Nail Changes Research Articles

A clinical study of Geriatric dermatoses at Tertiary care center in South India

Geriatric health care has become a worldwide concern as advance in medical science has contributed to increase in average life span of an individual. Cutaneous dermatoses constitute one of the major comorbidities of elderly. To determine the prevalence of various skin conditions in elderly patients. A Total of 200 patients aged 60 and above attending Dermatology OPD at tertiary care centre for a period of six months from March to August were assessed for cutaneous dermatosis, routine investigations and histopathological examination done for relevant cases. Out of 200 patients included in study group 128 were males (64%) and 72females (36%), majority were in age group of 65 to70 yrs. All patients recruited were from rural area. wrinkling was seen in >95% of cases , Generalized pruritus and xerosis was seen in 56patient(28%) and 85 patients(42.5%) respectively, eczematous skin condition seen in 41 patients(21%)and psoriasis in 17 patients(8.5%) fissure foot in 15(7.5%) patients .Fungal infection is the most common infection noted(7.5% ) followed by viral infection herpes zoster and post herpetic neuralgia ( 4%), pyoderma (3.5%) and scabies(2.5% ).Benign tumors like acrochordons, Dermatosis Papulosis nigra and seborrheic keratosis seen in 28% of cases. Nails changes was seen in 45% of patients. The increasing prevalence of skin condition in elderly especially ruritus and eczema, emphasizes the importance of health education regarding skin care concerning appropriate use of emollients, foot care, proper hygiene, sun protection and for early diagnosis and management of the same, such that the process of senescence allowed to live hail and healthy.

Onychoscopy and nailfold capillaroscopy in leprosy: A case–control study

Objectives: Studies have reported significant number of individuals with leprosy develop nail changes of heterogeneous variety. Direct or indirect damage secondary to neural damage, repeated trauma, vascular injury, anemia or following drug therapy have been implicated. In this study, we compared nail changes in cases of leprosy with controls to determine leprosy specific nail changes through detailed onychoscopic evaluation along with nailfold capillaroscopy. Materials and Methods: We performed a case–control study in a tertiary care institute with 30 leprosy patients and 30 age- and sex-matched controls. The study was done over a period of three months from June 2023 to August 2023. Patients were classified as per Ridley-Jopling classification. A detailed clinical examination followed by onychoscopy and proximal nailfold (PNF) capillaroscopy using Dermlite DL4 was done in all the nails of cases and controls. Results: A total of 600 nails of 30 leprosy patients on treatment attending our outpatient department were studied over a span of three months. Nail changes were seen in 26 (86.6%) out of 30 patients of leprosy disease compared to 10 (33.3%) of the controls. The most common nail finding seen in leprosy patients was longitudinal melanonychia followed by leukonychia. Transverse lines, leukonychia, subungual hyperkeratosis, nail discoloration, nail pallor, onychochauxis, subungual hematoma, splinter hemorrhage, and brachyonychia were seen more in cases than in controls, and the difference was statistically significant. The PNF capillaroscopy showed microhemorrhages in eight patients of leprosy while none in controls. Conclusion: Nail changes seen in leprosy are multifactorial. The PNF capillaroscopy showed microhemorrhages, which could be an early feature of vascular changes in leprosy.

Nail involvement in connective tissue diseases: an epidemiological, clinical, and dermoscopic study.

