Healthy Nail Research Articles

Characterization of a biofilm formed by Fusarium oxysporum on the human nails.

Fusarium spp. has been considered as an onychomycosis agent, but little is known about the etiopathogenesis of fusarial onychomycosis; thus, the objective of this study was to characterize the fungal-nail interaction and the consequences of the nail infection process by Fusarium oxysporum using the human nail, in an exvivo model. The kinetic of biofilm production and infection by F. oxysporum using the nail as the only nutritional source were evaluated by scanning electron microscopy, number of culturable cells, metabolic activity, characterization of extracellular matrix, spectroscopy and histopathology analyses. After evaluating the biofilm kinetic over 7 days using different parameters and techniques, it was possible to characterize the Fusarium-nail interaction. This study is a part of a big project aiming to clarify the fusarial pathogenesis and contributes to proving F. oxysporum is able to adapt, grow, develop, and form a biofilm on healthy human nails, which are crucial steps for the invasion process.

Subclinical Onychomycosis in Apparently Healthy Adults

Introduction: Onychomycosis is a frequent chronic nail infection, with a worldwide prevalence of 5.5% making it the most common nail disease, and its incidence increases with age. Clinically, it causes discoloration and thickening of the nail plate and may be accompanied by onycholysis. However, little is known of the subclinical infection. Methods: We studied adult male and female outpatients auto-referred as healthy and that had healthy appearing toenails. Nail distal clippings were obtained from the right first toenail. This sample was stained with PAS and observed by an expert dermatopathologist searching for fungal structures. Results: A total of 32 samples were included: 8 from men (25%) and 24 from women (75%), with ages ranging from 27 to 66 years (mean age of 43 years). Twenty-four patients did not present any histopathological finding suggestive of infection (75%), while 7 patients had a single finding (spores or hyphae) (21.8%), and 1 patient had both findings (3.12%). Discussion/Conclusion: We found 4 patients with yeasts, 3 with hyphae, and 1 patient with a combined infection with both yeasts and hyphae (3.1%). These add up to 25% of the clinically apparent healthy nails. Our results show that we still have much to learn from the initial stages of onychomycosis and that our population probably has higher incidence of this nail disease, so we must be alert to subtle nail changes. As our participants signed an informed consent, we will contact those that resulted positive for follow up consultations.

Human Nails Permeation of an Antifungal Candidate Hydroalcoholic Extract from the Plant Sapindus saponaria L. Rich in Saponins.

We evaluated a hydroalcoholic extract of Sapindus saponaria L. pericarps (ETHOSS), as a candidate to a topical antifungal medicine for onychomycosis. ETHOSS was produced by extracting the crushed fruits in ethanol. The saponin contents were identified and characterized by electrospray ionization mass spectrometry. We measured the in vitro antifungal activity against three dermatophyte fungi, isolated from onychomycosis: Trichophyton rubrum, T. mentagrophytes, and T. interdigitale, using broth microdilution tests. The minimum fungicide concentration of ETHOSS ranged from 195.31 to 781.25 μg/mL. The cytotoxicity of the crude extract was tested on the HeLa cell line, and its ability to permeate into healthy human nails by photoacoustic spectroscopy and Fourier transformation infrared spectrometer (FTIR) spectroscopy by attenuated total reflection. Besides its strong antifungal activity, ETHOSS showed low cytotoxicity in human cells. It was able to permeate and reach the full thickness of the nail in one hour, without the aid of facilitating vehicles, and remained there for at least 24 h. These results suggest that ETHOSS has great potential for treating onychomycosis.

