Nail Matrix Research Articles

Therapeutic outcomes of one-minute application of sodium hydroxide versus phenol in the chemical cauterization of ingrown toenails.

Ingrown nails are frequently encountered in dermatology practice. The recurrence tendency of the disorder makes chemical cauterization essential during surgical procedures. In studies comparing nail matrix cauterization with sodium hydroxide (NaOH) versus phenol, phenol's application time was highly variable. To compare the therapeutic outcomes of matrix cauterization for a standard duration of one minute for NaOH versus phenol in stage II and III ingrown nails. The medical records of patients undergoing matrix cauterization with 10% NaOH or 88% phenol were evaluated. The primary outcome measure was the lack of recurrences on long-term follow-up. The secondary outcome measures were complete healing duration, patient-reported pain scores, and adverse effects related to the procedure. Enrolled in this study were 62 ingrown toenail sides treated with 10% NaOH and 56 ingrown toenail sides treated with 88% phenol. The mean follow-up duration was 25.17months. Recurrence was observed in four nail sides of the NaOH group (%6.45) and three nail sides of the phenol group (%5.35). The difference between the recurrence rates did not reach statistical significance. Patients treated with both methods were free of pain on the post-procedural tenth day. The visual analog scale pain scores and complete healing duration were similar between the two groups (p>0.05). In a large group with long-term follow-up results, the short-term and long-term post-operative treatment outcomes were similar between the one-minute applications of 10% NaOH versus 88% phenol groups.

Dermatoscopic and clinical features of congenital or congenital-type nail matrix nevi: A multicenter prospective cohort study by the International Dermoscopy Society

Congenital nail matrix nevi (NMN) are difficult to diagnose because they feature clinical characteristics suggestive of adult subungual melanoma. Nail matrix biopsy is difficult to perform, especially in children. To describe the initial clinical and dermatoscopic features of NMN appearing at birth (congenital) or after birth but before the age of 5 years (congenital-type). We conducted a prospective, international, and consecutive data collection in 102 hospitals or private medical offices across 30 countries from 2009 to 2019. There were 69 congenital and 161 congenital-type NMNs. Congenital and congenital-type NMN predominantly displayed an irregular pattern of longitudinal microlines (n=146, 64%), reminiscent of subungual melanoma in adults. The distal fibrillar ("brush-like") pattern, present in 63 patients (27.8%), was more frequently encountered in congenital NMN than in congenital-type NMN (P=.012). Moreover, congenital NMN more frequently displayed a periungual pigmentation (P=.029) and Hutchinson's sign (P=.027) than did congenital-type NMN. Lack of systematic biopsy-proven diagnosis and heterogeneity of clinical and dermatoscopic photographs. Congenital and congenital-type NMN showed worrisome clinical and dermatoscopic features similar to those observed in adulthood subungual melanoma. The distal fibrillar ("brush-like") pattern is a suggestive feature of congenital and congenital-type NMN.

Efficacy and safety of phenol-based partial matricectomy in treatment of onychocryptosis: A systematic review and meta-analysis.

Chemical matricectomy is an established treatment modality of onychocryptosis. In this meta-analysis, we studied the efficacy and safety profile of phenol-based matricectomy. We performed an electronic database search of PubMed, EMBASE and grey literature using the search terms '(onychocryptosis OR ingrown toe nail) AND (phenol OR chemical matricectomy)' from inception till 31-12-2020, for controlled clinical trials with phenol in one of the treatment arms and at least 10 participants in each arm. From the initial search of 335, eighteen articles were included in the final analysis. There were a total of 1655 patients, of which 856 received phenol as an intervention modality. We found that nail matrix phenolisation was associated with a 49 fewer number of recurrences per thousand patients compared with other modalities (OR: 0.28-0.57, CI 95%). It also had a reduction in 175 cases of discharge or haemorrhage per thousand patients compared with other modalities (OR: 0.25, 95% CI: 0.14-0.45). However, we found that TCA- and NaOH-based matricectomies fared better compared with phenol in incidence of postoperative discharge and haemorrhage. Patients also experienced less pain (257 fewer number per 1000, OR: 0.52, 95% CI: 0.43-0.63). Nearly, half of the included studies had some concerns about the risk of bias. As of now, phenol matricectomy combines a low recurrence rate with favourable adverse effect profile and is the preferred modality for matricectomy in grade II and III onychocryptosis.

