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Nail disorders are very common, and about 50% of all nail conditions are of fungal etiology. A proper diagnosis is essential because many nail conditions look alike. Diagnosis and treatment of other nail disorders, such as psoriasis, lichen planus, and neoplasms, are discussed.
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Background:
Few clinical trials have evaluated long-term treatment of nail psoriasis with biologics.
Objective:
Safety and efficacy of adalimumab (ADA) (Humira [AbbVie Inc, North Chicago, IL]) long-term treatment (52 weeks) was evaluated in a phase-3, randomized trial in patients with moderate-to-severe plaque psoriasis and concomitant moderate-...
Onychogryphosis is an acquired nail plate change. It often affects the toenail and is characterized by an opaque, yellow-brownish nail plate that is distorted, grossly thickened, elongated, and partly curved resembling a ram's horn. Tuberous sclerosis complex is a multisystem disorder associated with high rates of mental retardation, autism, cognit...
Citations
... These findings are consistent with the study by Raja babu KK. andValia RG, Valia AR 2001. 1,11 Absence of lunula, was found in 93% of our patients.It is also reported to be an important senile nail change by various workers in their studies by Lewis BL (1955) and Cohen PR(1996). 12,13 Terry's nails were associated with systemic illness in 6 cases, namely, type II diabetes mellitus (3 cases), pleural effusion with congestive heart failure (1 cases), stroke (1 case) and 1 patient of renal failure. ...
... The mean growth rate of fingernails and toenails per month is 3 mm and 1 mm respectively, implying approximately 4-6 months to completely regenerate a fingernail or 8-12 months to replace a toenail. Nail growth is linked to a number of factors such as age, presence of systemic and localized diseases, and medications [5,6]. ...
Onychomycosis, other than a cosmetic concern, is also a prevalent nail disease, which is extremely difficult to treat, and sometimes is refractory to available topical and systemic treatment options. Moreover, many patients are not eligible to take oral antifungals owing to polypharmacy and comorbidities. Systemic side effects seen with oral antifungals have lead to patient nonadherence and adverse events. Therefore, newer therapies are being investigated for onychomycosis that would be free of systemic complications posed by oral therapy. Photodynamic therapy (PDT) is one of those being currently studied, which involves the use of photosensitizer and a light source to excite the photosensitizer to generate reactive oxygen species. The present review will put some light on PDT as an upcoming treatment modality for onychomycosis. This review will cover all currently peer-reviewed studies addressing PDT for onychomycosis in hopes to guide future research.
... The mean growth rate of fingernails and toenails per month is 3 mm and 1 mm, respectively , implying approximately 4–6 months to completely regenerate a fingernail or 8–12 months to replace a toenail. Nail growth is linked to a number of factors, such as age, presence of systemic and localized diseases, and medications [1, 2]. ...
Nails are underutilized as diagnostic tools, despite being involved in many dermatologic conditions. This paper explores new concepts in the treatment of median nail dystrophy (MND), onychomycosis, and the nail pathology of hand, foot, and mouth disease (HFMD). A Pubmed database literature search was conducted for MND treatment, onychomycosis treatment, and HFMD nail pathology. Only papers published after January 2008 were reviewed. The results showed that 0.1% tacrolimus ointment can be an effective treatment for MND. Early studies on laser therapy indicate that it is a safe and efficacious treatment option for onychomycosis, compared to conventional oral antifungal agents. Vicks VapoRub (The Proctor & Gamble Company, Cincinnati, OH) is effective against onychomycosis and is a reasonable option in patients who choose to forgo conventional treatments. Lastly, there is evidence to support a correlation between HFMD and onychomadesis.
... This matrix is the "root" of the nail, and its distal portion is visible on some nails as the half-moon-shaped structure called the lunula. 1 The nail plate is hard and translucent, and is composed of dead keratin. 2 The plate is surrounded by the perionychium, which consists of proximal and lateral nail folds, and the hyponychium, the area beneath the free edge of the nail 1 (Figure 1). ...
Paronychia is an inflammation of the folds of tissue surrounding the nail of a toe or finger. Paronychia may be classified as either acute or chronic. The main factor associated with the development of acute paronychia is direct or indirect trauma to the cuticle or nail fold. This enables pathogens to inoculate the nail, resulting in infection. Treatment options for acute paronychia include warm compresses; topical antibiotics, with or without corticosteroids; oral antibiotics; or surgical incision and drainage for more severe cases. Chronic paronychia is a multifactorial inflammatory reaction of the proximal nail fold to irritants and allergens. The patient should avoid exposure to contact irritants; treatment of underlying inflammation and infection is recommended, using a combination of a broad-spectrum topical antifungal agent and a corticosteroid. Application of emollient lotions may be beneficial. Topical steroid creams are more effective than systemic antifungals in the treatment of chronic paronychia. In recalcitrant chronic paronychia, en bloc excision of the proximal nail fold is an option. Alternatively, an eponychial marsupialization, with or without nail removal, may be performed.