The assessment of nail changes in connective tissue diseases (CTD) has been rarely explored in previous studies. The use of dermoscopy to study vascular changes in nailfolds is an interesting diagnostic technique. The aim of the study was to describe the epidemiological, clinical, and dermoscopic features of nail lesions in CTD. A prospective study was performed at the Dermatology Department of Habib Thameur Hospital (Tunis, Tunisia) in collaboration with the Internal Medicine Department over a period of 15 months, from July 2020 to September 2021, including patients diagnosed with systemic sclerosis (SS), systemic lupus erythematosus (SLE) and dermatomyositis (DM). Our study included 48 patients. Nail involvement was found in 44 cases. Dermoscopic nailfold abnormalities were identified in 37 cases. The most common clinical features were ragged cuticle, nailfold erythema, and onycholysis. Additionally, splinter hemorrhage, longitudinal ridging, lunula abnormalities, melanonychia, trachyonychia, leukonychia, increase in transverse curvature, parrot beak nail, half and half nails, and onychorrhexis were described. Nailfold dermoscopy showed a normal pattern in 10 cases, a nonspecific pattern in nine cases (SLE), and a scleroderma pattern in 29 cases (SS and DM). The scleroderma pattern was further categorized into an early pattern (6), an active pattern (14), and a late pattern (9). Normal pattern was observed solely in patients in remission. The late scleroderma pattern was associated with disease duration and systemic involvement. In SLE, disease activity correlated with onycholysis, nailfold erythema, and pathologic pattern in dermoscopy. However, patients with DM displayed a positive correlation between pulmonary involvement and scleroderma pattern. Nail involvement in CTD includes a diverse range of abnormalities. Despite being nonspecific, it can provide crucial clues for establishing a diagnosis. Nailfold dermoscopy serves as a mirror for microangiopathy, enabling the detection of changes at an initial stage, and thus, it becomes a diagnostic and prognostic tool.

Unravelling Beau's Lines as a Potential Indicator of Severe Immune Response in Covid-19 and Reinfection.

Beau's lines are transverse grooves in the nail plate that result from transient interruption of the growth of the proximal nail matrix. These rare nail disorders can be triggered mostly by infections or systemic diseases. We describe a 65-year-old man who presented with nail changes on all fingernails. The patient, a non-smoker with no medication history, had severe immune responses during two hospitalisations, 9 and 4 months ago, for COVID-19. Both hospitalisations were accompanied by markedly elevated interleukin-6 levels, and treatment with tocilizumab on top of dexamethasone was required. The present examination revealed Beau's lines which were associated with both prior COVID-19 infections. Although nail changes look harmless, seeking Beau's lines during the physical examination might indicate past severe COVID-19 infection and a higher probability for reinfection and rehospitalisation. Beau's lines are grooves that traverse the nail plate horizontally.The appearance of Beau's lines may indicate past severe COVID-19 infection.Beau's lines can potentially indicate a higher probability of COVID-19 reinfection and rehospitalisation.

Nonunions after intertrochanteric and subtrochanteric femoral fractures

The overall frequency of proximal femoral fractures means that we are repeatedly confronted with failed healing and implant failure, despite arelatively low nonunion rate especially in intertrochanteric fractures (< 5%). The aim of this paper is to present our approach to treating these nonunions of the proximal femur and discuss the treatment results. Between 2009 and 2023, patients with nonunion of the proximal femur were retrospectively identified and analyzed. Age, gender, time to revision, the Weber-Cech classification of pseudarthrosis and radiographic imaging before and after revision were analyzed. Atotal of 66patients were analyzed. The mean age was 58years (range 25-88years). The overall healing rate was 88% with amean consolidation time of 8months (range 2-29months). The main osteosynthesis procedures were plate osteosynthesis (n = 45, of which 44 were blade plates), and nail replacement (n = 12). Other procedures included augmentative plate osteosyntheses (n = 4), isolated cancellous bone graft (n = 2), nail dynamization (n = 2), and the use of adynamic hip screw (n = 1). The analysis of our treatment data as well as the current literature, revealed atrend towards intramedullary revision procedures. Implants that can be used to correct the CCD angle, such as the blade plate, remain apredictable option to achieve correction, especially in nonunions with an increased degree of varus. Particularly in the subtrochanteric region, fractures can also be treated in atargeted manner by acombination of mechanical and biological methods with areamed nail change to alarger caliber implant.

