指甲疾病

20110280获得性非真菌性甲病的临床与病理特征分析/宋翔(四川省医院皮研所),万慧颖,应川蓬…∥中华皮肤科杂志.-2010,43(4).-242~244病理确诊甲银屑病14例,以脆甲、厚甲和点状凹陷等多见。甲扁平苔藓21例,甲损害分为两大类:第一类为甲萎缩、甲胬肉和无甲;第二类为甲纵嵴、远端甲裂和薄甲。甲非特异性湿疹样变17例,损害主要有沙纸样甲和甲纵嵴。     

20甲营养不良患者的甲病理诊断分析

目的探讨临床诊断的20甲营养不良患者的病理改变特征,明确病因,指导治疗。方法 23例20甲营养不良患者,临床表现为获得性单纯性20甲损害,甲板表面有许多纵嵴,失去光泽不透明,似砂纸样外观,甲板增厚或变薄,真菌检查阴性。采用纵行甲活检手术方法获取甲组织标本,观察甲单位病理改变。结果 23例患者中病理改变符合甲银屑病4例,甲扁平苔藓3例,甲非特异性湿疹样变16例。发病年龄以青中年发病人数占绝对优势(73.91%);病程<2年者占21.74%,2～10年者占69.57%,>10年者占8.70%。结论甲单位病理检查能对20甲营养不良患者进行病理诊断,其病因包括甲银屑病、甲扁平苔藓以及甲非特异性湿疹样变,为下一步选择治疗药物提供重要依据。     

甲活检技术及其在非真菌性甲病诊断中的意义

目的:介绍甲活检的取材方法,通过甲单位组织病理改变,为非真菌性甲病提供诊断依据.方法:对66例无任何皮肤、黏膜损害的非真菌性甲病患者,通过纵行甲活检手术取得标本,进行甲单位组织病理检查.结果:根据甲单位组织病理改变诊断为:甲银屑病16例、甲扁平苔藓22例、甲非特异性湿疹样变22例、连续性肢端皮炎6例.结论:甲单位组织病理学检查对确定非真菌性甲病的发病原因非常重要.纵行甲活检手术较安全、损伤小、疼痛轻,不会引起甲部的严重畸形.     

指甲疾病

20131292甲营养不良患者的甲病理诊断分析/应川蓬(四川省人民医院皮研所),万慧颖,徐敏燕…∥中国皮肤性病学杂志.-2012,26(7).-608～61023例20甲营养不良患者,临床表现为获得性单纯性20甲损害,甲板表面有许多纵嵴,失去光泽不透明,似砂纸样外观,甲板增厚或变薄,真菌检查阴性     

儿童非真菌性甲营养不良170例临床分析

甲病变病因复杂,可为先天性或获得性,表现多样,临床医生常常感到诊断困难、治疗棘手.儿童作为相对特殊的群体,其甲病表现与成人有较大的区别,儿童甲真菌病的发病率较成人低,临床多见的是非真菌性甲营养不良.为了加强对儿童甲病的认知,我们观察总结了170例儿童非真菌性甲病患者的临床特点,现报告如下.     

儿童甲病的诊断和治疗进展

儿童甲病与成人不同,可分为先天性或遗传性甲病综合征和获得性甲病两类。常见的先天遗传性甲病综合征包括先天性厚甲症、遗传性全白甲、先天性角化不良、甲-髌骨综合征和黄甲综合征。获得性甲病包括真菌性甲病、非真菌性甲病、损伤性甲病和甲肿瘤。儿童甲病应通过全面的体格检查后再诊断。     

甲真菌病与非真菌性甲病的鉴别诊断

甲真菌病是指由皮肤癣菌、酵母菌及非皮肤癣菌的霉菌等引起的甲板或甲下组织感染,主要表现为甲的外形损害和色泽改变。其治疗方案与非真菌性甲病治疗方案迥异。如对非真菌性甲病认识不足,则容易简单地将甲损害等同于甲真菌病从而导致误诊,因此鉴别两者具有重要的临床意义。本文对两者的诊断方法进行综述。     

