Nail Changes Research Articles

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, intra-individual 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, intra-individual study.

Sulfasalazine-Induced Nail Changes: A Unique Clinical Observation

Sulfasalazine-Induced Nail Changes: A Unique Clinical Observation

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.

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.

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.

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.

Prevention of taxane chemotherapy-induced nail changes and peripheral neuropathy by application of extremity cooling: a prospective single-centre study with intrapatient comparison

PurposeCommon side effects of taxane chemotherapy are nail toxicity and peripheral neuropathy (CIPN) causing severe impact on the quality of life. Different methods of cryotherapy to prevent these side effects have been tested. We investigated the use of machine-controlled cooling of hands and feet to reduce nail toxicity and CIPN in patients receiving taxane chemotherapy.MethodsPatients receiving Docetaxel (planned dose ≥\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\ge$$\\end{document} 300 mg/m2) or Paclitaxel (planned dose ≥\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\ge$$\\end{document} 720 mg/m2-\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$-$$\\end{document}) in the adjuvant or palliative setting of different cancers were included. The dominant hand and foot were cooled to approximately 10 °C using the Hilotherapy machine. The contralateral hand and foot were used as intrapatient comparison. The primary endpoint was the occurrence of any CIPN due to paclitaxel or nail toxicity due to Docetaxel. Both the intention to treat population (ITT) and the per protocol population (PPP) were analyzed.ResultsA total of 69 patients, 21 treated with Docetaxel and 48 with Paclitaxel, were included at our centre between 08/2020 and 08/2022. Nail toxicity due to Docetaxel was overall not significantly improved by cooling in the ITT or PPP but a significant benefit across visits was found for the ITT. CIPN due to Paclitaxel was numerically better in the ITT and significantly better in the PPP. A significant benefit of cooling on CIPN occurrence across visits was found for the ITT and the PPP. Cooling was very well tolerated.ConclusionCooling of hands and feet has a clinically meaningful impact on reducing occurrence of CIPN and nail toxicity on treatment with taxanes. Effects are more significant over time and are dose dependent.Trial registration number.2020–00381.Date of registration.24th February 2020.

A nonsense variant in KRT31 is associated with autosomal-dominant monilethrix.

Monilethrix is a rare hereditary hair disorder that is characterised by a beaded hair shaft structure and increased hair fragility. Patients may also present with keratosis pilaris and nail changes. Research has identified three genes for autosomal-dominant monilethrix (KRT81, KRT83, and KRT86), and one gene for the autosomal-recessive form (DSG4). To investigate the genetic basis of autosomal-dominant monilethrix in families with no pathogenic variants in any of the known monilethrix genes, and to understand the mechanistic basis of variant pathogenicity using a cellular model. Nine affected individuals from four unrelated families were included in this study. A clinical diagnosis of monilethrix was assigned based on clinical examination and/or trichoscopy. Exome sequencing (ES) was performed in six individuals to identify pathogenic variants, and Sanger sequencing was used for co-segregation and haplotype analyses. Cell culture experiments (immunoblotting, immunofluorescence, and reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR) analyses) were used to confirm variant pathogenicity, to determine expression and subcellular localisation of proteins, and to identify a possible nonsense-mediated mRNA decay. In six affected individuals with clinically suggested monilethrix, ES led to the identification of the nonsense variant c.1081G>T; p.(Glu361*) in KRT31, which was subsequently identified in other affected members of these families by Sanger sequencing. This variant led to the abolition of both the last three amino acids of the 2B subdomain and the complete C-terminal tail domain of keratin 31. Immunoblotting demonstrated that when co-expressed with its binding partner keratin 85, the truncated keratin 31 was still expressed, albeit less abundantly than the wild type protein. Immunofluorescence revealed that p.(Glu361*) keratin 31 had an altered cytoskeletal localisation and formed vesicular-like structures in the cell cytoplasm near the cell membrane. RT-qPCR analysis did not generate evidence for a nonsense mediated decay of the mutant transcript. This study is the first to identify pathogenic variants in KRT31 as a cause of autosomal-dominant monilethrix. This highlights the importance of hair keratin proteins in hair biology, and will increase the molecular diagnostic yield for rare ectodermal phenotypes of hair and nail tissues.