Median Nail Dystrophy

A 35-years-old housewife woman presented with fissuring and yellowish-green discoloration of the central and distal part of the left thumbnail to the Dermatology and Venereology clinic three months ago (Panel A). There was no history of trauma to the nail, no family history of the same condition, and no history of taking drugs. On examination, the left thumbnail had a longitudinal split that extended throughout the entire length of the nail plate, forming a V-shaped configuration. The color of the nail plate was changed mostly to yellowish-green. The nails of the other fingers were normal. Subungual debris and nail clipping were prepared for 10% KOH examination under the microscope but hyphae were not demonstrated. The culture was not available. Median nail dystrophy (MND) consists of longitudinal splitting in the midline of the nail. Thumb is mostly affected. It is of unknown origin, but trauma, familial cases, papilloma, and glomus tumor of the matrix and drugs like isotretinoin and ritonavir, have been reported. Due to color changes of the nail plate, we suspect that dermatophyte infection was the cause of MND. Accordingly, the patient was treated by two pulses of Itraconazole capsules, 200 mg two times per day for one week per month for two successive months. One month after treatment, few mm of a healthy nail appears at the proximal nail fold, (Panel B) and three months, about 1 cm of a normal nail with the disappearance of yellowish discoloration of the nail plate (Panel C). To our best knowledge, the fungal infection doesn't report in the literature as a cause of MND, so fungal infection might be the cause as in this case and further study on this issue is required. The patient now followed-up regularly for 6 months, the time required for the fingernail to replace itself.

Object-Oriented Diaspora Sensibilities, Disidentification, and Ghostly Performance

Object-Oriented Diaspora Sensibilities, Disidentification, and Ghostly Performance

Impregnation of healthy nail tissue with optical clearing agents for improved optical coherence tomography imaging.

The impact of optical tissue clearing on optical coherence tomography (OCT) for nail tissue imaging has not been investigated. This study seeks to compare the effects of an emollient and water on visualization of micromorphology and morphometric outcomes. Thirty-six healthy nail plates were processed with a fractional CO2 laser, imaged with OCT, and measured with calipers in duplicates. All samples were reassessed after 12-hour long sequential immersion in water and an emollient (Crodamol™ STS). OCT images were evaluated for thickness and scattering signal of the nail. Emollient-impregnation caused stronger scatter responses (P<.0001) and decreased nail thickness (MD 45μm, P<.0001) measured on OCT. Caliper-derived measurements were not affected by Crodamol™ (MD 11μm, P=.5538). Hydration increased nail thickness on OCT (MD 49μm, P<.0001) but reduced thickness measurements taken with calipers (MD 41μm, P<.0001). Emollient-impregnation improved visualization of onychocytes compared with dry (P=.0209) and hydrated samples (P<.0001), and reduced occurrence of refractive artifacts (P<.0001). The use of an emollient for OCT imaging can enhance nail tissue visualization without significant effects on caliper measurements. Hydration of nails, in contrast with emollient-impregnation, may lead to disagreement between caliper- and OCT-measured nail thickness and should be practiced cautiously.

1540 nm LIBS Investigation of Healthy and Pathological Human Nails

The paper discusses the possibility of using laser-induced breakdown spectroscopy (LIBS) as a method for the diagnosis of human nail onychomycosis. LIBS spectra obtained with excitation of plasma on the surface of healthy and onychomycotic nails by pulses of Q switched Yb, Er: Glass laser radiation with a wavelength of 1540 nm were compared for the first time. The spectrum of onychomycotic nail contained unique lines additional to characteristic spectral lines of healthy nails. These additional lines disappeared after 90 days of sample storage in air at room temperature 20 ± 3 °C.

Modern risk factors and features of treatment of onychomycosis

Onychomycosis is a widespread nail disease caused by dermatophytes, yeast and non‑dermatophytes. Risk factors for the development of onychomycosis can be various somatic conditions, for example diabetes, age, lifestyle features. Often onychomycosis occurs in athletes. According to some reports, 60.7 % of football players have this disease. The reason for the increased risk of developing onychomycosis in athletes is wearing unsuitable shoes, the frequent use of synthetic clothing and sweat‑preserving shoes, and injuries to the nail plates. Preference should be given to systemic therapy. Treatment can take up to 18 months, due to the slow regrowth of a healthy nail plate. Of the systemic drugs, itraconazole is widely used. The drug can be prescribed according to the scheme of pulse therapy, and positive dynamics is observed after 2 months of use.

