Nail Changes Research Articles

Pediatric supracondylar humerus fracture with fascicular median nerve injury: The role of neuromuscular ultrasound in diagnosis and management – a case report

Background Supracondylar humerus fractures are the most common type of elbow fractures in children. Nerve injuries, primarily neuropraxia, are frequent complications and are often managed with a “wait-and-see” approach. Electroneuromyography (ENMG) is the standard method for evaluating peripheral nerve injuries, while ultrasound (US) is valuable for localizing lesions. Objective This case report aims to highlight the beneficial role of US in the follow-up and rehabilitation of nerve injuries following pediatric supracondylar humerus fractures. Case presentation A 4-year-old boy presented with a supracondylar humerus fracture that was treated with closed reduction and K-wire fixation. He exhibited weakness in the first two fingers of his left hand, difficulty grasping, and nail changes. Ultrasound revealed a median nerve lesion adjacent to the fracture site. ENMG indicated an acute severe axonal injury involving the branch innervating the flexor carpi radialis muscle. Following rehabilitation, there was improvement in hand grip strength, measured using a JAMAR hand dynamometer, and in health-related quality of life (QoL), assessed by the Pediatric Outcomes Data Collection Instrument (PODCI) score. Follow-up ENMG showed signs of mild reinnervation. Conclusion Pre-ENMG ultrasound provides crucial information regarding which nerve should be examined with a nerve conduction study and identifies the initial muscle to be evaluated during needle EMG. This aids in accurately localizing nerve damage and guiding effective treatment.

Nail Disorders as clues to systemic disease.

Disorders of the nail unit can provide important clues to underlying systemic diseases. Onychodystrophy or nail abnormalities include altered nail color, shape, or texture, with morphology and growth patterns often related to local anatomic factors such as edema, vascular supply, and neurologic innervation. Associated pain or loss of function can also affect daily activities. Because nail changes may be due to a range of systemic diseases, we chose to provide a systems-based broad overview of the common nail findings in patients with internal disease.

Skin and Nail Predictors of Psoriatic Arthritis Development: A Holistic Overview Integrating Epidemiological and Physiopathological Data.

Dermatological manifestations are considered to be of significant importance in identifying individuals with psoriasis at a higher risk of developing arthritis, as rheumatological involvement typically follows the onset of skin/nail lesions. This review summarizes the literature evidence about dermatological predictors of psoriatic arthritis (PsA) development, also analyzing the underlying physiopathological mechanisms and potential biases. Such an integration between statistical evidence and a mechanism-based approach aims to emphasize the most robust skin/nail risk factors upon which clinicians should focus most in daily clinical practice. Accordingly, psoriasis severity and nail changes due to matrix involvement would result in the most relevant risk factors for PsA occurrence, while other possible predictors (e.g., scalp and inverse psoriasis) do not seem to be supported by a significant pathogenetic link.

Efficacy and safety of nail gutter therapy and topical timolol for treating epidermal growth factor receptor inhibitor-induced nail changes: A randomized, single-blind, intraindividual study

Efficacy and safety of nail gutter therapy and topical timolol for treating epidermal growth factor receptor inhibitor-induced nail changes: A randomized, single-blind, intraindividual study

Nail changes in patients receiving systemic isotretinoin therapy

In this study, it was aimed to describe isotretinoin-induced nail changes and increase patients’ treatment compliance. A total of 200 patients diagnosed with acne vulgaris were included in the study. 100 of the patients were started systemic isotretinoin treatment and 100 control patients were receiving topical acne treatment. Age and gender of all of the participants, duration of treatment, total doses per month, and type of nail changes were recorded. Patients with persistent nail changes were followed at the 3rd and 6th months after treatment. A total of 34 patients had nail changes in the isotretinoin group. These changes included onychoschizia (55.9%), leukonychia (11.8%), onychorexis (8.8%), median nail dystrophy (5.9%), pyogenic granulomas (5.9%), chronic paronychia and granulation tissue (5.9%), onycholysis (2.9%) and Beau’s line (2.9%). The rate of nail changes in the isotretinoin group was significantly higher than in the topical treatment group (34% vs. 11%, p:0.001). Isotretinoin increases the risk of nail changes, primarily onychoschizia. The risk of developing nail changes is not associated with treatment duration but is associated with the total cumulative dose. Nail findings induced by isotretinoin are completely reversible.

