Brittle Nails Research Articles

Nail Care for Healthcare Workers during COVID-19 Pandemic.

Nail Care for Healthcare Workers during COVID-19 Pandemic.

Efficacy of Oral Micronutrient Supplementation on Linear Nail Growth in Healthy Individuals

Introduction: Several studies demonstrate the effects of the oral supplementations on the skin while there are limited data for their effects on the nail quality in healthy individuals. Only placebo controlled double blind studies could provide the reliable data considering the physiologic nail growth. Objective: The objective of this study was to evaluate the efficacy of consumption of a micronutrient supplementation on linear nail growth and thickness. Subjects and Method: 60 healthy female volunteers aged 35 to 65 years old were enrolled, randomized blindly in treatment and placebo groups, taking one tablet per day for 3 months. The evaluation was performed on D0 and D90 ± 3 days by measuring the linear nail growth, nail thickness by high frequency ultrasound imaging and also subjects’ self-assessment. Results: All 60 subjects finished the study without any serious adverse event. At D90 both groups revealed a significant linear nail growth (5.20 ± 0.35 for treatment group (p = 0.001) and 5.15 ± 0.30 for placebo group (p = 0.001)). However, the difference between the treatment and placebo group was statistically significant (p = 0.01) demonstrating the efficacy of oral supplementation on linear nail growth. No significant difference was observed at D90 for nail thickness measured with HFUS between 2 groups. The self-assessment score regarding ?brittle nails? and ?split nails? was diminished non-significantly in both groups. Conclusion: The results observed in this trial revealed that the oral micronutrient supplementation can provide beneficial effect on nail growth. This result may be due to the whole formula as the single vitamin treatment like biotin was shown to be non-effective. A longer study would be needed to confirm the efficacy on nail thickness.

Clinical and Instrumental Objective Evidence of the Efficacy of a New Water-Based Nail-Strengthening Solution Containing Pistacia lentiscus and Hyaluronic Acid Applied for Up to 6 Months to Improve the Appearance of Weak, Brittle Nails.

IntroductionBrittle nails are fragile or split nails; they affect 20% of the population and may be primary or secondary to different conditions. The aim of our studies was to evaluate the efficacy and tolerability of a new water-based nail-strengthening treatment containing hyaluronic acid and Pistacia lentiscus with daily application for a period of 1–3 months for one study (n = 30) and up to 6 months for a second study (n = 30).MethodsIn total, we enrolled 60 patients of both sexes with brittle and weak nails due to primary or secondary causes and evaluated the efficacy of this new product using subjective and objective methods: clinical evaluation, assessment of photographs, onychoscopy evaluation, investigator and patient global assessment, dynamic optical coherence tomography (D-OCT) and reflectance confocal microscopy (RCM).ResultsStudies subjects presented a statistically significant improvement in global assessment scale (GAS) scores at 14 days (GAS = 1.7 ± 0.6), 1 month (GAS = 1.4 ± 0.7) and at 3 months (GAS = 1±0.7) versus the GAS score obtained before treatment (1.9 ± 0.5) (p < 0.0001). From the Italian study at 6 months (n = 30) 76% of the patients had an improvement in their nail appearance. Reduction in nail plate roughness with improved nail resistance and decreased distal breakage were the most evident benefits, demonstrated on clinical and instrumental evaluations. No side effects were reported. All patients reported an improvement in nail appearance after using the product for 1 month, 3 months and 6 months, and had a positive opinion on the product.ConclusionsThis new product is an effective, safe, and easy-to-use option for topical treatment of brittle nails and primary nail fragility and an adjuvant therapy in secondary nail fragility. Moreover, its ease of application and cosmetic qualities allow good compliance.FundingISDIN.

Pathogenesis, Clinical Signs and Treatment Recommendations in Brittle Nails: A Review.