MON-470 Biotin Masquerading as Subclinical Hyperthyroidism

Introduction: Thyroid conditions are among the most common endocrine disorders. Diagnosis is dependent on interpretation of laboratory tests. The challenge comes when the clinical picture is discordant with laboratory results.Case Report: Patient is a 53-year-old male with history of cardiac transplantation, type 2 diabetes mellitus, history of amiodarone-induced hyperthyroidism. He was noted to have labs indicative of hyperthyroidism, while taking amiodarone, in 2016-2017, which was treated with methimazole. He was then noted to have abnormal thyroid function tests with low TSH to 0.3 IU/L, normal T3 and normal T4 levels. Thyroid stimulating immunoglobulin had been checked multiple times, and was normal, which is inconsistent with Graves’ disease. Prior radioactive iodine uptake scan, while off amiodarone, was noted to be normal. He was also scheduled for thyroidectomy at another hospital, which was cancelled due to normalization of thyroid function tests. Consultation was received for suppressed TSH to 0.323 IU/L, without symptoms of hyperthyroidism. He had been taking biotin during this time, which he subsequently stopped taking. Repeat TSH following discontinuation of biotin, was within normal range, most recent TSH 2.48 IU/L, free T4 1.03 ng/dL, free T3 2.7 pg/mL.Discussion: Thyroid function tests are commonly ordered. Interpretation of these tests relies on the provider’s understanding of thyroid physiology in addition to interferences with medications and other conditions. High doses of biotin, which people take as supplements for multiple sclerosis, or metabolic disorders, or for healthy nails and hair, can cause thyroid function test abnormalities. Streptavidin and biotin are used in some immunoassay platforms to capture antigens (TSH, free T4) or antibodies. High levels of serum biotin can inhibit the formation of T4 antibody complex, which results in a falsely high free T4 result.Conclusion: Thyroid Function tests should be interpreted very cautiously, especially in the setting of discordant clinical findings. Prior to ordering these tests, should attempt to obtain a detailed history of medications including over-the-counter supplements, which are commonly not reported during medication history.

Emerging Optical Techniques for the Diagnosis of Onychomycosis

Onychomycosis is the most prevalent nail infection. Although it is not a life-threatening condition, it impacts the quality of life for many patients and often imposes a challenging diagnostic problem. The causative agents are dermatophytes, yeasts and non-dermatophytic moulds. Accurate and early diagnosis, including the identification of the causative species, is the key factor for rational therapy. Still, early diagnosis is not optimal as the current gold standard for the differentiation of the infectious agents is culture-based approaches. On the other hand, noninvasive optical technologies may enable differential diagnosis of nail pathologies including onychomycosis. When light penetrates and propagates along the nail tissue, it interacts in different ways with the components of either infected or healthy nail segments, providing a wealth of diagnostic information upon escaping the tissue. This review aims to assess alternative optical techniques for the rapid diagnosis of onychomycosis with a potential to monitor therapeutic response or even identify the fungal agent non-invasively and in real time in a clinical setting.

Nail health in women.

Healthy nails are functionally and cosmetically important to the daily work of women. The globally increasing market for nail cosmetics reflects the importance of the appearance of nails. This article details the composition of a healthy nail, diagnosis and treatment of nail disorders, use of nail cosmetics and their risks, the impact of the aging process on nails, and the relative risks to nail salon workers. Knowledge of these issues will prepare health care providers and patients to maintain healthy nails throughout their lives.

Assessing Quality of Reporting of Herbal Dermatology Trials from the Philippines using the hCONSORT Checklist: a Systematic Review

Background. Herbal medicine is a growing and innovative field in Philippine dermatology. There is a need to assess the quality of reporting of published herbal randomized controlled trials (RCTs) in dermatology since these will serve to guide rational development and use of medicinal plants in the Philippines.&#x0D; Objective. The study aimed to assess the quality of reporting of published herbal RCTs in dermatology from the Philippines based on the hCONSORT checklist.&#x0D; Methods. We searched MEDLINE, CENTRAL, HERDIN (from inception to 20 September 2018), and other secondary sources for published randomized controlled trials that used any herbal preparation as intervention for the treatment or prevention of a dermatologic disease or for maintenance of healthy skin, hair, or nails. We determined the percentage of reported items based from the hCONSORT checklist.&#x0D; Results. We included 41 trials, majority of which were on infections, infestations, and bites (66%). The three most common families of herbs used were Fabaceae/Leguminosae (22%) (Gliricidia sepium (Jacq.) Walp. [kakawati]; Senna alata (L.) Roxb. / Cassia alata (L.) [akapulko]); Arecaceae (12%) (Cocos nucifera L. [coconut]); and Myrtaceae (12%) (Eucalyptus sp [eucalyptus], Psidium guajava L.[guava], and Melaleuca alternifolia (Maiden &amp; Betche) Cheel [tea tree]). Most of the trials (27/41, 66%) were conducted in accredited dermatology training programs of the Philippine Dermatological Society. Only 11 trials (27%) were published in PubMED-indexed journals. More than half of articles were published after the CONSORT publication in 2006 (59%). The mean percentage of reported hCONSORT checklist items in included studies was 39.6% (SD 9.9), with only seven studies reporting more than 50% of the hCONSORT checklist items.&#x0D; Conclusion. Published herbal RCTs in dermatology from the Philippines are poorly reported based on the hCONSORT checklist. There is a need for dissemination of the hCONSORT to local researchers and journal editors to ensure thorough and quality reporting.