Onychomadesis and Beau’s Lines- Rare Complications of Handfoot- and-mouth Disease

Hand-foot-and-mouth disease (HFMD) is a common self-limiting viral infection in children caused by Coxsackievirus A16 and human enterovirus 71, presenting with fever, erythematous papulovesicular eruptions/ blisters on the palms, soles, knees, buttocks, and oral mucosa. Although rare, complications may arise in nails e. g. onychomadesis (nail separation) and Beau’s lines (transverse lines on the nails). These typically appear within four to eight weeks of HFMD and persist for around 5-6 weeks. No active treatment is required and these nail changes resolve spontaneously within few weeks as the nail bed remain intact. We present here a boy of 4 years who presented with such nail changes after around 5 weeks of HFM disease and diagnosed as onychomadesis and Beau’s lines after ruling out other possible causes of nail changes. BANGLADESH J CHILD HEALTH 2023; VOL 47 (1) : 47-50

Docetaxel Induced Nail Changes: A Case Report

Docetaxel Induced Nail Changes: A Case Report

Survey on adverse events associated with drug therapy for breast cancer patients

BackgroundIn the breast cancer treatment, there may be a gap between patients’ information needs and physicians’ perceptions. To address this issue, we conducted a comprehensive questionnaire survey aimed to assess the specific information needs of patients regarding the adverse events (AEs) associated with treatment.MethodsA web-based questionnaire survey (UMIN000049280: Registered on October 31, 2022) was conducted in patients with a history of breast cancer treatment. Responses were obtained regarding AEs experienced, AEs for which remedies were identified, AEs patients sought to prevent, and pre-treatment information on AEs patients desired to have.ResultsData from 435 breast cancer patients were analyzed. The most common AEs reported included hair loss (93.3%), malaise/fatigue (89.4%), nail changes (83.2%), dysgeusia (69.0%), leukopenia/white blood cell decreased (65.1%), neuropathy (62.3%), and nausea/vomiting (61.4%). Financial anxiety was reported in 35.2% of the participants. AEs for which a minority of patients found effective solutions included neuropathy (20.3%), financial anxiety (21.6%), edema (24.3%), joint pain (26.0%), and malaise/fatigue (26.7%). Patients expressed the greatest desire to avoid hair loss (34.7%), followed by nausea/vomiting (23.7%), interstitial lung disease/pneumonitis (5.5%), malaise/fatigue (5.1%), and dysgeusia (5.1%). The most commonly requested pre-treatment information regarding AEs was their duration, followed by prevention methods, management strategies, time to onset, and the impact on daily life.ConclusionsThis survey highlights the existence of significant unmet medical needs among breast cancer patients, due to the inadequate solutions available for managing AEs associated with various therapeutic agents. In addition, the survey revealed that patients have different information needs regarding different types of AEs.

Dermatoscopic Evaluation of Nail Changes among End Stage Renal Disease Patients

Abstract Background Nail changes observed in end stage renal disease (ESRD) patients undergoing regular hemodialysis (HD) are polymorphic and diverse. HD causes heterogeneous pathology of nail which may be related to renal condition itself, complications related to it and drugs. Aim of the Work To study nail changes in ESRD patients undergoing regular HD by clinical and dermoscopic examination and to correlate these changes with age of patients, duration of hemodialysis, laboratory investigations, etiology of renal failure and type of vascular access. Patients and Methods The study consists of 100 ESRD patients on regular hemodialysis. Nails of these 100 patients were examined clinically and by dermoscopy. Different nail changes were detected and their frequencies were noted. Also, we correlated these changes with age of patients, duration of hemodialysis, laboratory investigations, etiology of renal failure and type of vascular access. Results Nail changes found in ESRD patients on HD were scales, leukonychia, thickening and crumbling, longitudinal striations, transverse striations, onycholysis, splinter hemorrhage, subungual hematoma, trachyonychia, subungual hyperkeratosis, Terry’s nail, onychomycosis, pincer nail, melanonychia, pitting, Lindsay nail, onychomadesis, dilated nail bed capillaries, Beau’s lines, Muehrcke’s lines, onychodystrophy, Mee’s line, loss of lunula, koilonychia and onychogryphosis in decreasing manner. Also, we found statistical significant correlation between some of these changes and age of patients, duration of hemodialysis, laboratory investigations, etiology of renal failure and type of vascular access. Conclusion Nail changes that were seen on examination of ESRD patients undergoing regular HD were very frequent and the dermoscopic examination helped us to detect nail changes not seen by clinical examination.

