IDIOPATHIC ATROPHY OF THE NAILS

SUMMARY.— A group of 9 patients is presented in whom painless loss of nails is the principal cutaneous abnormality. The nails are normal at birth but after a few years one or more finger or toe nails become affected. The condition is progressive for a time but then remains stationary and no further nails are involved. The nail changes range from discoloration and ridging, through pterygium formation to permanent total loss with obliteration of the nail fold. Some nails remain quite normal. The condition occurs without apparent cause and is apparently not genetically determined. The diseases with which it is most likely to be confused are nail loss from lichen planus or from impaired peripheral circulation.     

Transonychial water loss in healthy and diseased nails

The objective of this study was to determine the transonychial water loss (TOWL) in both healthy and affected nails in different diseases and to compare it with the transepidermal water loss (TEWL). TOWL was measured by a new evaporimetric method: Plasticine was used to fix the protection cover of the evaporimeter probe to the nails. The TOWL behaved contrary to the TEWL. Affected nails in patients with atopic eczema (p <0.01), psoriasis (p<0.05) and onychomycosis (p<0.001) showed a significantly lower TOWL than did nails of healthy test subjects. The decrease in TOWL in diseased nails in comparison to healthy nails could be due to the formation of a stratum granulosum in atopic, psoriatic or fungus-affected nails, as this layer is normally absent in healthy nails.     

Yellow nail syndrome

Yellow nail syndrome was first described in 1964 by Samman and White. The full syndrome consists of the triad yellow nails, lymphedema, and pleural effusions with associated respiratory tract involvement. However, yellow nails alone or with any combination of the triad is termed yellow nail syndrome. We are describing a patient with yellow nails and pulmonary disease, whose nails cleared after resolution of his pulmonary condition. Although various therapeutic approaches have been used, the treatment of pulmonary disease was important in our patient.     

The Yellow-nails syndrome. Apropos of 2 cases. Review of the literature

The authors report 2 cases of yellow nails. These cases have evolved these last years, producing clinical aspects that reflect a typical association between the pulmonary and/or sinus reactions and the yellow nails. The authors discuss the scarce typical to the yellow nails syndrome and the different associations reported in the literature. The physiopathology is not known but many hypothesis have been discussed.     

Nail beauty therapy: an attractive enhancement or a potential hazard?

Nail coatings which harden upon evaporation and coatings that polymerize may produce some reactions at the site of application to the nail itself, and distant reactions when small amounts of nail cosmetics are transferred by the hand to other areas of the skin. Nail cosmetic hazards may be occupational, or accidental, especially in children. Individuals wearing artificial nails tend to wear their nails longer, and are more careful about their nails when washing their hands. The sanitary conditions for the application of artificial nails are therefore paramount in preventing nail infections.     

Tazarotene 0.1% gel in the treatment of fingernail psoriasis: a double-blind, randomized, vehicle-controlled study.

A double-blind, randomized, vehicle-controlled, parallel-group trial was performed to compare the efficacy and tolerability of tazarotene 0.1% gel and vehicle gel in 31 patients with fingernail psoriasis. Patients were randomized to receive tazarotene or vehicle gel, which they applied each evening for up to 24 weeks to 2 target fingernails, one under occlusion and one unoccluded. The tazarotene treatment resulted in a significantly greater reduction in onycholysis in occluded nails (P < or = .05 at weeks 4 and 12) and a significantly greater reduction in onycholysis in nonoccluded nails (P < or = .05 at week 24). Tazarotene also resulted in a significantly greater reduction in pitting in occluded nails (P < or = .05 at week 24). There were no other significant between-group differences in pitting, subungual hyperkeratosis, leukonychia, nail plate crumbling/loss, splinter hemorrhage, or nail growth rate. Tazarotene 0.1% gel was well tolerated with only 5 of the 21 tazarotene-treated patients reporting a treatment-related adverse event (all mild or moderate). In conclusion, tazarotene 0.1% gel can significantly reduce onycholysis (in occluded and nonoccluded nails) and pitting (in occluded nails) and is well tolerated in the treatment of nail psoriasis.     

