Phenolic ablation of the nail matrix

Therapeutic ablation of nail is necessary in a variety of settings. The challenge is to achieve destruction of nail matrix with minimal pain and to ensure that there is no re-growth of nail. There are many different methods of nail ablation, with excisional surgery and phenolic ablation of matrix representing the most common. The balance of published data favours phenolic ablation as a simple procedure with low morbidity and the least chance of recurrence.     

Pigmented nail streak associated with Bowen's disease of the nail matrix

We described a 59-year-old male physician with Bowen's disease occurring on the nail matrix of his right 5th finger. The rapid growth of the pigmented nail streak accompanied by nail deformity led us to consider the possibility of subungual melanoma clinically. Histologic features, however, were compatible with those of Bowen's disease accompanied by melanocytes with melanin-rich long dendrites in the nail matrix. We speculate that his occupational exposure to X-rays for 25 years played an important role in the pathomechanism of the present case.     

Expression of integrins in human nail matrix

Summary The aim of this study was to characterize cell-cell and cell-matrix interaction by evaluating the expression of different integrins in the nail matrix.
Nail biopsies were obtained from two cadaver lingers, and eight patients with ingrowing toenails. Frozen sections were stained by indirect immunofluorescence using anti-α, anti-α2, anti-α3 anti-α4, anti-α5, anti-α6, anti-αv, anti-β. anti-β4 and anti-ICAM-1 monoclonal antibodies. Biopsies from normal human foreskin were evaluated as controls, α. α4 and α5 subunits were absent from both nail matrix and normal human skin. α2, α3 and β1 subunits were expressed in the basal and suprabasal layers of nail matrix, but only in the basal layer of skin epidermis, α6 and β4 subunits were strongly expressed in the basement membrane zone and in the basal layer of both nail matrix and epidermis. The αv subunit was expressed in the basal layer of nail matrix. ICAM-1 was not expressed in nail matrix epidermis.
Our findings show that despite the distinctive features of the nail apparatus, compared with the epidermis, the pattern of integrin expression Is similar, although some differences in the distribution of α2. α3 and β1 subunits are detectable. These are probably related to the peculiar differentiation and keratinization of the nail.     

Itraconazole penetrates the nail via the nail matrix and the nail bed—an investigation in onychomycosis

Nail-matrix kinetics were studied in 21 patients (19 with onychomycosis, two with tinea corporis) as soon as taking itraconazole (Sporanox) 100 mg daily for up to 7 months. Itraconazole was detected in the distal nail as soon as 1 month after the start of therapy (42 ng/g in fingernails and 16 ng/g in toenails). During the course of treatment, this concentration rose and reached a mean of 160 ng/g in fingernail clippings and 197 ng/g in toenail clippings. Moreover, in fingernails of 12 out of 21 patients and in toenails of six out of 20 patients, itraconazole was detected in the distal nail clippings before full outgrowth of the fastest-growing nail. In most patients, itraconazole was detected in the distal nail clippings earlier than would be expected if the drug were incorporated only via the nail matrix, indicating that in addition to the nail matrix, a second route of penetration into the nail exists, i.e. the nail bed.     

Dermoscopic examination of the nail bed and matrix

Abstract Background Dermoscopy has furthered advances in the differential diagnosis of longitudinal melanonychia; however, fewer details observed in the nail, as compared to skin lesions, make interpretation difficult. Methods Ten cases of longitudinal melancholia, from several etiologies, were submitted to direct dermoscopic examination of the nail bed and matrix. Results We observed the presence of globules, streaks, and pigment network in the nail bed and matrix, which are dermoscopic features not seen in the nail plate. Conclusions This procedure enables visualization of dermascopic features not seen in the nail plate, making the diagnosis of melanocytic lesions easier.     

Immunology of the human nail apparatus: the nail matrix is a site of relative immune privilege

The nail apparatus is constantly exposed to environmental damage. It requires effective immune responses to combat infection, while avoiding the loss of nail production and regeneration by autoaggressive immunity. By immunohistology, we define here previously unknown characteristics of the normal human nail immune system (NIS). Compared with other regions of nail epithelium, human leukocyte antigen (HLA)-A/B/C expression is prominently down regulated on both keratinocytes and melanocytes of the proximal nail matrix (PNM), whereas HLA-G(+) is upregulated here. Together with the expression of macrophage migration inhibitory factor in PNM, this may serve to inhibit an natural killer (NK) cell attack on major histocompatibility complex (MHC) class Ia-negative PNM. PNM also displays strong immunoreactivity for potent, locally generated immunosuppressants such as transforming growth factor-beta1, alpha-melanocyte stimulating hormone, insulin-like growth factor-1, and adrenocorticotropic hormone, exhibits unusually few CD1a(+), CD4(+), or CD8(+), NK, and mast cells. Finally, MHC class II and CD 209 expression on CD1a(+) cells in and around the PNM is reduced, indicating diminished antigen-presenting capacity. Thus, the NIS strikingly differs from the skin immune system, but shows intriguing similarities to the hair follicle immune system, including the establishment of an area of relative immune privilege in the PNM. This nail immune privilege may offer a relative safeguard against autoimmunity. But, the localized intraepithelial defect of innate and adaptive immunity in the PNM revealed here also may impede effective anti-infection defense.     