Nail plate brittleness (or fragility) is a common complaint affecting up to 20% of the population, especially women over 50 years of age, with fingernail fragility being more prevalent than toenail fragility. Nail brittleness is characterized by nails that split, flake and crumble, become soft and lose elasticity. The main clinical presentations are: onychoschizia, onychorrhexis, superficial granulation of keratin and worn-down nails. According to causative factors, we can distinguish 2 forms of nail fragility (NF): a primary “idiopathic or brittle nail syndrome” form and NF secondary to different causes such as inflammatory nail disorders, infections, systemic diseases and general conditions, traumas and alteration of the nail hydration. Optimal management requires treatment of the primary cause of brittle nails, when possible. In idiopathic NF oral supplementation, vitamins (especially biotin, also known as vitamin B7), trace elements and amino acids (especially cysteine) have been reported to be useful. In addition, several products, such as topical moisturizers and lacquers could be considered to restructure the affected nail plate and to reduce psychological impacts of this common problem.

Treatment of brittle nail with a hydroxypropyl chitosan-based lacquer, alone or in combination with oral biotin: A randomized, assessor-blinded trial.

We evaluated in a randomized, assessor-blinded, study the efficacy of a hydroxypropyl chitosan-based nail lacquer (HPC-NL) alone or in combination with oral biotin (HPC-NL + B) in the treatment of brittle nail syndrome (BNS). Fifty subjects (21 men; mean age 64 years) with BNS were enrolled. Twenty-six were randomly assigned to HPC-NL and 24 to the HPC-NL and biotin, 10 mg/daily (+B). Topical and oral treatments lasted for 4 consecutive months. The primary outcome was the evolution of the Onychodystrophy Global Severity Score (OGSS) assessing nail dystrophy, lamellar and longitudinal splitting, dyschromia, and pitting. At baseline, the OGSS, mean (SD), was 8.4 (2.1) in the HPC-NL group and 11.8 (2.3) in the HPC-NL + B group. The OGSS was significantly reduced during treatments in both groups. At Month 4, OGSS was reduced by 57% (HPC-NL) and 62% (HPC-NL + B). At the end of study period, the percentage of subjects with an OGSS reduction of ≥50% in comparison with baseline was 53% in the HPC-NL group and 80% in the HPC-NL + B group (p = .05). Both treatments were well tolerated. In subjects with BNS, HPC-NL alone is associated with a clinically relevant improvement of nail appearance. The combination of HPC-NL and oral biotin is associated with further clinical improvement.

Explorative Prospective Evaluation of Short-Term Subjective Effects of Hormonal Treatment in Trans People—Results from the European Network for the Investigation of Gender Incongruence

IntroductionAlthough many studies on the short- and long-term effects of hormonal treatment (HT) in trans people focus on objective changes such as body composition or bone density, few studies have evaluated self-reported effects of HT. AimTo evaluate self-reported symptoms during the first year of HT in trans people. MethodsThis study is part of the European Network for the Investigation of Gender Incongruence, a multicenter prospective cohort study. For this study, 205 trans women and 193 trans men from the gender clinics of Amsterdam, Ghent, and Florence, who were >18 years of age and started hormonal treatment were included. Questionnaires, self-developed based on the Menopause Rating scale and clinical experiences, were completed, and changes in symptom scores were analyzed using linear mixed models. Main Outcome MeasuresSelf-reported psycho vegetative symptoms, as well as physical, cognitive, emotional, sexual and genital complaints, and pain were evaluated at baseline and after 3, 6, and 12 months of HT using a 4-point Likert scale (no, mild, moderate, or severe complaints). ResultsIn trans men, with a median age of 23, transient increases were reported in night sweats, weight gain, and clitoral pain. Persistent increases were reported for hot flashes, balding, voice instability, acne, and increase in sexual desire, whereas emotional instability, fear, and menses decreased. For trans women, with a median age of 29, hot flashes, night sweats, fatigue, weight gain, changes in olfactory sense, brittle nails, emotional instability, mood swings, and breast tenderness increased persistently during 12 months of HT, whereas a decrease was observed for balding and sexual desire. Sleeping difficulties decreased temporarily. No changes were observed in palpitations, dizziness, abdominal complaints, anxiety, panic attacks, cognition, and pain, except for clitoral and breast pain. Clinical ImplicationsKnowledge on the occurrence of these self-reported, subjective effects and their course over time may help physicians informing trans people starting with and during HT. Strengths & LimitationsThis study was performed in a large cohort of trans people. The follow-up period was limited to 12 months. ConclusionChanges in self-reported symptoms were mentioned in all investigated areas, except cognition. Most symptoms were as expected and even desired, whereas others may be considered unpleasant by some trans people.van Dijk D, Dekker MJHJ, Conemans EB, et al. Explorative Prospective Evaluation of Short-Term Subjective Effects of Hormonal Treatment in Trans People—Results from the European Network for the Investigation of Gender Incongruence. J Sex Med 2019;16:1297–1309.

