Nail changes in patients with liver disease

Background Liver cirrhosis, hepatitis C virus (HCV) and hepatitis B (HBV) virus infections are known to be associated with different skin disorders. Nail changes are additional important criteria, which would help in identification of these systemic diseases. Objective To record the nail abnormalities in patients with liver disease which were not reported before, especially those with HCV and HBV infection. Patients and methods The study comprised 100 patients with HCV, HBV and liver cell failure, and 100 normal healthy controls. Both groups underwent full history taking and thorough general examination, complete blood picture, hepatitis B antigen, hepatitis C antibody, liver function tests, abdominal ultrasonography and PCR were performed in patients with liver disease. Full nail examination was performed. Results Nail changes were more prevalent in patient group (68%) than in the control group (35%). The nail infection, onychomycosis, was the most common finding in 18% of patients and that in controls was 10% followed by in a descending order, longitudinal striations, brittle nails, onychorrhexis, clubbing of fingers, dystrophic nails, leukonychia and longitudinal melanonychia. Conclusion Nail changes are observed with not only liver cirrhosis but also with HCV and HBV infection, and this will add additional clinical criteria for general practitioners and dermatologists to help them with diagnosis of these common systemic infections.     

Nail changes in Langerhans cell histiocytosis

Nail changes in Langerhans cell histiocytosis are distinctly uncommon. Paronychial erythema, swelling and subungual pustules of the fingernails and toenails were cardinal, and were supported by diffuse as well as dense collections of mononuclear Langerhans cells evidenced by microscopic investigation. Oral administration of co-trimoxazole (800 mg sulphamethoxazole + 160 mg trimethoprim) every 12 h, 50 mg/d cyclophosphamide and 80 mg/d predinisolone were the mainstay of treatment, supported by scalp tar shampoo and local betamethasone lotion application.     

Nail beauty

Nail beauty depends firstly upon nail health. It is a truism to say that a beautiful nail is always a healthy nail. In addition, there are subjective and evolving aspects of nail beauty which are related to fashion. The texture of the nail affects its appearance and function. Soft or brittle nails are fragile. This results in unattractive longitudinal and horizontal splitting. Fragility is encouraged by wet work and excessive nail manicuring, especially by the removal of nail cosmetics. Critical to the aesthetic appeal of the nail is its shape. Most pleasing are nails are those that conform to the 'magic' ratio, in which the nail's length is approximately equal to its breadth, especially for the thumbs. The role of nail decoration and nail art in nail beauty is a subjective and evolving question of fashion.     

Supravenous hyperpigmentation, transverse leuconychia and transverse melanonychia after chemotherapy for Hodgkin''s disease

Pigmentary abberations of the skin, mucosa and epidermal appendages are common side-effects after systemic treatment with chemotherapeutic agents. These pigment changes appear in different patterns and are partly quite typical for the applied chemotherapeutic drug. The pathogenesis of the different skin pigmentations are not well known. The most often discussed causes are the stimulation of melanocytes, involvement of the tyrosinase enzyme system and thrombophlebitis with postinflammatory hyperpigmentation by the aggressive substances. Nail discolorations are mainly due to direct toxic effects and stimulation of the matrix melanocytes. We report a rare event of supravenous hyperpigmentation, transverse leuconychia and melanonychia after chemotherapy of a patient suffering from Hodgkin's disease.     

Nail manifestations of some important genetic disorders in children

There are some genetic disorders in which nail changes are the major feature, such as the nail patella syndrome and pachyonychia congenita. Nail abnormalities are a constant feature of other disorders such as hidrotic ectodermal dysplasia, dyskeratosis congenita, some forms of epidermolysis bullosa, and ichthyosis follicularis with alopecia and photophobia. Nail changes often occur in mal de Meleda, Papillon–Lefèvre syndrome, and the keratitis-ichthyosis-deafness (KID) syndrome and are an occasional feature in some other ichthyoses and in incontinentia pigmenti. In Goltz syndrome, nail changes can be supportive of the diagnosis in a case in which the other features are minimal or subtle. In Darier disease, nail changes may be the first sign of the disorder and lead to the diagnosis being made. Nail changes may occur in some conditions such as Apert syndrome and Adams–Oliver syndrome as a result of abnormalities of the distal phalanges.     