A Descriptive Study of Nail Changes in Systemic Diseases

Abstract Background and Objectives: Nail findings may represent a part of the symptom complex that may be useful for the physical diagnosis. Thus, the present study was undertaken to know the nail changes in systemic diseases among patients attending the outpatient and inpatient departments of dermatology, medicine, nephrology, pulmonology, and surgery attached to Karnataka Institute of Medical Sciences (KIMS), Hubballi. Methodology: A hospital-based original study was conducted at KIMS, Hubballi. During January 1, 2021–January 30, 2023, data were collected by personal interview after obtaining informed consent from all eligible participants using a prestructured and pretested pro forma, among a convenient sample of 272 patients selected by the simple random sampling method. Results: Among 272 patients, 57.5% of the patients were young adults with male predominance (56.0%) and inpatients (66.0%) were more compared to outpatients (44%). Of the 272 patients, respiratory system (RS) (26%) was most common involved followed by hematology (21.0%), gastrointestinal tract (GIT) and liver (17%), cardiovascular system (CVS) and renal (12%), and clubbing was the most common nail change encountered (35.5%) followed by longitudinal ridging (33%) and pallor (31%) of the nail subsequently. RS was found as the common cause of clubbing followed by CVS and liver and GIT. Conclusion: RS (clubbing) was the most common system involved. Other systems involvement were renal system (half and half nail), liver, and GIT system (Terry’s nail) which are the specific nail changes that can lead us to the diagnosis. Thus, nails can serve as a window for the underlying systemic illness.

TARGET: A phase I/II open-label multicenter study to assess safety and efficacy of fexagratinib in patients with relapsed/refractory FGFR fusion-positive glioma

Abstract Background Oncogenic FGFR–TACC fusions are present in 3–5% of high-grade gliomas (HGGs). Fexagratinib (AZD4547) is an oral FGFR1–3 inhibitor with preclinical activity in FGFR–TACC+ gliomas. We tested its safety and efficacy in patients with recurrent FGFR–TACC + HGGs. Patients and Methods TARGET (NCT02824133) is a phase I/II open-label multicenter study that included adult patients with FGFR–TACC + HGGs relapsing after ≥1 line of standard chemoradiation. Patients received fexagratinib 80 mg bd on a continuous schedule until disease progression or unacceptable toxicity. The primary endpoint was the 6-month progression-free survival rate (PFS6). Results Twelve patients with recurrent IDH wildtype FGFR–TACC + HGGs (all FGFR3–TACC3+) were included in the efficacy cohort (male/female ratio = 1.4, median age = 61.5 years). Most patients (67%) were included at the first relapse. The PFS6 was 25% (95% confidence interval 5–57%), with a median PFS of 1.4 months. All patients without progression at 6 months (n = 3) were treated at first recurrence (versus 56% of those in progression) and remained progression-free for 14–23 months. The best response was RANO partial response in 1 patient (8%), stable disease in 5 (42%), and progressive disease in 6 (50%). Median survival was 17.5 months from inclusion. Grade 3 toxicities included lymphopenia, hyperglycaemia, stomatitis, nail changes, and alanine aminotransferase increase (n = 1 each). No grade 4–5 toxicities were seen. A 32-gene signature was associated with the benefit of FGFR inhibition in FGFR3–TACC3 + HGGs. Conclusions Fexagratinib exhibited acceptable toxicity but limited efficacy in recurrent FGFR3–TACC3 + HGGs. Patients treated at first recurrence appeared more likely to benefit, yet additional evidence is required.

Factors Affecting the Response and Patient Satisfaction of Topical Immunotherapy in Alopecia Areata: A Nationwide Study.

Contact immunotherapy using diphenylcyclopropenone (DPCP) is a recommended treatment for severe alopecia areata (AA); however, few clinical factors are known, and few standardized application methods affecting therapeutic efficacy have been devised. To confirm the therapeutic response of DPCP immunotherapy in AA, first we analyze the factors influencing its outcome and patient satisfaction levels, after which we standardize the DPCP treatment method for better outcomes. We utilized a nationwide questionnaire-based survey to assess patient satisfaction and undertook a medical record review involving 412 patients currently undergoing treatment for DPCP. The patients' mean age was 36.4 years, and 27% of the cases were diagnosed as AA in childhood. Treatment response was higher when DPCP was used to treat the entire scalp, including subclinical lesions, and longer treatment durations and longer intervals between treatments were associated with a better treatment response. Atopy (atopic dermatitis, allergic rhinitis and bronchial asthma), thyroid disorder, and extent of hair loss were all negatively correlated with the treatment response. However, there was no correlation between the treatment response and factors such as the age of onset, a family history of AA, nail changes, or AA duration, which are commonly known to be associated with a poor prognosis. DPCP immunotherapy is an effective treatment for AA, and the study demonstrated the factors affecting DPCP treatment response and patients' satisfaction and may contribute to standardizing the DPCP treatment method for better outcomes.