非真菌性甲病误诊为甲真菌病38例临床分析

1990年 3月～ 2 0 0 2年 3月 ,我科共遇见非真菌性甲病误诊为甲真菌病患者 3 8例 ,现报告如下。1　临床资料1.1　一般资料　男 15例 ,女 2 3例 ;年龄 6岁～ 68岁 ,平均 3 5 .4岁 ;病程 1个月～ 42年。1.2　误诊情况　 3 8例非真菌性甲病均仅根据临床症状而被误诊为甲真菌病。曾接受伊曲康唑治疗者 17例 ,特比萘芬治疗者 6例 ,酮康唑治疗者 3例 ,拔甲治疗者 3例。另 9例接受过外用药物治疗 ,包括冰醋酸、碘酊、卡氏搽剂、霉克霜等。1.3　实际甲病　 3 8例患者病甲 2 15只。经询问病史、体检、真菌直接镜检、培养、皮肤病理及X线摄片 ,确诊为…     

甲下鲍恩病6例临床及组织病理分析

目的：探讨甲下鲍恩病的临床、组织病理特征及鉴别诊断。方法：对2012年5月—2021年11月该院确诊的6例甲下鲍恩病患者的临床及组织病理资料进行回顾性分析。结果：所有患者均为男性，就诊年龄为45～77岁，病程为4个月～8年。6例患者肿瘤均位于手指甲，其中3例表现为纵行黑甲，1例表现为甲下出血，1例表现为甲板增厚、变形，局部呈疣状外观，1例表现为甲下角化过度。所有患者甲组织病理均表现为典型鲍恩病改变。结论：甲下鲍恩病可表现为纵行黑甲。该病临床容易误诊，及时行组织病理检查有助于明确诊断。     

20甲扁平苔藓11例临床分析

目的：了解11例20甲扁平苔癣的临床特点，以提高对该病的认识。方法：对11例20甲扁平苔癣患者的临床资料、真菌学和组织病理检查进行分析，并对相关文献进行复习。结果：11例患者中男6例，女5例，平均年龄27．9岁，均表现为20指趾甲全部受累，真菌镜检、培养均阴性，经组织病理检查明确诊断为甲扁平苔癣。结论：甲扁平苔癣好发年龄为青少年和40～60岁，无性别差异。单独发生于甲部，特别是20甲受累的扁平苔癣十分少见，容易误诊，确诊需要组织病理活检。     

Frequency of toenail onychomycosis in patients with cutaneous manifestations of chronic venous insufficiency

BACKGROUND: Chronic venous insufficiency (CVI) can originate onychopathy per se. We have anecdotally observed nail changes in patients with CVI, but there are few studies which determine the frequency of both onychopathy and onychomycosis in these patients OBJECTIVE: The aim of the study was to determine the frequency of nail pathology and onychomycosis in patients with CVI PATIENTS AND METHODS: We included 36 adult patients, both men and women, aged from 18 to 59 years, with clinically documented venous leg ulcers. All patients were examined by a dermatologist and the venous leg ulcers were classified according to severity in three grades. The nail changes were described and a mycological examination was performed. We obtained a small fragment of the nail for histological examination. In 27 patients, we also performed functional studies to determine the type of venous insufficiency. RESULTS: The ratio of women to men was 5 : 1. The mean age of patients was 46.39 +/- 8.51 years, men being slightly younger than women. Ten patients had ulcers of grade I severity, 12 had grade II, and 14 had grade III. The overall time of evolution of the cutaneous lesions was 11.02 +/- 10.11. Fourteen patients had superficial venous insufficiency, whereas 13 had deep venous insufficiency. Twenty-two (61.11%) of our patients had nail alterations. These nail changes were related more to the type of vascular affection than with the severity of cutaneous involvement. In more than half of the cases (59.09%), onychomycosis was the cause of the nail changes. The overall frequency of onychomycosis was 36.11%. The etiologic agent of onychomycosis was isolated in 38.46% of the cases, and Trichophyton rubrum was the most frequent agent. The histologic examination of the nail plate showed a low sensitivity (62%) but a high specificity (100%) in the detection of nail plate parasitization. No clinical differences could be established between the nail changes observed in patients with true onychomycosis and those with nonfungal onychopathy. CONCLUSIONS: Nail changes are common in patients with venous leg ulcer, and onychomycosis accounts for slightly more than half of the cases. We therefore recommend a routine mycological examination in patients wit nail changes and cutaneous manifestations of CVI, to diagnose or rule out onychomycosis, and therefore avoid overtreating patients without onychomycosis with antimycotics.     