The Effect of a Combination of an Arginine Silicate Complex and Magnesium Biotinate on Hair and Nail Growth in Rats (P06-026-19)

ObjectivesAging, as well as inadequate intake of vitamins and minerals, can negatively affect the growth, strength, and appearance of hair and nails. For instance, biotin deficiency leads to brittle nails and hair loss. Moreover, certain nutrients, such as arginine and silicon, promote the biological conditions needed for optimal hair and nail growth. JDS-ASB is a novel combination of inositol-stabilized arginine silicate complex (ASI), a highly bioavailable form of arginine and silicon, and magnesium biotinate (MgB), a novel, well-absorbed biotin salt. The purpose of this study was to observe the effects of JDS-ASB on hair and nail growth in rats. MethodsTwenty-one female Sprague-Dawley rats (8-weeks old) were randomized into one of the following groups; 1: Control (no treatment), 2: ASI + Low Dose MgB (140 mg human equivalent dose (HED) of ASI and 1.5 mg HED of MgB), 3: ASI + High Dose MgB (140 mg HED of ASI and 10 mg HED of MgB). Study product was dosed daily by oral gavage for six weeks. Rat diets included egg whites to standardize absorbable biotin levels. At baseline, hair was shaved from the dorsal area of the rats and hair growth was assessed on days 7, 14, 21, 28, 35, and 42. Hair growth measurements included hair density (per square cm), and percentage of hair follicles in the anagen (growing phase) and telogen (resting phase) phases of the hair cycle. Mean nail growth was measured on days 14, 28, and 42. Blood samples were collected on day 42. ResultsVisual observations revealed greater hair growth in both treatment groups compared to control, however the effect was more pronounced in group 3. Compared to control, the percentage of hair follicles in the anagen phase was significantly greater in group 3 from day 14 onward (Figure 1). Compared to control, hair density was significantly greater in group 3 from day 21 onward. These parameters improved in group 2 compared to control on day 42. Blood levels of vascular endothelial growth factor, a protein associated with hair growth, were higher in both treatment groups compared to control, with levels greatest in group 3 (p < 0.05). Mean nail growth data showed faster daily growth in group 3 compared to other groups (p < 0.05). ConclusionsThe results of this study demonstrate that the combination of an arginine silicate complex and magnesium biotinate promotes hair and nail growth. Funding SourcesThis study was funded by JDS Therapeutics, LLC. Supporting Tables, Images and/or Graphs▪

Assessing Quality of Life in Patients with Graves’ Disease Following Thyroidectomy