A Study of Onychoscopic Findings in Various Dermatological Disorders

Context: About 10% of all the dermatological conditions are comprised nail disorders. It is challenging for the dermatologists to diagnose nail disorders quickly without the help of invasive procedures. Aims: The aim of the study was to evaluate onychoscopic patterns associated with various nail disorders. Settings and Designs: Hospital-based cross-sectional observational study was conducted at a tertiary care teaching institute in Maharashtra, India from November 2019 to May 2021. Materials and Methods: One hundred and fifty patients, with a history and clinical presentation suggestive of nail disorders, were recruited in the study after confirming the clinical diagnosis. Patients having secondarily modified lesions were excluded. Dry as well as wet onychoscopy using polarized and nonpolarized modes was performed with the help of DermLite 4 dermoscope with an attached OnePlus 8T mobile phone camera to capture and save the dermoscopic images. Data were compiled and statistically analyzed using SPSS version 21.0. Statistical Analysis Used: Categorical variables were expressed in frequency and percentages. Data were entered in Microsoft Excel and analyzed using SPSS version 20. P value (using Z-test for proportions) was calculated wherever needed. Results: The majority of the patients were in the age group of 21–50 years with slight male preponderance. Overall most common onychoscopic findings studied in all the disorders were the nail plate alterations followed by chromonychia. The most common nail changes associated with connective tissue disorders were changes in the proximal nail fold capillaries along with changes in the curvature. The most common change observed in onychomycosis was chromonychia. Aurora borealis, spikes, and jagged edges of onycholytic plate with ruin pattern of hyperkeratosis were specific to onychomycosis. Inflammatory disorders of the nail unit (e.g., lichen planus and nail psoriasis) showed nail plate alterations with increased nail plate fragility. Conclusions: Some onychoscopic patterns are observed consistently with certain diseases, and these can be used for their diagnosis, hence, avoiding unnecessary biopsies, thus improving the patient outcome.

Serum Calprotectin as an Inflammatory Marker in a Cohort of Egyptian Patients with Psoriatic Arthritis and its Correlation with Disease Activity and Radiological Findings

Abstract Background Psoriatic arthritis (PsA) is a chronic inflammatory arthritis associated with psoriasis and is found in about 20 to 30% of psoriatic patients. The use of inflammatory markers can be disappointing in PsA, since they are elevated in only half of the patients with PsA., in this study we assessed serum calprotectin as a marker of inflammation in psoriatic arthritis and correlated it to disease activity and radiological findings. Objective To measure serum calprotectin level in psoriatic arthritis patients and to assess its association with disease activity score and radiological findings using musculoskeletal ultrasound. Methods This was a Case-Control Study Rheumatology inpatient departments and outpatient clinics at Ain Shams University Hospitals. This study was conducted on 50 patients with psoriatic arthritis according to the classification criteria for psoriatic arthritis (CASPAR) criteria and 30 Normal subjects with no past medical history and with no family history of psoriasis. Results Patients serum calprotectin level had statistically significant higher value in comparison to the control group P-Value < 0.001., and with cutoff point 106.36 ng/ml with sensitivity 98% and specificity of 86.6 %, There was highly statistically significant relation between the level of serum calprotectin and synovial hypertrophy in small hand joints P-Value=0.004 and it can predict synovial hypertrophy in hands by joint ultrasound at the level of 258.9 ng/ml with sensitivity and specificity of 71%, 83% respectively There was also a with statistically significant relation nail bed affection in ultrasound P-Value=0.034. Multiple regression analysis was done in psoriatic arthritis patients and it was found that serum calprotectin was the most predictive for the presence of psoriatic arthritis in comparison to ESR and CRP. Conclusion in psoriatic arthritis patients, serum calprotectin level is significantly higher and is correlated to radiographic and nail changes. Further studies are required to define a specific cutoff serum level for diagnosis.

Ultrasound nail assessment in patients with psoriasic arthritis: is there an association of findings with clinical scores?