... 3,5,11,17 Olguların %1-5'inde deri tutulumu bulunmaksızın yalnızca tırnak tutulumu görülebilmektedir. 2,4,18,19 Distal interfalanjeal (DIP) eklemin psoriatik artritinde tırnak tutulumu daha fazla gözlenmektedir. [20][21][22][23] Psoriatik hastaların %40-45'inde, psoriatik artrit hastalarının ise %87'sinde tırnak değişiklikleri saptanmaktadır. ...
... 10,18 Tırnak matriksinin tutulduğu durumlarda tırnak plakası defektleri gözlenirken (yüksük tırnak, ince tırnak, transvers çizgilenmeler, onikoreksis, lökonişi), tırnak yatağının etkilenmesi ile yağ lekesi belirtisi, subungual hiperkeratoz, distal onikolizis ve kıymıksı kanamalar; tırnak kıvrımlarının etkilenmesi ile ise distrofik tırnak gözlenecektir. 2,8,10,18,25,26 ...
... 4,9,44 Klinik olarak ayırım mümkün olmadığından KOH preperatı ve fungal kültür gibi incelemeler gereklidir. 2,3,6,9,14,31 Arada kalınan olgularda fungal incelemelerin tekrarlanması ya da tırnak biyopsisi alınarak H&E ve PAS ile boyanması önerilmektedir. 3,6,9 Özellikle ayak tırnaklarında psoriazis ve onikomikozisin birlikte görülebileceği de akılda tutulmalıdır. ...
Psoriasis and lichen planus are the most important inflammatory
cutaneous disorders afflicting the nail unit. Apart from the cosmetic
unsightly appearance, nail dystrophy in these disorders may lead to
emotional problems, severe pain, loss of manual dexterity and difficulty in walking. In addition, lichen planus may cause irreversible
matrix scarring and eventuate in persistent nail loss. Not only the
diagnosis, but treatment of these disorders pose significant problems
for the dermatologist. Herein, the medical literature regarding nail
involvement in psoriasis and lichen planus is reviewed and clues to
diagnosis and treatment of these disorders is presented.
... Nail matrix psoriasis consists of any of the following: pitting, leukonychia, red spots in the lunula and nail plate crumbling. 2 Also, chronic paronychia can occur. Because of nail bed hyperkeratosis, the clinical diagnosis most commonly confused with nail psoriasis is onychomycosis. ...
... Additionally, direct trauma to the nail plate can occur from nail biting and such everyday activities as typing, dialing a telephone , or playing a musical instrument ; even grasping, prying, or scraping can be sufficiently traumatic to lead to dehydration (Kechijian, 1985; Scher & Bodian, 1991). Sources: Holtzberg & Walker (1985); Kpea & Scher (1987); Lieber & Dotz (1986); Mayeaux (2000); Noronha & Zubkov (1997); Rich (1998); Sinclair (1997). The normal water content of the nail is approximately 18%. ...
... Pitting of the nail is associated with nail psoriasis , alopecia areata, or eczema (Sinclair, 1997). Roughness of the nail with increased longitudinal ridging and a thin nail plate occurs in psoriasis , alopecia areata, and/or lichen planus (Noronha & Zubkov, 1997; Rich, 1998; Tosti & Piraccini, 2000). As many as 50% of patients with psoriasis have some nail involvement; that almost always accompanies other dermatologic manifestations. ...
... History. The patient history should address whether the nail changes are new or chronic, if any recent trauma or insult has occurred, if the patient has had relevant occupational or environmental exposures, and if an illness or disease may be Sources: Albert (1996); Holtzberg & Walker (1985); Kpea & Scher (1987); Lieber & Dotz (1986); Mayeaux (2000); Noronha & Zubkov (1997); Rich (1998); Sinclair (1997); Tosti & Piraccini (2000). present that might have precipitated or contributed to the changes (Albert, 1996 ). ...
Dermatology nurses are uniquely positioned to assess brittle nail syndrome, a multifactoral disorder, in conjunction with a physician, and to help develop a therapeutic plan. Once underlying causes are identified, dermatology nurses can support patients in nail care and assist the dermatologist in promoting treatment compliance.
... This matrix is the "root" of the nail, and its distal portion is visible on some nails as the half-moon-shaped structure called the lunula. 1 The nail plate is hard and translucent, and is composed of dead keratin. 2 The plate is surrounded by the perionychium, which consists of proximal and lateral nail folds, and the hyponychium, the area beneath the free edge of the nail 1 (Figure 1). ...
Paronychia is one of the most common infections of the hand. Clinically, paronychia presents as an acute or a chronic condition. It is a localized, superficial infection or abscess of the paronychial tissues of the hands or, less commonly, the feet. Any disruption of the seal between the proximal nail fold and the nail plate can cause acute infections of the eponychial space by providing a portal of entry for bacteria. Treatment options for acute paronychias include warm-water soaks, oral antibiotic therapy and surgical drainage. In cases of chronic paronychia, it is important that the patient avoid possible irritants. Treatment options include the use of topical antifungal agents and steroids, and surgical intervention. Patients with chronic paronychias that are unresponsive to therapy should be checked for unusual causes, such as malignancy.
To study the demographic profile of the geriatric age group patients among the rural population in kanchipuram district who are presenting to the Dermatology department.