Quantification of the nail fold capillary abnormalities in systemic sclerosis and Raynaud's syndrome

Measurements were made of capillary luminal diameters and capillary numbers in four groups: 19 normal controls 10 patients with 'idiopathic' Raynaud's disease, 12 patients with Raynaud's phenomenon with an underlying connective tissue disease other than systemic sclerosis, and 18 patients with systemic sclerosis. There was a significant reduction of capillary numbers in all three patient groups compared with the normal controls. Both the afferent and efferent luminal diameters were also increased in each patient group. Patients with Raynaud's phenomenon, either on its own or associated with connective tissue disease, gave results intermediate between normal controls and patients with systemic sclerosis. There were no significant correlations between either the reduction in capillary numbers or increase in luminal diameter with disease severity or duration in systemic sclerosis. It is unlikely that capillary microscopy will provide useful prognostic information for an individual patient with systemic sclerosis; its predictive value in Raynaud's disease must await the outcome of long term follow-up studies.     

儿童甲母痣35例外科治疗效果分析

目的:探讨儿童甲母痣外科手术治疗的合理术式。方法:回顾分析重庆医科大学附属儿童医院2015年9月至2019年3月手术治疗的35例甲母痣（病理确诊）患儿的临床资料,根据病变部位、宽度采取不同的手术方式。对病变宽度≤ 3 mm者,采用甲床及甲母质病变外缘旁开1~2 mm直接切除缝合术治疗,共11例。对病变宽度>3 mm者,...     

Dermoscopy of the nail bed and matrix to assess melanonychia striata

Melanonychia striata represents a diagnostic dilemma for dermatologists. The use of dermoscopy to assess the nail has advantages over clinical examination. However, when compared to skin lesions, it gives fewer details. We describe two cases of melanonychia striata submitted to dermoscopic examination of the nail bed and matrix. This is a new procedure that enables observing dermoscopic characteristics that are not visualized in the nail plate, thus, providing additional information.     

Lichen planus of the nail matrix with predominant plasma cell infiltrate

Lichen planus (LP) is an inflammatory dermatitis of idiopathic origin that can involve the skin, mucous membranes, hair and nails. Histologically, LP is characterized by compact orthokeratosis, wedge-shaped hypergranulosis, irregular acanthosis, damage to the basal cell layer and a band-like inflammatory infiltrate in the upper dermis. Lymphocytes are the predominant cells making up the infiltrate, along with a few macrophages, eosinophils and plasma cells. In addition, melanophages are often found in the upper dermis adjacent to the damaged basal cells.(1) We describe a patient with a lesion of the toenail clinically and histopathologically consistent with LP, but with a band-like inflammatory infiltrate composed primarily of plasma cells. Previously, only three other cases of LP with plasma cell predominant infiltrate have been reported, none of which involved the nail matrix.     

Keratin expression in the normal nail unit: markers of regional differentiation

Differentiation within the nail unit was examined using a range of antikeratin monoclonal antibodies including the recently described antibody LHTric-1, specific to the acidic hair-type keratin Ha1. Keratinocytes of the nail matrix, nail bed and the digit pulp were characterized by different patterns of keratin expression. Nail matrix was the sole site of expression of Ha1, which colocalized in suprabasal matrix epidermis with epidermal keratins K1 and K10. Small amounts of K17 were found at the apex of the matrix in some cases. K6 and K16 were found where the epidermal surface folds forwards to become the ventral aspect of the proximal nail fold. The nail bed was distinguished by the absence of hair-type keratin Ha1 and the absence of markers of cornified epidermis and mucosal differentiation K1/K10 and K4/K13, respectively, while K6, K16 and K17 were detected. The basal keratin conformation marker, LH6, was expressed suprabasally throughout the nail bed. This complement of keratins exists in the nail bed in the absence of notable proliferative activity, and suggests a state of minimally developed differentiation which may be afforded by the physical or biological properties of the overlying nail. Keratins, K6, K16 and K17 were all found in the digit pulp in limited amounts, possibly in association with the epidermal component of the eccrine duct. The simple epithelial keratins, K7, K8 and K18, were found in small amounts in the specimens from younger individuals, mainly in epibasal cells of the apex of the matrix and in putative Merkel cells.     

15例甲母痣外科治疗分析

甲母痣以甲板一黑色纵形条带为表现,通常边界清楚,颜色均一.临床上因对其认识不足而易误诊或漏诊,常常治疗不及时,一旦发生恶变治疗效果极差.我们于2005年8月至2007年7月共治疗15例甲母痣患者,取得较好的疗效.