in an English-speaking population being seen at an outpatient dermatology clinic. Furthermore, the PST may be used to identify psoriasis phenotypes. Although the PST may be limited by spectrum bias in this pilot study, we believe it remains a reliable tool to collect information on psoriasis in remote populations. [source]

Interobserver reliability of the Nail Psoriasis Severity Index

CLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 2 2007
. Aktan
Summary Background., Because the Psoriasis Area and Severity Index (PASI) does not consider the severity of nail disease, a scale that assesses the extent of involvement of psoriatic nails is needed. A new grading system, the Nail Psoriasis Severity Index (NAPSI) has been proposed. Aims., The purpose of this study was to assess the interobserver reliability of NAPSI. Methods., The nail features of 25 patients with psoriasis with nail involvement were evaluated and graded by three dermatologists for total NAPSI scores and nail scores. The quadrants of all nails were examined for the presence of matrix and bed features. Total NAPSI score (0,160) of patients and nail score (0,32) of the individual nails were calculated. Interobserver reliability assessments were performed by computing intraclass correlation coefficients (ICC; two-way mixed model, consistency definition). Results., The ICC(3,1) results for total NAPSI score and nail score were found to be 0.781 and 0.649, respectively. The ICC(3,1) for nail-bed and nail-matrix features were 0.869 and 0.584, respectively, in the total NAPSI scoring system, and 0.705 and 0.603, respectively, in the nail scoring system. Conclusion., Moderate to good agreement of scoring with the NAPSI was determined among the observers in this study. Our results suggest that scoring for nail-bed features seems to be more reliable than scoring for nail-matrix features. [source]