An Uncommon Clinical Presentation of a Rare Disease-Alkaptonuria: Case Report

Palmoplantar pigmentation is a rare clinical presentation of alkaptonuria, a rare inborn error of phenylalanine and tyrosine metabolism. Alkaptonuria occurs owing to a deficiency of an enzyme homogentisic acid oxidase inherited as an autosomal recessive disorder. We report a case of alkaptonuria, which presented with palmoplantar pigment pigmentary nail changes and the involvement of the spine and joints. He was advised of ascorbic acid along with symptomatic management and detailed counselling.

Nail psoriasis in China: A prospective multicentre study.

Data on nail psoriasis (PsO) in China are scarce. To provide nail PsO-related data regarding epidemiologic characteristics, manifestations, fungal infections, arthritic complaints and treatments that may facilitate improved patient management globally. From August 2021 to August 2022, patients with nail PsO were enrolled in a prospective multicentre observational study at 25 hospitals in China. We collected and analysed data concerning nail PsO demography, clinical signs, fungal detection, arthritic symptoms and treatment. A total of 817 patients with nail PsO were involved, with a mean body mass index of 24.13 ± 2.93. In addition, 71.41% of the patients were male. The Nail PsO Severity Index score was weakly positively correlated with body surface area. The percentage of nail involvement was 95.29% for fingernails and 57.18% for toenails, with pitting (67.11%) and subungual hyperkeratosis (60.40%) being the most prevalent manifestations, respectively. Toenails showed a significantly higher frequency of nailfold scales, subungual hyperkeratosis and nail plate crumbling and a lower frequency of splinter haemorrhages, pitting and erythema of the lunula. A total of 13.26% of the PsO patients had onychomycosis, and 77.08% were observed in the toenails. Articular symptoms were reported by 12.17% of the patients, with the peripheral type being predominant. Significant associations between articular symptoms and nailfold swelling, subungual hyperkeratosis, nailfold scales, onycholysis and longitudinal ridges were found. Only 2.30% (20 out of 871) of patients with nail PsO received treatment. The most frequently employed therapy for cutaneous PsO with nail involvement was biologic therapy (n = 366). PsO showed distinct manifestations in the toenails and fingernails. Additionally, toenail PsO combined with onychomycosis requires special attention. Articular symptoms in psoriatic patients are associated with specific nail changes. It is important to research and advocate for more potent treatments for nail PsO.

Implementation of the Treat-to-Target Approach in Psoriatic Arthritis and Its Outcomes in Routine Clinical Practice.