BackgroundPsoriatic arthritis can involve several domains. Due to its multifaceted nature and its frequent comorbidities such as depression, obesity, osteoarthritis and fibromyalgia, it is difficult to monitor these patients because the clinical scores involve subjective data. High-resolution ultrasound probes allowed the evaluation of more superficial structures, such as the nails and their synovio-entheseal framework, in close relationship with the enthesis of the distal extensor digitorum tendon. Nail ultrasound studies vary in terms of the parameters and fingers studied and in their findings.ObjectivesTo describe the most significant sonographic nail changes and the most affected fingers in psoriatic arthritis and to verify the association of nail ultrasound findings with clinical scores (nail psoriasis severity index (NAPSI), ankylosing spondylitis disease activity score with C-reactive protein (ASDAS-CRP), minimal disease activity (MDA), disease activity index for psoriatic arthritis (DAPSA)).MethodsThis was a cross-sectional study with 52 patients with psoriatic arthritis at the Hospital de Clínicas do Paraná and 50 controls. A total of 1016 nails were analyzed (517 from patients with psoriatic arthritis and 499 from controls). Ultrasonography of the nails of the 10 fingers was performed to assess the trilaminar appearance, measure the distance from the nail bed, identify synovitis of the distal interphalangeal joints and the presence of a power Doppler signal from the nail matrix/nail bed. The captured images were independently evaluated by a rheumatologist with expertise in musculoskeletal ultrasound. Data analysis was performed using IBM SPSS Statistics v.28.0.0 software, and the association of nail plate changes, nail bed distance and power Doppler signal with the NAPSI, DAPSA, MDA and ASDAS-PCR were calculated. Spearman correlation coefficients were estimated to analyze the correlations between pairs of quantitative variables. Student’s t test and the Mann‒Whitney U test were used to compare quantitative variables, and Fisher’s exact test was used to compare categorical variables between patients and controls. The nonparametric Mann‒Whitney U and Kruskal‒Wallis tests were used to compare groups according to the MDA or DAPSA classification.ResultsThe Doppler signal of the nail matrix and nail bed was more frequently identified in patients (44.2%) than in controls (6%), and the difference in the mean power Doppler signal between the two groups was significant (p < 0.001). Changes in the nail plate were more common in the right thumb (44.2%), left thumb (36.5%) and second finger on the right hand (32.7%). The number of fingers with nail plate changes, enthesitis, paratendinitis, grayscale synovitis and DIP involvement in the distal interphalangeal joints was higher among patients with psoriatic arthritis (p < 0.001). There were found some correlations between US findings and clinical scores: ultrasound nail involvement and the NAPSI score (p = 0.034), the number of fingers and mean change in the nail plate and the ASDAS-CRP (p = 0.030). DAPSA (remission/low activity versus moderate/high activity) was associated to the mean change in the nail plate (p < 0.013). CONCLUSIONS: Nail ultrasound has the potential to assist in the capturing of the actual disease activity status in patients with psoriatic arthritis.

Drug Delivery Through Nails: An Overview

Changes in nails are not only a concern for aesthetic appeal but also can be a window to an internal problem or disease. Delay in taking therapy for nail problems can aggravate the condition and drastically affect performance of task of everyday life, hampering the overall wellbeing of human. Onychoschizia, onychomycosis, paronychia, nail psoriasis, longitudinal melanonychia, are usual nail problems observed in medical practice, originating from infections, swelling or injuries of nails. Accurate diagnosis can be done through nail surface microscopy, computed tomography, biopsy and fungal studies. Nail disease management needs personalized therapy. Root cause for the problem such as ceasing the drug causing nail problems or surgical intervention can be done. Appropriate manicure and methods to reduce harm to the injured nails is a key aspect. Nail disorders can occur irrespective of age. Most of the nail problems due to infections. This review article enlists the details of types of nail disorders and recent treatment avenues.

Questionnaire survey of healthcare professionals on taxane-induced nail change in Japan.

Taxanes are widely used chemotherapeutic agents that frequently cause nail changes and have a significant impact on patients' quality of life. Despite the prevalence of taxane-induced nail toxicity, limited data are available regarding evidence-based management strategies for the prevention or treatment of taxane-induced nail changes. Therefore, we aimed to gain insights into the prevention, treatment, and evaluation of nail changes in patients with cancer in Japan by conducting a questionnaire survey of physicians, pharmacists, and nurses involved in oncology treatment. The questions addressed prophylactic methods, evaluation practices, and treatment approaches for various nail disorders. The questionnaires were distributed on March 1, 2022, with a response deadline of December 1, 2022. Of the 120 questionnaires distributed, 88 (73.3%) were returned, and all of them were analyzed. The respondents included 69 physicians (32 oncologists, 26 breast surgeons, 6 dermatologists, 3 obstetricians/gynecologists, 1 gastroenterological surgeon, and 1 urologist), 9 pharmacists, and 10 nurses. Prophylactic measures included moisturizing (58.0%), protection (42.0%), cooling therapy (37.5%), and cleanliness (33.0%). Approximately 70% of the respondents used the Common Criteria for Adverse Events (CTCAE), while approximately 30% did not use a specific evaluation method. Opinions regarding treatment with antimicrobial or corticosteroid ointments varied; however, all severe cases were referred by dermatologists. Our survey revealed that the management of chemotherapy-induced nail changes varies in clinical practice in Japan. These findings emphasize the need for standardized management strategies and further research.