Introduction. Graves’ disease is a disorder associated with thyroid gland producing excessive amounts of hormones which causes changes in the functional status of various organs and systems. Among thyroid disorders it takes the second place (after endemic goitre) in prevalence. Until now, there is no consensus on a single strategy for the treatment of disorders of the thyroid gland. This is why this paper aims to assess the impact of surgical treatment of Graves’ disease on patients’ quality of life and whether it would be possible to improve it by following the surgery with hormone replacement therapy.Materials and methods. This paper presents a retrospective analysis of 70 case histories of patients who received surgical treatment for diffuse toxic goitre at the BIH UR “First Republican Teaching Hospital” MH UR,Izhevsk, in the period from 2008 to 2014. Percentages of the disease by stage were as follows: stage II — 20%, stage III — 70%, stage 4 — 10%. One lobe resection was performed in 3% of patients, two lobe resection — in 1%, hemithyroidectomy — in 18±4.6%, subtotal resection — in 8%, thyroidectomy — in 70±5.5%.Results. Percentages of patients with various degrees of severity of postoperative hypothyroidism were as follows: severe — 66%, medium — 29%, light — 5%; there were no Graves’ disease recurrences. Patients’ complaints following thyroidectomy included body weight gain — 79.1±4.8%, cold in extremities — 83.3±4.4%, cardiac arrhythmia — 85.2±4.2%, oedemas — 84.3±4.3%, drowsiness, atonia — 67.1±5.6%, changes in appetite — 21±4.8%, skin pallor — 47.6±5.9%, brittle nails, hair loss — 51.2±5.9%, joint pain — 31.2±5.53%.Conclusion. Hypothyroidism always follows thyroidectomy and requires ongoing hormone replacement therapy with L-thyroxine. Th quality of life does not have to suffer if an individual dosage is established and followed on a permanent basis.

SUN-576 Abrupt Switching From Hypertyroidism To Hypothyroidism With Pretibial Myxedema And Acropachy, In Graves’ Ophthalmopathy: Case Report.

Background Graves’ disease (GD) is an autoimmune thyroid disease usually associated with hyperthyroidism. There have been cases of patients switching from hyperthyroidism to hypothyroidism, and even rarer patients flipping from hypothyroidism to hyperthyroidism. However, a case of spontaneously alternating hyperthyroidism and hypothyroidism in GD is comparably an even rarer phenomenon. It is thought that the switching of stimulating TSH receptor antibodies (TSAb) and blocking TSH receptor antibodies (TBAb) has a role in alternating thyroid function. We present a case of spontaneously oscillating thyroid function, pretibial myxedema and achropachy in three months. CASE REPORT 50 y,m,active smoker(90 yr old), weight loss (12 kg),tremors, irritability,proptosis,bad sensation eyes and acropachy(FigE) hyperthyroidism and ophthalmopathy secondary GD,underwent irregular treatment with methimazole 1st y. After1y, Graves' ophthalmopathy was worsened CAS 9(FigAB),with stereotactic radiotherapy, 10sec, 20Gy,pulse methylprednisolone followed by oral prednisone and decompressive surgery, initially used methimazole 30mg/d with reduction to 10mg/d.After 3 months of corticotherapy the patient returns with complaints of intestinal constipation, asthenia, brittle nails, the appearance of pre-tibial myxedema (FigC), being confirmed hypothyroidism frankly associated with the increase of thyroid autoantibodies (tb1), thyroid USG showing parenchyma with diffuse and grossly heterogeneous ecotexture and reduced echogenicity, diffusely increased vascularization, total thyroid volume of 33.4 ml (FigD). Patient maintained ambulatory follow-up, maintaining hypothyroidism on remission with levothyroxine 6 months ago. DISCUSSION This's the first case presenting hyperthyroidism shift to abrupt hypothyroidism with myxedema and acropachy in patient with GO. GD spontaneous change from hyperthyroidism to hypothyroidism (without ablative radioactive iodine intervention or treatment with antithyroid drugs) can occur in two ways: by the unexpected development of TBI (TSH receptor blocking immunoglobulin); or by chronic lymphocytic thyroiditis surpassing the stimulatory effects of TSI (Immune Globulin stimulating TSH receptors). The shift from TSI to TBI, with changes in immunoglobulin concentration, affinity and potency, leading to TBI dominance, is usually associated with the use of DAT (antithyroid drugs) and immunosuppressive states. We describe a case of hyperthyroidism due to GD evolving with frank hypothyroidism probably related to the alternation of TSI to TBI, with a predominance of the TBI effect, with onset after immunosuppressive therapy with corticosteroids. CONCLUSIONThe occurrence of a shift of predominance of the stimulatory effect to the inhibitor on TSH receptors emphasizes the need for careful monitoring of patients with Graves' disease.