Trachyonychia (rough nails)

The term trachyonychia is a useful one to describe roughening of the surface of many nails due to various causes. Psoriasis and alopecia areata are responsible for some cases. Lichen planus can roughen nails but the change is usually limited to a few nails and accompanied by discomfort. In many cases no cause can be found and these cases are somewhat arbitrarily listed either as twenty nail dystrophy of childhood or severe nail dystrophy.     

Surgical interventions of the nail organ

The nails are the largest appendage of the skin. They provide protection of the tactile regions of the fingers; moreover, well cared-for nails are an attribute of beauty. Operations of the nails should, therefore, regard both functional and cosmetic aspects. Surgical procedures are indicated in the case of nail deformities, bacterial or mycotic infections, as well as pigmentation of the nail wall or plate, and periungual or subungual tumors, which are always suspicious of malignant melanoma. All operations of the nail region can be performed in Oberst's anesthesia. We recommend the preoperative application of a tourniquet to stop the blood flow.     

Trachyonychia: a comprehensive review

Trachyonychia or rough nails, may present as an idiopathic disorder of the nails or it can be associated with other dermatological conditions. The dystrophic nail findings seen in trachyonychia are characterized by brittle, thin nails, with excessive longitudinal ridging. The most common histopathologic features associated with trachyonychia are spongiosis and exocytosis of inflammatory cells into the nail epithelia; typical features of lichen planus or psoriasis can also be detected. Determining the cause of trachyonychia is challenging. Treatment is often unsatisfactory, although in general it should be aimed at the underlying cause, if found. In most cases, the nail abnormalities improve spontaneously.     

16例甲习惯性刺激变形临床表现分析

对华西医院16例甲习惯性刺激变形患者的临床资料进行回顾分析。16例患者中,男10例,女6例,发病年龄4～31岁,平均(15.56±10.03)岁。病甲共计38个,其中拇指指甲30个、环指指甲4个、示指及中指指甲各2个。所有患者均为双侧对称累及,绝大多数为拇指指甲。主要甲体征为甲板中央凹陷及多条平行横纹。     

Incidence of brittle nails

Only few reports exist about the occurrence of brittle nails. We examined 1,584 persons with respect to the incidence of this anomaly. The patients were from five different groups: outpatients of a dental clinic, blood donors, residents of an old people's home, patients of a clinic for internal diseases and patients of a general practice. Approximately 20% of the subjects examined had brittle nails. Women suffered from brittleness of nails much more frequently than men (27 vs. 13%) with a ratio of men to women from 1:1.6 to 1:7 depending on age. 44% of the subjects affected (75% of the females, 25% of the males) had tried one or several treatments but only 26% believed in their curative effect. The market for the therapy of brittle nails in the FRG is estimated to be between 2 and 4 million people.     

Abnormal amino acid composition of nails in Bazex's paraneoplastic acrokeratosis

Bazex's paraneoplastic acrokeratosis is a syndrome with psoriasiform acral hyperkeratosis and nail changes associated with carcinoma of the upper respiratory or alimentary tract. We report here a case where amino acid analysis of the hyperkeratotic and friable nails differed from normal and other diseased nails investigated by us, but they were similar to those reported in trichothiodystrophy or the BIDS syndrome.     

Isolated lichen planus of the toe nails treated with oral prednisolone

We report a case of lichen planus affecting the toe nails without involvement of the skin or finger nails. To our knowledge this is the first time this has been reported. We also discuss the clinical features, histology and treatment of nail lichen planus.     

Congenital Ectopic Nails Reconstructed with Local Skin Flaps

Congenital ectopic nails are quite unusual and characterized by development of nail-like tissue on the tips of one or more fingers. We present the case of a boy with congenital ectopic nails on both little fingers. To prevent tapering of the fingertips following surgery, we used subcutaneous pedicle flaps and obtained a satisfactory cosmetic result.     

