An effective surgical treatment for nail thickening in Darier''s disease

BACKGROUND: Nail thickening of idiopathic or hereditary aetiology originating in the matrix is difficult to treat. OBJECTIVE; The purpose is to describe an easy surgical technique to reduce the thickness of the nail. METHODS AND RESULTS: The result is achieved by shortening the matrix with an excellent cosmetic appearance in the newly formed nail plate. CONCLUSION: Nail thickening in Darier's disease originating in the matrix, and other similar hereditary or idiopathic conditions, may benefit from this surgical approach.     

Clinical pathologic correlations for diagnosis and treatment of nail disorders

Clinicopathologic correlation is crucial to the correct diagnosis of disorders of the nail unit. This chapter will explore four common clinical scenarios and how pathology can help differentiate between their various etiologies. These include: dark spot on the nail plate (melanin versus heme), subungual hyperkeratosis (onychomycosis versus psoriasis), longitudinal melanonychia (benign versus malignant), and verrucous papule (verruca versus squamous cell carcinoma). Consideration must be given to both when to perform a biopsy and the location of the biopsy site, which must be based on an understanding of the origin of the changes. An overarching principle is that lesions within the same differential diagnosis may be present concomitantly, such as malignant melanoma of the nail unit associated with hemorrhage. Therefore, even with a biopsy-proven diagnosis, the clinician must always monitor lesions of the nail unit for appropriate response to treatment and consider an additional biopsy for recalcitrant lesions.     

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,...     

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.     

Flaps in nail surgery

Nail surgery, particularly when it involves the matrix, may lead to permanent nail deformity, with associated disruption in digital function. Soft tissue rearrangement of the nail tissues, nail flaps, can be used to reconstruct the nail to preserve a more normal nail plate. Other nail flaps can also be used to correct congenital malalignment, to cover full thickness nail unit defects, and for nail fold reconstruction. The indications and techniques for successful flap reconstruction are reviewed.     

Non‐infectious inflammatory disorders of the nail apparatus

Inflammatory non‐infectious diseases of the nails are not uncommon. The nail changes may look different in the same diseases, but also very much alike in various different nail disorders depending on which particular structure of the nail apparatus is involved. Of all skin diseases, psoriasis is the one with the most frequent nail involvement. The presence of many pits allows the diagnosis to be made, but salmon spots and onycholysis are also characteristic features. Lichen planus may occur isolated on the nails or in association with lesions of the skin and adjacent mucosal membranes. Longitudinal striations and loss of the nail plate shine are the most frequent features of nail lichen planus. The more severe the alopecia areata is and the younger the patient is, the more often it affects the nail, usually with a rough surface and loss of shine. Eczemas and various autoimmune dermatoses may also affect the nails but the changes are not clinically specific.     

Nail surgery: practical tips and treatment options

This paper provides an introductory overview of nail surgery, including basic principles, anesthesia, wound dressings, and several common nail procedures. In detail, it reviews how to achieve complete anesthesia and hemostasis, perform matrix injection, punch biopsy of the plate, bed, and matrix, and nail fold biopsy, with practical tips and suggested surgical indications.     

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.     

Pincer nail: aesthetic concept in surgery

Although pincer nail deformity (PND) treatment is time consuming independent of whether it is based on surgical or conservative procedures, long lasting beneficial results are found only after surgical intervention. Typically destruction of the lateral matrix horns either surgically or by phenol cauterization or even ablation of the matrix is performed. In the past these procedures mainly aimed at relief from pain; however, currently more patients ask for the preservation of the nail unit and a good cosmetic outcome. Today reconstructive results that meet the patient expectations are available. An adapted novel surgical method which will preserve the matrix horns while correcting the shape of the phalanx and preventing renewed adhesion of the nail bed to the phalanx is presented. Therefore the restoration of a normal width-to-length ratio of the nail plate with a cosmetically appealing result becomes possible. Surgical steps in an affected right toenail are presented.     

Cosmetic surgery for congenital nail deformities

Only a few nail dystrophies may be improved by surgery: malalignment of the big toenail, racquet thumbs, trapezoidal nails, and vertical implantation of the nail on the fifth toe. Knowledge of the surgical management of these deformities may allow a nice cosmetic outcome if performed by skilled surgeons.     