手足口病12例甲损害临床与皮肤镜表现

目的:观察手足口病甲损害的临床和皮肤镜表现。方法:分析2015年6月至2015年11月在山东省立医院皮肤科就诊的12例手足口病甲损害患者的临床资料,观察甲损害的特点。结果:手足口病甲损害临床表现为甲周皮肤干燥（12例）、空鼓区（11例）、甲断裂（11例）、Beau线（4例）;皮肤镜表现为甲板色泽改变（12例）、分层（1...     

Perioperative confocal microscopy of the nail matrix in the management of in situ or minimally invasive subungual melanomas

Background Although dermoscopy of the nail plate is helpful to discriminate between benign and malignant causes of nail pigmentations, there remain ambiguous cases in which a matricial biopsy is required. When a subungual melanoma is diagnosed histopathologically, a complementary surgical treatment is performed secondarily, the duration of postoperative disability being accordingly prolongated. Objectives The purpose of our study was to evaluate the feasibility of an intraoperative diagnosis by reflectance confocal microscopy (RCM). Patients and methods Our series included nine consecutive patients who underwent a matricial biopsy for an acquired melanonychia (one benign lentigo and eight melanomas). RCM examination was performed in vivo on the nail matrix after reclination of the nail plate, and/or ex vivo on the fresh tissue biopsy. RCM data were compared with histopathology. Results There was a good correlation between confocal and histopathological features. Seven melanoma cases were unequivocally diagnosed intraoperatively according to the confocal features, whereas the lentigo was correctly classified as a benign lesion according to RCM. The remaining lesion could not be unequivocally classified by RCM and corresponded histopathologically to an early melanoma that required immunostaining to be diagnosed. Conclusions Intraoperative RCM examination of the nail matrix is an efficient diagnostic approach of melanonychia striata that permits an extemporaneous diagnosis of malignancy and therefore a one-step surgical treatment of in situ or minimally invasive melanoma, reducing dramatically the duration of postoperative disability.     

Nail abnormalities in rheumatoid arthritis

Many nail abnormalities have traditionally been described in association with rheumatoid arthritis (RA), but their specificity has never been assessed in a controlled study. Our purpose was to evaluate the frequency and the specificity of nail changes associated with RA in a case-controlled study including 50 patients suffering from RA and 50 controls. For each patient, a general skin examination was performed and the 20 nails were examined. The nail features were noted and classified. Ax² test or a Fisher test was used to compare the two groups. The only nail abnormalities significantly associated with RA were longitudinal ridging on nine or 10 finger nails (29 patients in the RA group vs. three in the controls. X²: p<0.001) and clubbing on at least one nail (24 patients vs. 10.X²:p<0.01). Other nail changes were noticed but were not frequent enough to be significant. The presence of longitudinal ridging on the finger nails was significantly associated with RA.     