Nail changes in chronic renal failure patients under haemodialysis

Background Chronic renal failure is known to cause various nail pathologies. They may be directly related to the renal condition itself or its complications or to the therapy. Objective To compare nail changes in end‐stage renal failure patients under haemodialysis with healthy persons and to study the potential relationship with various parameters in the patients. Patients and Methods The study comprised 100 patients with chronic renal failure under regular haemodialysis as well as 100 healthy control subjects of matched age and sex. Both groups were subjected to full history taking and thorough general and nail examination. Complete blood picture, liver and kidney function tests and fasting blood glucose level were investigated. Results Nail disorders were more prevalent in patients (76%) than in control group (30%). The half and half nail was the most common finding (20%) followed by – in descending manner – absent lunula, onycholysis, brittle nail, Beau's lines, clubbing, longitudinal ridging, onychomycosis, subungual hyperkeratosis, koilonychias, total leukonychia, splinter hemorrhage, pitting and pincer nail deformity. There was non‐significant correlation between nail changes and age of the patients or duration of haemodialysis. In addition, no evidence of significant relation was found between nail changes and both haemoglobin and albumin levels. Conclusion Frequent nail changes are observed on systematic nail examination of uraemic patients undergoing haemodialysis; however, the cause of them remains obscure and could not be traced to a particular abnormality in the renal condition, medication or the procedure itself and it needs further investigations.     

Nail abrasion

Certain diseases of the nail complex cause hyperkeratosis or alterations of the shape of the nail plate. These conditions may be painful, may decrease the penetration of topical medicaments and may be ugly. The nail plate abrasion, performed with dermabrader device or sandpaper, has application in patients suffering from onychomycosis, psoriasis, subnail infections and haematomas. The technique facilitates the collection of scales for mycological examination, decreases treatment time (of topical monotherapy) for onychomycosis and provides greater comfort for the patient by reducing nail plate thickness. It can also be useful for the partial removal of the nail plate in cases of haematomas and subnail infections. Nail abrasion is an effective and inexpensive method, easily applied in either nail pathologies with hyperkeratosis of the nail plate or in those requiring partial removal of the plate.     

Nail damage from gel polish manicure

Manicures can result in nail damage via instrumentation, nail polish, nail polish removers, and artificial nails. We report nail weakness, brittleness, and thinning in five subjects after the application of a new manicure system called gel polish and removal with acetone and manual peeling. All subjects complained that the polish was very difficult to remove and that their nails became much thinner after the procedure. Pseudoleukonychia and onychoschizia lamellina were noted on examination. One subject underwent ultrasound and reflectance confocal microscopy (RCM) measurements of nail plate before and after the gel polish application, which showed thinned nail plate (0.063 vs. 0.050 cm and 0.059 vs. 0.030 cm, respectively). Overall, we call attention to the adverse effects of gel polish manicures in five subjects. In addition, our case illustrates potential utility of ultrasound and RCM in measuring nail plate thickness.     

Nail bed onychomatricoma

Onychomatricoma is a rare tumor originating from the nail matrix, and, in rare conditions, from the ventral aspect of the proximal nailfold. Here we report a rare case of a 51‐year‐old man presenting with melanonychia mainly involving the distal nail plate. Histopathologic examination showed typical findings of onychomatricoma mainly involving the nail bed, while the nail matrix was largely uninvolved. We also identified fungal infection in a focal area of the distal nail plate. Our findings indicate that onychomatricoma can develop in the surrounding epithelial tissue of the nail unit, including the nail bed, and suggest that fungal infection may represent a secondary phenomenon of onychomatricoma.     