Dermoscopic Evaluation of Nail Changes in Patients with End-Stage Renal Disease on Regular Hemodialysis

Introduction: Chronic renal failure can impact various body systems, including the skin and its appendages. Patients with uremic conditions have been observed to experience a variety of nail changes. This study was conducted to evaluate the presence and type of fingernail changes in patients with end-stage renal failure (ESRF) on regular hemodialysis (HD) by nail dermoscopy. Methods: A total of 100 patients with ESRF on regular HD three times a week. Nails were examined by dermoscopy for the presence of subtle nail changes. Results: Nail changes were found in 91% of patients, while 9% did not have nail changes. The most common dermoscopic findings were as follows; scales in lateral nail fold in 91% of the patients, dry cuticle in 84%, onychoschizia in 72%, and longitudinal striation in 69%. There was no significant relation between nail changes and sex, duration of HD, and albumin level. Conclusion: Patients with end-stage renal disease on HD are more likely to experience nail disorders. Scales in LNF, dry cuticle, onychoschizia, longitudinal striation, terry’s nails, and half-and-half nails were the most common nail changes in HD patients.

52812 Lichen Planus or Not? A Review of Conditions with Lichenoid Nail Changes

52812 Lichen Planus or Not? A Review of Conditions with Lichenoid Nail Changes

53588 The efficacy of nail gutter method for epidermal growth factor receptor inhibitors-induced nail changes: A randomized, single-blinded, intra-individual study

53588 The efficacy of nail gutter method for epidermal growth factor receptor inhibitors-induced nail changes: A randomized, single-blinded, intra-individual study

Lymphedema in Turner syndrome: correlations with phenotype and karyotype.

Lymphedema (LD) in Turner syndrome (TS) is a commonly reported comorbidity, though its associations with karyotype and other comorbidities are poorly understood. Characteristics of patients with TS and LD, including correlation with phenotype and karyotype, are described. Medical records of patients with TS seen in two pediatric institutions from 2002 to 2020 were retrospectively reviewed. Demographic data (age, presentation onset, clinical features, genetics, LD presence, investigations, treatments) were collected. 393 girls with TS with mean age of 12.5 years (SD: 5.7) were identified. LD was noted in 37 % of patients (n=146). Among the 112 patients with TS and documentation of onset of LD, LD was noted within the first year of life in 78.6 % (n=88). 67.6 % (n=96) of total patients with TS and LD had non-mosaic 45, X karyotype. Frequency of webbed neck was significantly greater in girls with TS and LD compared with girls without LD (58 vs. 7 %, p<0.001). Congenital heart anomalies, hypertension, and renal anomalies were also more common in girls with LD. Nail abnormalities with presence of hypoplastic or dysplastic nails were significantly associated with LD (OR: 6.784, 95 % CI 4.235-11.046). The number of girls reporting presence of LD decreased with age. LD in TS often occurs within the first year of life, is less prevalent in older children and adolescents, and issignificantly associated with 45, X karyotype, presence ofwebbed neck, nail changes, congenital heart anomalies, and renal anomalies.

Paediatrics and Genetics.

A 14-year-old boy presented with ongoing suppurative plaques across his hands and feet with associated nail change. He had an excellent response to adalimumab. What was the underlying diagnosis and associated mutations in this patient’s case?

Nail Toxicity Related to Taxane Treatment

Taxanes are a diverse class of chemotherapeutic agents. Cutaneous toxicity has been reported with taxanes and includes erythema and desquamation, involving primarily the hands. Nail changes are described in different series and case reports, but the real incidence of this side-effect is probably underestimated, literature reports that adverse events occur in up to 89% of patients. The nail changes caused by chemotherapy in cancer patients are difficult to assess and often overlooked by clinicians.