二十甲营养不良合并普秃1例

患者女,50岁,全部头发伴部分体毛脱落6个月。双手足甲甲板相继浑浊、粗糙变形20年。皮肤科情况:头发几乎全部脱落,眉毛、睫毛、腋毛和阴毛部分脱落;二十甲甲板表面粗糙,有纵脊,状如砂纸。毛发镜检查:可见惊叹号样发、断发,黑点征(+)、黄点征(+)。指甲皮肤镜检查:甲板浑浊不透明、角质层变厚粗糙、点蚀、纵脊。诊断:二十甲营养不良合并普秃。     

Evaluation of nail involvement in patients with chronic cutaneous graft versus host disease: a single-center study from Turkey

Although graft versus host disease (GVHD) is associated with a myriad of cutaneous signs, nail involvement is rarely mentioned in the literature. This study was conducted at the Department of Dermatology and The Bone Marrow Transplantation Unit of Hematology. All patients were examined clinically for presence of nail abnormalities. Severity of nail involvement was assessed as mild or severe. Of 28 patients diagnosed with chronic cutaneous GVHD, 14 had nail manifestations. Longitudinal ridging was the most frequently observed nail change on both the fingernails and the toenails. Severe nail changes such as ptergyium and onicoatrophy were noted in a few patients. As a result we could not find any relationship between nail changes and clinical severity but there was a relationship between nail changes and duration of disease. Nail manifestations could be responsible for considerable morbidity.     

Onychopathy of mushroom-growers

Particular nail damage appeared in patients working on mushroom beds. In five cases, all similar, the recent use of plastic bags containing the growing medium, seems to be the origin of this onychopathy. Onycholysis with latero-distal "usure des ongles", koilonychia, longitudinal splitting with sometimes splinter haemorrhages are the most specific changes. Chemical damage by phytosanitary products or fungi infection have no significant part in these abnormalities; their cause is traumatic, representing occupational stigmata mark, and results from repeated rubbing of the nails in workers lifting up heavy plastic bags.     

儿童纵行黑甲皮肤镜模式分析

目的了解儿童纵行黑甲的皮肤镜特点,探索通过皮肤镜模式分析诊断儿童纵行黑甲的方法。方法收集2013年6月—2015年9月就诊于首都医科大学附属北京儿童医院皮肤科的50例纵行黑甲患儿,分析其术前皮肤镜模式,对其中42例患儿行手术治疗,分析其术中皮肤镜模式。结果术前皮肤镜检查为灰色模式的8例患儿,均未行手术治疗,行手术治疗的42例患儿,术前甲板皮肤镜显示棕色条带的4例术中皮肤镜为棕色模式,组织病理证实为雀斑样痣。术前皮肤镜显示黑色条带的7例,术中表现为规则的棕色模式伴有色素球及色素斑,组织病理证实为甲母痣。术前显示规律的棕色线条组成的条带18例,术中皮肤镜为规则的棕色模式伴有色素球14例,规则棕色模式4例,组织病理分别证实为甲母痣和雀斑样痣。术前显示规律的棕色线条组成的条带伴色素球13例,术中皮肤镜为规则的棕色模式伴有色素球,组织病理证实其中12例为甲母痣,1例为黑素细胞活化。结论术前及术中皮肤镜检查及模式分析对儿童纵行黑甲的诊断具有显著意义。     

Lichen striatus with nail involvement. Report of 4 cases and review of the 4 cases in the literature (author's transl)

Four cases of lichen striatus (L.S.) with nail involvement were studied and the four cases published previously reviewed. There are several types of nail dystrophy: fraying, longitudinal ridging, splitting and shredding, onycholysis, and total nail loss. All of them are transient and can be explained by the pathologic changes observed, particulary the transitory disruption of the basal layer. Lichen striatus must be differentiated from systematized eruptions such as lichen planus (the simultaneous occurrence of L.S. and lichen planus is extremely rare and the resemblance of one dermatosis to the other can be so pronounced that a differential diagnosis is difficult) linear localized neurodermatitis, linear psoriasis (almost always associated with more typical lesions of psoriasis elsewhere on the body), linear keratosis follicularis (histologically typical of Darier's disease) and linear epidermal nevus which occasionaly does not appear at birth but later in life and may present nail involvement. In some cases, however, clinical similarity of the inflammatory linear verrucose epidermal nevus to lichen striatus is striking.