Patterns of nail changes in chronic liver diseases

Background: Nail abnormalities were frequently associated with liver diseases. Early detection of these nail changes may help to initiate early treatment and reduce serious complications, sequelae, morbidity, and mortality of chronic liver diseases. Objective: To record the frequency and patterns of nail changes in patients with chronic liver diseases. Patients and methods: The study included 1000 patients who attended the Tropical Medicine and Gastroenterology department in Sohag University Hospital, between October 2017 and October 2018 with clinical and/ or laboratory diagnosis of liver diseases. A full nail examination was performed. Results: In this study, nail changes are found in the majority of patients with liver diseases (80.5% ). White nails were the commonest abnormality noted followed by longitudinal striations, terry's nails, brittle nails, clubbing, flat nails, and onychomycosis. Conclusion: Nail abnormalities are common with liver cirrhosis as well as with HCV and HBV infections. The cause of these changes remains unknown; it may be as a consequence of decreased cell-mediated immunity, immunosuppression, iron deficiency, anemia or old age, but not that of the virus itself. It is important for the clinicians to understand and examine carefully the nails for color, texture, thickness, and curvature to reach a prompt and early diagnosis of patients with liver disease.

Cysteinyl-tRNA Synthetase Mutations Cause a Multi-System, Recessive Disease That Includes Microcephaly, Developmental Delay, and Brittle Hair and Nails

Aminoacyl-tRNA synthetases (ARSs) are essential enzymes responsible for charging tRNA molecules with cognate amino acids. Consistent with the essential function and ubiquitous expression of ARSs, mutations in 32 of the 37 ARS-encoding loci cause severe, early-onset recessive phenotypes. Previous genetic and functional data suggest a loss-of-function mechanism; however, our understanding of the allelic and locus heterogeneity of ARS-related disease is incomplete. Cysteinyl-tRNA synthetase (CARS) encodes the enzyme that charges tRNACys with cysteine in the cytoplasm. To date, CARS variants have not been implicated in any human disease phenotype. Here, we report on four subjects from three families with complex syndromes that include microcephaly, developmental delay, and brittle hair and nails. Each affected person carries bi-allelic CARS variants: one individual is compound heterozygous for c.1138C>T (p.Gln380∗) and c.1022G>A (p.Arg341His), two related individuals are compound heterozygous for c.1076C>T (p.Ser359Leu) and c.1199T>A (p.Leu400Gln), and one individual is homozygous for c.2061dup (p.Ser688Glnfs∗2). Measurement of protein abundance, yeast complementation assays, and assessments of tRNA charging indicate that each CARS variant causes a loss-of-function effect. Compared to subjects with previously reported ARS-related diseases, individuals with bi-allelic CARS variants are unique in presenting with a brittle-hair-and-nail phenotype, which most likely reflects the high cysteine content in human keratins. In sum, our efforts implicate CARS variants in human inherited disease, expand the locus and clinical heterogeneity of ARS-related clinical phenotypes, and further support impaired tRNA charging as the primary mechanism of recessive ARS-related disease.

CHRONIC HEPATITIS C VIRUS;

Objective: To determine the frequency and pattern of dermatological manifestationsin patients receiving interferon and ribavarin for hepatitis C. Patients &amp; Methods: The studywas conducted in the Dermatology out patients department (OPD) of Dow University HospitalKarachi from April –November 2013.Patients diagnosed with hepatitis C who received interferona(3 MIU subcutaneously thrice weekly) plus ribavirin (1200 mg daily for 24 weeks).Detailedhistory and dermatological examination including mucous membrane,hair and nails wasperformed initially and then monthly for six months and findings were recorded. Results: Atotal of 109 patients were included in the study.Frequency of various skin diseases in thesepatients werepruritis 44(40.36%), transient alopecia 14(12.84%),generalized morbiliform rashin 22 (20.18%),photosensitivity in 8(7.33%), secondary hyperpigmentation in 17(15.59%)patients.Lichen Planus was observed in 6 (5.50%) patients while brittle nails were seen in 5(4.58%), glossitis in 4(3.66%),chelitis in 8(7.33%)and generalized exfoliating dermatitis in9(8.25%) patients.Apthous ulceration was observed in 7 (6.42%) patients. Conclusions: HCVand its treatment with interferon plus ribavirin is associated with significant dermatologicalcomplications. Physicians should be aware of these side effects and patients should becounseled before starting treatment.