Background Measuring disease activity in psoriatic arthritis using validated tools and treating to a target (T2T) is advocated. It improves quality of life and delays radiographic progression. In clinical practice, it guides therapy escalation to achieve better disease control. This study aimed to assess the real-life implementation of the T2T concept in daily clinical practice and the proportion of patients achieving the target of low disease activity or remission. Methodology In this study, a retrospective review of patients diagnosed with psoriatic arthritis having clinical visits from January 2020 to February 2023 was done. The proportion of patients in whom disease activity was monitored using the Disease Activity Index for Psoriatic Arthritis (DAPSA) 28 and Physician Global Assessment (PGA) and those achieving the target was calculated using SPSS version 21 (IBM Corp., Armonk, NY, USA). Results A total of 89 patients were included in the study after fulfilling the inclusion and exclusion criteria. Overall, 56.2% (50) of patients were males and 43.8% (39) were females, with a mean age of 43.5 ± 14.5 years, mean disease duration of 6.6 ± 3.8 years, and mean follow-up duration of 2.8 ± 1.6 years. Of the study population, 43.8% (39) had axial involvement, 23.6% (21) had dactylitis, and 12.4% (11) had enthesitis. Skin psoriasis was present in 84.3% (75), 11.2% (10) had a family history of psoriasis, 19.1% (17) had nail changes, 1.1% (1) had uveitis, and in 94.8% (73) of patients skin psoriasis presented before arthritis. Overall, 97.7% (85) of patients were on conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), with the most common being methotrexate in 77%, followed by leflunomide in 8%. Further, 34.8% (31) were using biological DMARDs (bDMARDs), with the most common being tofacitinib (33.7%), infliximab (28.1%), and secukinumab (24.7%) being other choices. Overall, 21.1% (18) of patients experienced adverse events with csDMARDs and 3.2% (1) with biological DMARDs. DAPSA28 was recorded in 44.9% (40), Psoriasis Area and Severity Index in 16.8% (15), and PGA in 100% of patients. Target of low disease activity (LDA)/remission was achieved in 50.6% (45) patients, as assessed by PGA or DAPSA28 cutoff. The LDA/remission target was achieved in 51.2% of patients taking csDMARDs, and 74.2% in those who were on bDMARDs. Conclusions It is crucial to measure the disease activity using validated tools and treat the patient to target for achieving better disease control and improved quality of life. Despite the evidence that T2T improves outcomes, it is not widely practiced in routine clinical practice.

Symptomatic Iron Deficiency without Anemia: An Underrecognized Phenomenon

Background: Iron deficiency is a multifactorial condition affecting millions globally and is the leading cause of anemia worldwide. The identification of iron deficiency usually occurs during the work-up of anemia. However, iron deficiency without anemia may adversely affect patients' quality of life. Our objective is to highlight the link between iron deficiency and various patient symptoms in the absence of anemia. Methods: We conducted a retrospective chart review of patients identified using ICD-10 codes D64.9 (Anemia, unspecified), D50.9 (Iron deficiency anemia, unspecified), and E61.1 (Iron deficiency) who were seen in a tertiary care hospital hematology clinic between 01/2019 and 09/2022. Patient symptoms were obtained from two consecutive visit notes. Hemoglobin (Hb), hematocrit, MCV, ferritin, and iron profile values associated with the visits were obtained from the electronic health records. Documentation of intravenous (IV) treatment was obtained from infusion center flowsheets. Results: Our study identified a total of 65 patients. 24 patients with Hb above 12 g/dL were found, 16.67% (4/24) were male, 83.33% (18/24) were female. The most common age groups were 30-40 at 33.33% (8/24) and 40-50 at 20.83% (5/24). The mean Hb for this group of patients was 13.44 ± 1 g/dL, MCV 83.3 ± 7.1 fL, and the mean ferritin was 16.13 ± 10.37 ng/mL. 87.5% (21/24) of patients reported symptoms, with fatigue being reported by 83.33% (20/24) of patients. Pica was reported by 8.33% (2/24), restless leg syndrome by 12.5% (3/24), cold intolerance by 12.5% (3/24), and hair and/or nail changes by 25% (6/24) of patients. 70.83% (17/24) of patients received IV iron treatment, 16.67% (4/24) received oral iron treatment. Iron dextran was the most frequently used preparation at 76.47% (13/17). Mean post-treatment Hb was 13.92 ± 0.77 g/dL, MCV 88.53 ± 5.18 fL, and mean post-treatment ferritin 135.64 ± 99.66 ng/mL. In our study, 62.5% (15/24) of patients stated their symptoms improved, 4.17% (1/24) of patients stated their symptoms did not improve, 33% (8/24) of patients could not be evaluated at a subsequent visit for symptoms. Discussion:Iron deficiency without anemia can be a significant contributor to patient morbidity, and patients are not routinely assessed for iron deficiency in the absence of anemia. A recent study (Weyand et al. JAMA 2023) suggests up to 40% of females can have iron deficiency when defined by a ferritin level of 15 ng/mL, and up to 80% of females when a less stringent cut-off of 50 ng/mL is used. Our study suggests both male and female patients can report symptoms of iron deficiency without the presence of anemia and subjective improvement following iron replacement without significant changes in Hb. The high prevalence of iron deficiency indicates a greater need for screening for this underrecognized phenomenon. We recommend considering ferritin and iron panel evaluation while assessing patients for symptoms such as those seen in iron deficiency anemia, even without the presence of low Hb. Importantly, it appears correction of the iron deficiency can improve fatigue, even without affecting the Hb level. Further studies utilizing validated Quality of Life instruments should be done to more accurately assess this issue.