全甲板撕脱术治疗五例逆生性甲的疗效评估

目的 评估全甲板撕脱术治疗逆生性甲的疗效.方法 2018年6月至2019年11月于上海交通大学医学院附属第九人民医院皮肤科纳入5例(5趾)逆生性甲患者,采用全甲板撕脱术治疗.对部分病例拇趾远端多余皮肤组织切除,术后放置甲片.结果 5例患者术后新生甲板逐步长满甲床区域,疼痛完全解除.术后6～12个月随访,甲板均恢复正常....     

Comparative study of nail sampling techniques in onychomycosis

Onychomycosis is a common problem. Obtaining accurate laboratory test results before treatment is important in clinical practice. The purpose of this study was to compare results of curettage and drilling techniques of nail sampling in the diagnosis of onychomycosis, and to establish the best technique and location of sampling. We evaluated 60 patients suffering from distal and lateral subungual onychomycosis and lateral subungual onychomycosis using curettage and vertical and horizontal drilling sampling techniques from three different sites of the infected nail. KOH examination and fungal culture were used for detection and identification of fungal infection. At each sample site, the horizontal drilling technique has a better culture sensitivity than curettage. Trichophyton rubrum was by far the most common pathogen detected by both techniques from all sampling sites. The drilling technique was found to be statistically better than curettage at each site of sampling, furthermore vertical drilling from the proximal part of the affected nail was found to be the best procedure for nail sampling. With each technique we found that the culture sensitivity improved as the location of the sample was more proximal. More types of pathogens were detected in samples taken by both methods from proximal parts of the affected nails.     

Subungual squamous cell carcinoma presenting with minimal nail changes: A factor in delayed diagnosis?

Squamous cell carcinoma of the nail bed is a relatively uncommon tumour that may be diagnosed only after considerable delay. The first case presented is a 79-year-old man with a history of discomfort and discoloration affecting the right thumbnail of 3 years duration. The second case is a 70-year-old man who presented with a recurrent, offensive discharge from beneath the left thumbnail of 40 years duration. Clinical examination of the affected digits revealed minor nail abnormalities. The presence of tumour was fully apparent only after removal of the nail plate and inspection and biopsy of the nail bed. The cases demonstrate that subungual squamous cell carcinoma may present with prolonged symptoms and a deceptively benign appearance. The importance of consideration of the possibility of malignancy, removal of the nail plate for inspection of the nail bed and appropriate biopsy is emphasized.     

Autoimmune disorders: nail signs and therapeutic approaches

Systemic sclerosis (scleroderma, SSc) is an autoimmune disease that targets small and medium-sized arteries and arterioles in the involved tissues, resulting in a fibrotic vasculopathy and tissue fibrosis. Several prominent nail and periungual changes are apparent in scleroderma. Examination of the nail fold capillaries can reveal the nature and extent of microvascular pathology in patients with collagen vascular disease and Raynaud's phenomenon. Among the complications stemming from Raynaud's phenomenon can be painful ischemic digital ulcers. This can be managed, and potentially prevented, through pharmacologic and nonpharmacologic means. Whereas oral calcium channel blockers remain the most convenient therapy, oral endothelin receptor antagonists and intravenous prostaglandins may be important therapeutic advances for ischemic digital vascular lesions.     

Treatment of inflammatory nail disorders

This article provides an updated review on diagnosis and treatment of inflammatory nail disorders including psoriasis, lichen planus, trachyonychia, and autoimmune bullous disorders. Despite the significant negative repercussion of the nail psoriasis in the quality of life of patients, treatment is often not sufficiently effective. The efficacy of topical therapies is limited to nail bed psoriasis. Intralesional corticosteroid injections are extensively utilized in nail matrix psoriasis. Systemic immunosuppressant drugs such as methotrexate and cyclosporine have shown efficacy. Biologics, particularly infliximab and etanercept, have also demonstrated high efficacy in the treatment of severe nail disease. Nail matrix lichen planus can cause nail atrophy and irreversible nail scarring and requires prompt treatment with systemic steroids. There is not gold standard therapy for trachyonychia, but in most cases the nail signs improve spontaneously and treatment is not necessary. Nail changes in pemphigus and other autoimmune disorders respond promptly to systemic therapy with steroids and immunosuppressants.