Nail cosmetics in nail disorders

The clinical features of nail dystrophies depend on the part of the nail that has been damaged. Due to the important functions of fingernails and toenails, any abnormality of the nail causes impaired function of the hand or foot. Moreover, the aesthetic aspect of the nail may affect employability, self-esteem, and interaction with other people. Because the nails are often difficult to treat, cosmetology may be an effective support to medical treatment. Nail cosmetics may help the patient to cope with his or her nail dystrophy while waiting for treatment to show its efficacy. It may also be the only choice to hide nail dystrophy where the nail is irreversibly damaged. Nail cosmetics may also function at treatment for onychtillomania, nail biting, and nail ingrowing.     

甲真菌病病指甲与正常指甲生长速率比较研究

目的　了解甲真菌病的病指甲与正常指甲生长速率的差异。方法　运用游标卡尺测量指甲生长长度 ,计算每日生长速率。结果　正常甲组 14 94个指甲 ,甲速为 0 .10 3± 0 .0 2 7mm/d ;病甲组 463个指甲 ,甲速为 0 .13 4± 0 .0 3 7mm /d。结论　病甲生长速度明显加快。病甲的生长速率也与甲位相关 ,受年龄 ,性别和温度的影响 ,但影响的程度远不如正常甲。     

部分甲基质切除甲沟重建治疗嵌甲

目的研究1种利用甲侧襞皮瓣改变甲体与甲沟的位置结构,从而彻底治愈嵌甲的手术方法。方法切除部分甲体、甲床,并利用甲侧襞皮瓣重建甲床、甲沟、甲侧襞联合结构。结果2000年1月～2003年5月对158 例嵌甲患者,足趾209、手指3,共276侧嵌甲进行甲沟重建手术。随访6月～2年,效果满意。结论该手术从根本上治愈嵌甲,且并发症少,复发率极低。     

斑秃患者合并甲病变及中医证型分析

目的探讨斑秃患者伴甲病变情况。方法回顾分析2010年3月—11月所收集的197例斑秃患者病史资料。结果合并甲病变者有70例,甲病变率为35.5%,其甲病变率较高的分别是重症斑秃(59.2%)、全秃(75.0%)、普秃(64.0%),而甲病变类型又以甲纵嵴、甲凹点及糙甲最为常见。结论斑秃患者一旦出现甲损害可能是一种预后不良的指征。伴甲病变的斑秃患者的中医证型以肝肾不足型、气血两虚型最常见。     

Hereditary 'white nails': a genetic and structural study

BACKGROUND: Hereditary subtotal leuconychia is a rare nail disease. The gene(s) underlying this phenotype is (are) not known. Immunohistochemical and ultrastructural studies of nails are performed infrequently. OBJECTIVES: To perform genetic linkage analysis and to assess ultrastructure and soft/hard keratin expression in hereditary white nails. METHODS: We have analysed microscopically and ultrastructurally the white nails of a patient from a family in which the trait is inherited in an autosomal dominant manner as an isolated symptom. No skin lesions or hair abnormalities could be detected. Genetic linkage studies were performed on DNA samples obtained from several members of the affected family. A longitudinal surgical biopsy of the nail from a great toe was split in two parts. One part was fixed in formalin and processed for histopathology. Another part was further subdivided and embedded either in Epon, following fixation in 2% glutaraldehyde, or in Lowicryl K4M, after fixation in 3% paraformaldehyde. Dewaxed nail sections and Lowicryl ultrathin sections were also stained with various antikeratin antibodies. RESULTS: Genetic linkage studies of the family pointed to the disease gene mapping to the chromosomal 12q13 region. Genes mapping within this chromosomal region include the genes coding for type II (basic) cytokeratins and hard keratins. The nail matrix presented an abnormal hypergranulosis. The upper part of the nail plate, originating from the proximal nail matrix, had a nonhomogeneous lamellar appearance, with numerous intracellular 'lipidic' vacuoles and 'empty' spaces separating keratin filament bundles. These cells were progressively shed at the nail surface. The cell loss was compensated by hyperproliferation of the distal matrix and of the nail bed keratinocytes, with persistent marked parakeratosis and loose arrangement of keratin bundles. The distal matrix and the nail bed contributed equally to formation of the lower plate. This presented the characteristics of a tissue composed of soft keratins. Accordingly, there was virtually no labelling with the Hb1 antibody to a basic hard keratin in the white nail, whereas the labelling with AE3 antibody to all type II keratins and with KL1 recognizing suprabasal soft keratins was normal or even enhanced. CONCLUSIONS: Genetic linkage indicates that the gene defect underlying the leuconychia in the family studied resides on chromosome 12q13. As the type II keratins map within this chromosomal interval, it is possible that a mutation in one of these keratin genes may be a cause of the hereditary leuconychia. The white appearance of nails in this disease seems to be due to an abnormal keratinization of cells originating from the proximal nail matrix, leading to the presence of abundant intracellular vacuoles and to a lesser compactness of keratins.     