Scabies Norvegica in infant

Introduction: Crusted scabies are a rare manifestation of scabies characterized by uncontrolled proliferation of mites in the skin. Crusted scabies are a severe variant of highly contagious scabies. Various cutaneous, neurologic and immunologic diseases have been described to predispose to crusted scabies. Case presentation: The presented case is a 7-month-old male. He was hospitalized at the Clinic of Dermatovenerology, due to hyperkeratotic changes in the palms and food, papules throughout the body, and nail changes all of these accompanied by scratching. Initially, it was diagnosed as atopic dermatitis, hyperkeratosis palmoplantaris, and onychomycosis mani. The changes had started to appear five months ago. Also, the mother of the child presents the papules throughout the body, also associated with itching as classical scabies. Conclusion: Crusted scabies are a severe variant of highly contagious scabies. Is known the failure of the immune system to suppress the proliferation of the mite is an important cause of crusted scabies development. Crusted scabies usually do not present as an acute eruption as in classical scabies. The eruption is slow in onset and insidious in progression. In the present case, we learned that in the stimulation of the condition, there was a major role in the application of topically fluoride steroids.

CTNI-33. TARGET TRIAL: A PHASE I/II OPEN-LABEL MULTICENTER STUDY TO ASSESS SAFETY, TOLERABILITY, AND CLINICAL EFFICACY OF AZD4547 IN PATIENTS WITH RELAPSED/REFRACTORY FGFR FUSION POSITIVE GLIOMA

Abstract BACKGROUND AZD4547 is a potent oral FGFR1-3 inhibitor. We tested its safety, tolerability, and efficacy in patients presenting relapsed/refractory (r/r) high-grade gliomas (HGGs) with FGFR fusion in a phase I/II open label multicenter study (NCT02824133). METHODS the study was based on a two-stage design and included adult patients with HGG expressing a FGFR-TACC gene fusion (as centrally confirmed by RT-PCR sequencing) relapsing after at least one line of standard chemoradiation. Patients received AZD4547 (AstraZeneca) at a dose of 80mg bd on a continuous schedule, until disease progression or inacceptable toxicity. The primary endpoint was the 6-months progression-free survival rate (PFS6). This research was conducted with support from AstraZeneca. RESULTS 12 patients with r/r isocitrate dehydrogenase wildtype HGGs positive for FGFR-TACC fusions (all FGFR3-TACC3) were included in the efficacy analysis cohort (male/female ratio = 1.4, median age = 61.5 years). Most patients (67%) were included at the first tumor relapse. The PFS6 was 25% (95% confidence interval [CI] 5-57%), with a median PFS of 1.4 months. All patients without progression at six months (n = 3) were at the first tumor recurrence (versus 56% of those in progression) and remained progression-free for 14-23 months. The best response was stable disease in six patients and progressive disease in six. Median OS was 17.5 months. Grade 3 toxicities included hematological, metabolic, nail changes, stomatitis, or other disorder (n = 1 each). No grade 4 toxicities were seen. CONCLUSION overall, tolerance was acceptable. The study did not meet the predetermined objective of PFS6 ≥ 35% and was stopped. A molecular characterization is ongoing to identify potential markers associated with prolonged stabilizations.

Subungual Glomus Tumor of the Hallux A Report of 4 Cases.

This study reports the clinical outcomes and evolution of 4 patients with subungual glomus tumor (GT) of the hallux treated with tumor excision. Preoperatively, all patients had pain of intensity 9 or 10. Three were sensitive to cold and had stabbing pain, and one reported pulsatile pain. No patient presented nail alterations. There were no bone alterations on radiographic images and diagnostic suspicion of GT was supported by magnetic resonance images. Surgical treatment was indicated due to severe pain and functional limitation. The GT excision was performed by removing the nail through an L-shaped incision in the nail bed. After surgery, they all showed clinical improvement with return to previous activities and had no difficulty in wearing regular shoes. Three patients were pain-free and one had occasional stabbing pain of intensity 2. Half of them had nail changes. There has been no recurrence so far. Thus, we found that resection of subungual GT of the hallux was effective for the clinical improvement of patients.Level of Evidence: IV, case reports.