Nail Care for Healthcare Workers during COVID-19 Pandemic.

Nail Care for Healthcare Workers during COVID-19 Pandemic.

Development of a bioaction complex for the onychodystrophy treatment

This article is devoted to the problem of onychodystrophy treatment. The purpose of the study was to develop a bioactive complex for the external treatment of onychodystrophies. We conducted a prospective cohort study to determine the emotional status and life quality of patients with onychodystrophies. The optimal composition and technology for producing a complex for the onychodystrophy treatment was determined in vitro. We made a literature review using the PubMed, eLibrary, Scopus, Web of Science search engines. The structure of onychodystrophies in patients of the study group was determined, clinical forms such as leukonychia, paronychia, onycholysis were diagnosed the most frequently. A significant decrease in life quality was found in 86.8% of patients. A new method of onychodystrophies treatment using the innovative medical complex, which includes an emulsion for external use and camouflage nail polish is proposed. The developed bioactive complex for patients with onychodystrophy will contribute to the rapid regeneration of the changed nail plate due to improved microcirculation and trophic innervation. More viscous and thick consistency physiological colour nail polish which does not require polymerization, will create a visual effect of a healthy nail plate, which will improve the life quality of patients with onychodystrophy.

Translation elongation factor 1-alpha gene as a marker for diagnosing of candidal onychomycosis.

Background and Purpose:Culture-based identification methods have been the gold standard for the diagnosis of candidal onychomycosis. Molecular technologies, such as polymerase chain reaction (PCR) assays, can provide an alternative for the rapid detection of Candida species. The present study was conducted to investigate a pan-Candida PCR assay based on the translation elongation factor 1-alpha (TEF-1α) gene for the detection of the most prevalent pathogenic Candida species.Materials and Methods:For the purpose of the study, an optimized pan-Candida PCR primer pair was designed, and the target was amplified and sequenced. The analytical and clinical diagnostic performance of the designed primers was tested using 17 reference strains, 137 nail scrapings suspected of onychomycosis, and 10 healthy nail specimens.Results:The use of the universal pan-Candida primers designed on TEF-1α gene resulted in the successful amplification of a 270-base pair fragment in all Candida species tested, except for C. glabrata, and reacted neither with other fungi nor with E. coli. The sequence difference count matrix showed poor insertion/deletion differences (0-2 nt) among Candida species. Among 137 nail specimens, 35% (n=48), 30.7% (n=42), and 40.1% (n=55) of the samples were found to be positive by direct microscopy, culture, and pan-Candida PCR, respectively.Conclusion:Based on the findings, the PCR-based detection targeting the DNA TEF-1α gene is a rapid and simple procedure for the diagnosis of candidal onychomycosis directly from nail sample.

Optical coherence tomography of onychomycosis: proposed terminology and a suggestion of practical usage.

Onychomycosis is the most common cause of nail changes accounting for about half of all nail diseases. It is important to diagnose the fungal pathogen to prescribe adequate treatment, but as genus- and species-specific diagnostic tests can be time consuming and expensive, it is crucial to obtain representative tissue during nail scrapings. Optical coherence tomography (OCT) is a non-invasive imaging tool enabling real-time imaging of skin and tissue. Pilot studies using OCT have described morphological characteristics of onychomycosis, though diagnostic criteria of onychomycosis and other nail diseases are lacking. The aim of this study is to investigate the applicability of OCT to detect and localize fungal elements in nails with clinical signs of onychomycosis. OCT scans and nail scrapings were performed on all participants and only confirmed cases of onychomycosis were included in the data analysis. All scans were analyzed, and a set of morphological criteria based on known literature and deviations from healthy nail morphology were suggested. The suggested morphological features were: hyperreflective lines divided into sharply and diffusely demarcated; hyperreflective dots divided into singular and clustered patterns; irregular surface, divided into mild, moderate and severe degree; dark bands and disturbed architecture. The suggested OCT morphology is a refinement of previous studies, and though OCT cannot replace genus- or species-specific identification, it could be a useful assistance tool to increase diagnostic sensitivity of nail scrapings and laboratory tests as well as for monitoring treatment response.