Toxic Side Effects of Targeted Therapies and Immunotherapies Affecting the Skin, Oral Mucosa, Hair, and Nails.

Targeted therapies and immunotherapies are associated with a wide range of dermatologic adverse events (dAEs) resulting from common signaling pathways involved in malignant behavior and normal homeostatic functions of the epidermis and dermis. Dermatologic toxicities include damage to the skin, oral mucosa, hair, and nails. Acneiform rash is the most common dAE, observed in 25–85% of patients treated by epidermal growth factor receptor and mitogen-activated protein kinase kinase inhibitors. BRAF inhibitors mostly induce secondary skin tumors, squamous cell carcinoma and keratoacanthomas, changes in pre-existing pigmented lesions, as well as hand-foot skin reactions and maculopapular hypersensitivity-like rash. Immune checkpoint inhibitors (ICIs) most frequently induce nonspecific maculopapular rash, but also eczema-like or psoriatic lesions, lichenoid dermatitis, xerosis, and pruritus. Of the oral mucosal toxicities observed with targeted therapies, oral mucositis is the most frequent with mammalian target of rapamycin (mTOR) inhibitors, followed by stomatitis associated to multikinase angiogenesis and HER inhibitors, geographic tongue, oral hyperkeratotic lesions, lichenoid reactions, and hyperpigmentation. ICIs typically induce oral lichenoid reactions and xerostomia. Targeted therapies and endocrine therapy also commonly induce alopecia, although this is still underreported with the latter. Finally, targeted therapies may damage nail folds, with paronychia and periungual pyogenic granuloma distinct from chemotherapy-induced lesions. Mild onycholysis, brittle nails, and a slower nail growth rate may also be observed. Targeted therapies and immunotherapies often profoundly diminish patients’ quality of life, which impacts treatment outcomes. Close collaboration between dermatologists and oncologists is therefore essential.

Clinical study of skin manifestations of hypothyroidism at a tertiary hospital in North Kerala

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The effect of thyroid function on skin is very complex. Skin, hair and nail changes are not infrequent in hypothyroidism. There are only a few studies on the effect of hypothyroidism on skin in North Kerala.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 100 patients with hypothyroidism attending the outpatient departments of Dermatology and General Medicine were evaluated. The study was conducted at Kannur Medical College, Anjarakandy from September 2016 to August 2017. The various changes in skin, hair and nails are recorded in the study.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Hypothyroidism was much more common in females and manly affected the 21-40 years age group. The common skin changes seen were xerosis, myxoedema and keratoderma. Hair loss, brittle nails and onycholysis were the main hair and nail manifestations. The conditions commonly associated with hypothyroidism were melasma, urticaria, alopecia areata and vitiligo.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Thyroid and skin are closely related and so any abnormality in the functioning of thyroid commonly reflects on the skin, hair and nails. Proper knowledge about the various skin manifestations helps in avoiding the various systemic complications of hypothyroidism by arriving at an early diagnosis.&lt;/p&gt;