Computer Aided Disease Detection using Finger Nail Image Processing Technique

Human analysis is a method that can identify various diseases by examining different parts of the body. One of these is the fingernail, as it is the last organ in the body that receives oxygen. Because of this, it can sometimes exhibit early signs of a disease. More accurate findings may be produced by using digital image processing techniques to examine changes in human nails, making it possible to anticipate many illnesses with simplicity. The main focus of this study is on the role that nail colors, textures, forms, and flexibility play in illness prediction. Due to the limitations of human vision in differentiating minor colour changes, clinicians must rely on visual inspections of patients' nails in traditional illness detection procedures, which can be laborious and less reliable. Nail characteristics are detected using image analysis and digital image processing techniques include image capture, pre-processing, segmentation, and feature extraction. Normal healthy nails are glossy, pink, and smooth. However, this study examines multiple approaches used to analyse nail photos and find disorders. The objective is to advance beyond conventional observation-based methodologies and improve the precision and effectiveness of illness prediction.

Clinicoepidemiological Profile of Pediatric Psoriasis: Experience from a Tertiary Care Center

Abstract Introduction: Psoriasis is a common skin disorder and is relatively less studied in children. The objective of this study was to evaluate the clinical and epidemiological profile of pediatric psoriasis (PP). Materials and Methods: All patients of psoriasis (age &lt;18 years) who visited PP clinic from January 2017 to September 2021 were included in this record-based study, which was conducted in a tertiary care center in North India. Results: Records of 100 patients were analyzed, with female-to-male ratio of 1:1. The mean age of diagnosis was 10.87 ± 3.96 years. The most common initial site of onset was elbows, followed by knees and soles. The most common subtype was plaque psoriasis followed by palmoplantar and guttate types. Average body surface area (BSA) involved was 5.43% with majority (49%) had involvement of 3%–10% BSA. Average psoriasis area and severity index (PASI) in our study was 2.47. PASI &gt;10 was seen in only 5% of patients. Joint involvement was found in 7% of patients and nail changes in 54%. Infection (15%) was the most common aggravating factor, followed by trauma and stress. Koebner phenomenon was present in 15% of patients. Family history of psoriasis was reported in 22% of the patients. A history of other autoimmune disease was present in 5 patients, out of which vitiligo and hypothyroidism was present in 2 patients each and 1 had morphea. Conclusion: PP is a persistent, chronic condition that can have significant psychosocial and emotional implications. For better understanding of PP, more population-based studies are required from different parts of the world.

Nail Changes in a Patient With Cancer

Nail Changes in a Patient With Cancer

2104P Prevention of taxane chemotherapy induced nail changes and peripheral neuropathy by application of extremity cooling: A prospective single center study with intrapatient comparison

2104P Prevention of taxane chemotherapy induced nail changes and peripheral neuropathy by application of extremity cooling: A prospective single center study with intrapatient comparison

A Compendium of Late-onset Darier with an Unusual Report

Abstract Darier disease is an autosomal dominant inherited skin disorder with complete penetrance and variable expressivity due to mutation in the ATP 2A2 gene. It usually develops from childhood and persists through adolescence. Late onset of this genodermatosis has been infrequently reported and found to have minimal findings compared to the classical cases. Classical disease presents with greasy keratotic yellowish-brown papules over the seborrheic areas with palmar pits and nail changes. We hereby report a case of late onset comedonal darier disease with extensive hypopigmented lesions, involvement of palms and nails which is rarely reported in this setting. A thorough review of literature was done and a compendium prepared of late onset darier and no other case report was found to have such extensive involvement as the case reported. It will be interesting to compare more such late onset cases to see if they have a common pattern which can suggest them to be a separate entity from the classical darier.