Distal and lateral subungual onychomycosis of the finger nail in a neonate: a rare case

BackgroundOnychomycosis is extremely rare in neonates, infrequently reported in children and is considered to be exclusively a disease of adults.Case presentationWe, herein report a case of fingernail onychomycosis in a 28-day-old, healthy, male neonate. The child presented with a history of yellowish discoloration of the fingernail of the left hand for one week. The etiological agent was demonstrated both by microscopic examination and culture of nail clippings. The isolate grown on culture was identified as Candida albicans by phenotypic characteristics and by matrix-assisted laser desorption ionization-time of flight mass spectrometry. Antifungal sensitivity testing was performed by broth dilution method as per the Clinical & Laboratory Standards Institute guidelines. An oral swab culture of the child also yielded C. albicans with the same antibiogram as the nail isolate. The case was diagnosed as distal and lateral subungual candida onychomycosis of severity index score 22 (severe) and was treated with syrup fluconazole 6 mg/kg body weight/week and 5% amorolfine nail lacquer once/week for three months. After three months of therapy, the patient completely recovered with the development of a healthy nail plate.ConclusionsThe case is presented due to its rarity in neonates which, we suppose is the first case report of onychomycosis from Nepal in a 28-day-old neonate. Oral colonization with pathogenic yeasts and finger suckling could be risk factors for neonatal onychomycosis.

Fusarium oxysporum is an onychomycosis etiopathogenic agent.

To evaluate and characterize the etiopathogenesis of the fusarial onychomycosis in an ex vivo study through fragments of sterile human nail, without the addition of any nutritional source. The infection and invasion of Fusarium oxysporum in the nail were evaluated by scanning electron microscopy (SEM), CFU, matrix, histopathology and Fourier Transform Infrared Spectrometer coupled to an equipment with diamond accessory (FTIR-ATR). F. oxysporum infected and invaded across the nail, regardless of application face. However, the dorsal nail surface was the strongest barrier, while the ventral was more vulnerable to infection and invasion process. The fungal-nail interaction resulted in the formation of a dense biofilm. F. oxysporum infect and invade the healthy human nail, resulting in biofilm formation. Therefore, F. oxysporum is likely a primary onychomycosis agent.

Occupational Exposures among Nail Technicians in Toronto, Canada

Introduction: Nail salons have proliferated recently. In Toronto, Canada, many of these salons are small businesses that employ immigrant women. The Healthy Nail Salon Network has undertaken initia...

Evaluation of structural damage and pH of nail plates of hands after applying different methods of decorating.

The purpose of this study was to evaluate the effect of nail polish, gel polish hybrid, gel nail, and acrylic nail powder and the removal of these formulas on the nail plates properties, particularly the influence of different coatings on morphology and pH. The morphology and structure of nail plates were analyzed with use of scanning electron microscopy. The pH values of the nail plates of hands were measured using the system Courage & Khazaka. The analysis of morphology and structure of the surface of nail plates showed distinct changes caused by decorative coatings. The most common ones include fragility and splitting of the nails. The pH value measured in the whole group ranged from 5.21 to 7.00. The methods used to prepare nails for decoration and all methods of removing the applied preparations damage the healthy nail plates. The most common changes are brittleness and nail splitting. The nail polish remover causes less damage than acetone, and the use of a nail drill machine and nail file causes the greatest destruction of nail plates. The biggest effect on the pH change has the gel polish hybrid, gel nail, and acrylic nail powder, causing the pH value of nail plates to rise above 6.0, whereas after the application of the nail polish, the pH of the plates was on average 5.8 which is closest to the normal value, assumed as physiological.