Clinical and Onychoscopic Nail Findings in Preschool Children: An Observational Study

Abstract Background: Nail examination plays a critical role in dermatologic conditions. Children with nail changes involve fewer physician consultations. Nail signs in early childhood can indicate the presence of a syndrome or underlying systemic disorder. Aim: The aim of the study was to investigate the frequency of nail findings in patients under 5 years of age. Subjects and Methods: The study involved 368 pediatric patients under the age of 5 years. It was an observational study conducted in dermatology, obstetrics and gynecology, and pediatric departments. A Dermlite handyscope FFH2 (×10 zoom) was used to magnify visible nail changes during a comprehensive nail examination. Results: Out of 368 cases, 213 were male and 155 were female. The average age of the patients was 22.74 months (range: 0–60). Nail findings were observed in 130 (35.3%) patients. In the study, single nail changes were observed in 123 (33.42%), whereas multiple nail changes were seen in 5 (1.35%) patients. The most common clinical nail finding was white striations in 60 (16.3%) cases, followed by punctate leukonychia in 21 (5.7%), onychoschizia in 13 (3.5%), pseudohypertrophy of the hallux in 12 (3.3%), koilonychia in 7 (1.9%), Beau’s lines in 3 (0.8%), and subungual hematoma in 3 (0.8%) cases. Median canaliform nail dystrophy, Muehrcke’s lines, onychophagia, and pitting were found in only one case each (0.3%). Conclusion: Physiological nail findings were more prevalent than pathological ones. The use of an onychoscope facilitated a more precise identification of nail changes by highlighting their features.

Nail fold capillaroscopy in leprosy: Unveiling the microvascular changes

BackgroundLeprosy, a chronic infectious disease, is associated with various nail changes. Its etiopathogenesis is multifaceted, with microvascular damage being crucial. Nail fold capillaroscopy (NFC) emerges as a novel tool for detecting early vascular deficits in leprosy. The study aimed to assess and provide a complete clinical characterization of NFC changes in leprosy patients. MethodsIt is an observational cross-sectional study, done over a period of 1.5 year (January 2021 to august 2022) in a tertiary care hospital, encompassing 60 patients diagnosed with leprosy (18–60 years). After obtaining informed consent; detailed history, complete cutaneous and neurological examinations were conducted. All fingernails and toenails were examined for clinical changes. Subsequently, onychoscopy was performed using USB type of video-dermatoscope (Model AM7115MZT Dino-lite), a non-invasive tool. This was followed by NFC which was done for all fingernails and images were recorded by single operator, which were then assessed for quantitative and qualitive changes and statistical analysis was conducted using SPSS v20, with mean capillary density compared using Student's t-test, morphological change frequencies assessed by proportions, and group comparisons made using Chi-square or Fischer exact tests, with a significance threshold of p < 0.05. ResultsAmong the 60 patients, 39 were in the lepromatous group, which included both borderline lepromatous (BL) and lepromatous leprosy (LL) patients, and 17 were in the tuberculoid group, which included borderline tuberculoid (BT) leprosy patients; 23.3 % had Type 1 reactions, and 18.3 % had Type 2 reactions. Nail fold capillaroscopy (NFC) showed microvasculature changes in 93.3 % of patients. The average capillary density was 6.8 ± 1.5 capillaries per mm, with the lepromatous group having a lower density (6.5 ± 1.09) compared to the tuberculoid group (7.0 ± 0.86). The most common NFC changes in the tuberculoid group were tortuous capillaries (70 %), capillary dropouts, and dilated capillaries (both 64.7 %). In the lepromatous group, capillary dropouts (82 %) were most frequent, followed by tortuous (69 %), receding (69 %), and dilated capillaries (66 %). A dilated and prominent subpapillary plexus was more common in the lepromatous group (35 %, p = 0.04). Patients with trophic changes in the lepromatous group had more capillary dropouts and bizarre capillaries. Capillary dropouts, dilated capillaries, and visible subpapillary venous plexus were more prevalent in patients with Type 2 reactions. ConclusionNFC changes are prevalent in both tuberculoid and lepromatous leprosy, which may be an indicator of peripheral vascular compromise and trophic changes, especially in lepromatous leprosy. NFC can be an auxiliary tool for detecting microvascular abnormalities in leprosy patients.