ONYCHOMYCOSIS FINGER AND TOE NAIL BY CRYPTOCOCCUS LAURENTII.T VERRUCOSSUM AND CANDIDA SP

ONYCHOMYCOSIS FINGER AND TOE NAIL BY Cryptococcus laurentii, Trychophyton verrucosum, and Candida sp Dhelya Widasmara, Diane Tantia SariDepartment of Dermatology and Venereology, Medical Faculty, Brawijaya Universitydr.Saiful Anwar Regional Public Hospital, Malang, IndonesiaEmail: dhelya.widasmara@gmail.com AbstractIntroduction : Onychomycosis is included in most common nail disease and contributes to 50% of onychodystropic events. So far, there are rare cases of onychomycosis due to Cryptoccus laurentii and Trychophyton verrucosum. Case : Woman, 54 y.o, complaining of brittle nails and cracked on the soles of the feet and hands since 6 months ago. Patients have daily habits to go to rice fields without gloves and footwear, and rarely wash their hands and feet after the rice fields. Dermatologic examination of all unguium digiti manus and the right and left hand, obtained discolorization of yellow and white and some blackish, subungual hyperkeratosis, onikolisis, and onikodistrofik. In plantar dekstra et sinistra, obtained erythema plaque, multiple, irregular shape, varied size, with rough skuama, as well as multiple yellow and white hyperkeratotic plaques with fissures. A 20% KOH examination of a hand and foot nail, both of which obtained a long septae hyphae. Periodic Acid-Schiff coloration (PAS) obtained a description of spores. Fungal culture from fingernail obtained growth of Criptococcus laurentii and Trichophyton spp., culture of toenails obtained growth Trichophyton verrucosum and Candida sp. Patients were treated with itraconazole tablet dose of 2x200mg / day dose for a week every month, gentamicin ointment, and 20% urea cream, myologic improvement after 4 weeks of therapy. Discussion : The incidence of onychomycosis due to Cryptoccus laurentii and Trychophyton verrucosum is still rare. The predisposing factor of infection in these patients is due to the patient's habitual contact with the paddy fields. Keywords : onychomycosis, Cryptococcus laurentii, Trychophyton verrucosum

Spoon nails: still seen in today's world.

Key Clinical MessageKoilonychia is a nail abnormality characterized by thin, brittle, and spoon‐shaped nails. It is frequently observed in chronic iron deficiency secondary to malnutrition, chronic blood loss, or malabsorption. It may also be idiopathic or related to occupation and rare systemic disorders. Presence of koilonychia should prompt investigations for iron deficiency.

Nail Changes in Chilblains Mimicking Lichen Planus

Nail Changes in Chilblains Mimicking Lichen Planus

Nutraceutical compound for the treatment of telogen effluvium associated with brittle nails syndrome

The use of nutraceutical products in the treatment of chronic telogen effluvium of non-specific cause – associated or not with signs and symptoms of nail plate frailty – has been proposed in the literature. Supplementation of nutrients and trace elements that are crucial to follicle’s metabolism seems to be linked to this effect. Objective: To evaluate the efficacy of a nutraceutical containing vitamins A, C, E and B complex, folic acid, iron, niacin, biotin, zinc and calcium pantetonate, among others, in the treatment of telogen effluvium associated with the brittle nails syndrome. Methods: A clinical, prospective, open and monocentric study was carried out with the evaluation of 62 volunteers. Clinical evaluation measurements – based on digital phototrichogram and imaging – were performed at the baseline, and at 45 and 90 days after the use of the studied product. Results: At the end of the study, a statistically significant (p <0.05) reduction of 31.56% in the number of telogen strands could be observed, coupled with a significant improvement in clinical parameters related to hair and nails. The instrumental evaluation based on image analysis showed a 36.63% reduction in nail desquamation, which, although not statistically significant, has shown benefits in the absolute outcome. Conclusions: The use of nutraceuticals was proven effective in the treatment of telogen effluvium associated with the brittle nails syndrome

Hair and nail diseases in the mature patient

The elderly population is growing, lifespans are increasing, and a greater emphasis on geriatric care is being implemented in hospital systems. With a higher percentage of the population living longer, hair and nail diseases associated with the advanced stages of life are becoming more prevalent. Common hair diseases in the elderly include androgenetic alopecia, senile alopecia, frontal fibrosing alopecia, and erosive pustular dermatosis of the scalp. Nail diseases associated with advanced age include onychomycosis, brittle nails, onychocryptosis, onychoclavus, onychogryphosis, subungual hematomas, subungual exostosis, myxoid cysts, and malignancies. These diseases can have a serious impact on a patient’s quality of life. In an effort to familiarize the reader with these common changes and abnormalities, we discuss hair and nail diseases in the mature patient.

270 The Clinical, Biochemistry and Biophysics signature of brittle nails

270 The Clinical, Biochemistry and Biophysics signature of brittle nails