Wet working conditions increase brittleness of nails, but do not cause it.

The incidence of brittle nails is higher in women than in men. Repeatedly a suspected cause for the higher incidence of brittle nails in women is the frequent exposure to water. This study was aimed at clarifying whether wet working conditions increase the incidence of brittle nails in women and men in a similar degree. We determined the incidence of brittle nails in 511 persons in professions that involve frequent hand contact with water. The data were compared to those of a large, non-selected control group. 50% of the female probands showed the sign of brittle nails (control group: 30.4%, p less than 0.05). Only 13.5% of the male test persons of this study had brittle nails; the difference to the control group (13.2%) was not significant. It is discussed that in women the bridges between nail corneocytes are possibly weaker than in males as a constitutional characteristic. Accordingly, frequent alternating periods of hydration and drying increase the incidence of brittle nails particularly in women.     

Childhood nail diseases

The diagnosis of pediatric nail populations is complicated because a large proportion of pediatric nail presentations involve parents bringing in their children with questions regarding nail appearance rather than the plain presentation of a disease or functional problem. Parents are concerned whether the nails are normal, if they are uncomfortable for the baby or child, if the nails will affect walking or other future function, or if the changes are of wider significance and suggest more sinister medical problems than are yet apparent. To address these concerns, the clinician needs a good grasp of what is normal.     

Nail changes caused by systemic drugs or ingestants

Systemic drugs or ingestants may affect the nails. Changes vary from asymptomatic growth rate changes and pigmentation abnormalities to nail shedding and permanent deformity. The former two changes are most common. Presented are changes in nails caused by antibiotics, cancer chemotherapeutic drugs, poisons and ingestants, antimalarial drugs, and miscellaneous drugs.     

Artificial nails and psoriasis

When dealing with artificial nails, it is often mentioned that psoriasis is a contraindication because artificial nails may worsen nail psoriasis by Köbner phenomenon. 1 However, although not thoroughly discussed, other interactions between psoriasis and artificial nails exist. On the basis of clinical cases, the following interactions are described: worsening of psoriasis, the fact that psoriatic patients wearing artificial nails are more exposed to infections, and allergic risks. The clinical similarities that may exist between nail psoriasis and nail alterations caused by allergic reactions to artificial nails are also emphasized.     

Treatment of brittle fingernails with biotin

Frailty and brittleness of the finger nails is frequently seen, particularly in women. In veterinary medicine, it has been documented that defect hooves of horses or claws of swines respond well to oral application of biotin. Accordingly, we studied the effect of biotin on human dystrophic finger nails, a keratin structure as well. 71 patients were treated with a daily oral dose of biotin of 2.5 mg. Out of the 45 cases which finally could be evaluated, 41 (91%) showed definite improvement with firmer and harder finger nails after an average treatment of 5.5 +/- 2.3 months. In 4 of the 45 patients (9%), the improvement was questionable. None of the patients considered the treatment altogether ineffective. We conclude that biotin in most of the cases provides an effective therapy also for human patients with brittle nails.     

An assessment of factors influencing flexibility of human fingernails

A new instrument has been developed and used to determine the effect of various materials on nail flexibility. It repeatedly flexes longitudinal nail sections through 90 degrees and records the number of flexions required to fracture each section. Immersion in water or a phospholipid-water preparation (PLW) greatly increases the flexibility of untreated and lipid extracted nails; immersion in mineral oil does not. Nail flexibility is directly related to the duration of their immersion in water. During water immersion, nail weight increases by 22% of its original weight within 2 h, and then decreases. The rapid increase in nail flexibility during water immersion is related to nail water content. It is possible to prolong the flexibility of previously hydrated nails by the application of PLW or mineral oil. PLW is more effective than water alone in prolonging flexibility of nails extracted with a mixture of acetone, water and acetic acid.