Ingrown Nails: A Comparison of the Nail Matrix Phenolization Method with the Elevation of the Nail Bed-Periosteal Flap Procedure

Seventy-five procedures were performed on 62 patients with ingrown nails from 1992 to 1996. Those consisted of 51 nail matrix phenolization methods (NMP) and 24 elevation of the nail bed-periosteal flap procedures (ENF). Ingrown nails were classified into type A (normal nail plate) and type B (incurved nail plate). The duration and intensity of postoperative pain were assessed, and the recurrence rate was monitered. The recurrence rate was 3.9% in the NMP group and 4.1% in the ENF group. Concerning the recurrence rate, there was no statistical significance between ENF and NMP in both types. Postoperative pain intensity was less in the NMP group than in the ENF group in both types (P<0.01). The same tendency was seen in postoperative pain duration. However, the NMP group had longer duration of wound healing compared with the ENF group in type A (P<0.01). We conclude that NMP is a recommendable treatment for most ingrown nails.     

Nail psoriasis: a combined treatment with 8% clobetasol nail lacquer and tacalcitol ointment

Background   Nail involvement is a common and distressing feature in the course of psoriasis. Although much progress has been made in the treatment of the disease, the presence of psoriasis in the nail continues to pose a challenge. In recent years, vitamin D3 analogs and a new formulation containing 8% clobetasol-17-propionate in a colourless nail lacquer vehicle have produced good results for the control of nail psoriasis.
Objective   To determine the efficacy and safety of the combined treatment of 8% clobetasol-17-propionate in a lacquer vehicle and tacalcitol ointment in nail psoriasis.
Methods   Fifteen patients with both nail bed and nail matrix psoriasis were included in the study. They were treated with a colourless nail lacquer containing 8% clobetasol-17-propionate applied at bedtime at the weekend, and with tacalcitol ointment under occlusion on the remaining days, for 6 months.
Results   All 15 patients responded well to treatment. The therapeutic effect was very fast and directly related to the length of therapy. All nail alterations, including nail pain, were reduced, and the modified target Nail Psoriasis Severity Index fell by an average of 78% compared to baseline levels (±59.6, P  < 0.0001).
Conclusions   Combined treatment with tacalcitol ointment and 8% clobetasol-17-propionate in a nail lacquer is a safe, effective treatment for nail bed and nail matrix psoriasis.     

A Case of Nail Picking

A case of nail picking seen in an eleven-year-old Japanese girl and confirmed by its favorable response to management is reported.     

Nail fragility syndrome and its treatment

For reasons of clarity, definitions are offered for strength, hardness, flexibility, brittleness and toughness of the nails. Six clinical types of nail fragility are delineated: longitudinal furrows and splitting (onychorrhexis), single longitudinal splitting, multiple crenellated splitting, lamellar splitting (onychoschizia), transverse splitting and nail friability. Changes may be observed in the keratin structure of fragile nails. Nail brittleness is usually 'environmental' in origin, but sometimes may be part of a nail dystrophy. Household daily chores are particularly damaging. Among the acquired general causes, hypochromic anaemia and sideropaenia, arthritic deformities of the distal joints, peripheral vascular impairment and endocrinopathies are the best known. Useful therapeutic approaches are updated. They entail protection with plastic gloves worn over light cotton glove linings, the use of nail hardeners composed of two main types of products: a modified nail varnish that functions as a base coat or a hardener, such as dimethyl urea, which overcomes the objections related to formaldehyde; a systemic drug, biotine, is still useful.