Onychomadesis- A Late Manifestation of Hand, Foot and Mouth Disease: A Case Series

Hand Foot Mouth Disease (HFMD) is one of the most common viral illness that is characterised by fever below 38.3°C, painful oral lesions on the tongue and buccal mucosa and macular, maculopapular or vesicular skin lesions on the soles and palms. Many viruses are implicated in HFMD, such as Coxsackievirus A5, A6, A7, A9, A10, A16 (most common), B1, B2, B3, B5, Echoviruses E3, E4, E9 and Enterovirus 71. The illness is usually mild and self-limiting. HFMD due to Enterovirus 71, is associated with a severe illness complicated by aseptic meningitis, acute flaccid paralysis, pulmonary oedema and heart failure. Onychomadesis is a very rare complication of HFMD, typically occurring three to eight week of onset of illness. This is characterised by the detachment of the nail plate from the proximal nail fold by a full thickness sulcus. It is postulated that viral infection causes inflammation around the nail matrix either due to direct effect or due to the deposition of immune complexes secondary to distal thromboembolism. Here, authors report six children of different age groups who were affected with onychomadesis during an outbreak of HFMD in the month of February to May 2022 in Chennai, Tamil Nadu, India. All these six children developed onychomadesis following HFMD, after a couple of weeks. Both upper and lower limb nails were involved. Other causes of onychomadesis like chronic illness, nutritional deficiencies, drug ingestion, periungual dermatitis, trauma were ruled out. Children were given supportive care and were followed-up. The changes in nails spontaneously regressed after a couple of weeks.

Nail Lichen Planus Severity Index (NALSI): A Novel Severity Score for Nail Lichen Planus.

Clinical challenge Rigorous data on treatment options in nail lichen planus (LP) is lacking and even the existing studies do not offer robust scientific evidence.[1] This is primarily due to lack of a comprehensive severity scoring tool for enabling consistent, comparative and thorough evaluation. It is unlike nail psoriasis, where nail psoriasis severity index (NAPSI) is a commonly used objective, validated tool for assessing nail disease severity and response to treatment.[2] We propose a nail severity score for nail LP which takes into account the peculiarities of this disease e.g., only few features being responsive to therapy; presence of scarring and irreversible changes; and extensive involvement of the nail unit including nail folds. Solution The nail lichen planus severity index (NALSI) is to be scored in four quadrants per nail, like NAPSI where two imaginary lines, perpendicular to each other are drawn. We score nail matrix, nail bed, and nail fold features per quadrant. A score of 0 or 1 is assigned based on the absence or presence of nail matrix disease features [longitudinal ridging/fissuring, longitudinal melanonychia, thinning/thickening of the nail plate, trachyonychia, red/mottled lunula]; nail bed features [diffuse/longitudinal erythema, discoloration (yellow, black, or dyschromia), onycholysis and/or subungual hyperkeratosis, bullous/erosive lesions]; or nail fold features [pigmentation, swelling, LP lesions, and ragged cuticle] [Figure 1; Table 1]. Thus, a maximum score of 3 per quadrant and 12 per nail is possible. In addition, irreversible changes [dorsal pterygium, atrophy, anonychia, or disappearing nail bed] are recorded separately with the English alphabet ‘I’ (for irreversible) being added to the final score [Figure 2]. Thus, the worst possible score would be 12-I per nail and nails without the “I” score could be chosen for comparing treatment efficacy. NALSI can be an objective and simple scoring system estimating the extent of involvement and location of diseases within the nail unit, and is subject to change with both the progression of disease or its resolution with or without treatment.Figure 1: Clinical picture of nail lichen planus showing the Nail Lichen planus Severity Index (NALSI) scoring. Each small box in each of the four quadrants is scored as 1 (if any one of the nail matrix/nail bed/nail fold feature is present) or 0 (if no nail matrix/nail bed/nail fold feature is present). The score for this nail is 10Table 1: Parameters to be Recorded in Nail Lichen Planus Severity Index (NALSI) ScoringFigure 2: Clinical picture of nail lichen planus showing the Nail Lichen planus Severity Index (NALSI) scoring. Each small box in each of the four quadrants is scored as 1 (if any one of the nail matrix/nail bed/nail fold feature is present) or 0 (if no nail matrix/nail bed/nail fold feature is present). The score for this nail is 8-IFinancial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Intravascular papillary endothelial hyperplasia (Masson’s tumor) in hallux nail matrix: a case report

Intravascular endothelial hyperplasia, or Masson’s tumor, is a benign vascular lesion with no well-defined pathogenesis. The response to vascular damage is believed to be one of the main reasons for its development. It is a typically painless injury, solitary, with slow evolution. This report aims to describe a case of Masson’s tumor in an unusual place, the hallux nail matrix, and discuss its main characteristics.

Efficacy of Fluocinonide\Bifonazole Cream for the Treatment of Trachyonychia: A Retrospective Case Series.

Trachyonychia is a benign nail condition, most commonly seen in children. Trachyonychia manifests as excessive longitudinal ridging, nail roughness, and nail brittleness. Treatment is sought mainly for esthetic reasons as well as functional reasons. A number of therapeutic approaches exist, mainly based on case reports or small non-comparative case series. To report treatment outcome among patients with trachyonychia. A retrospective case-series study was conducted among patients who were treated trachyonychia between years 2017 and 2020. Patients were prescribed fluocinonide 0.05% with bifonazole 1% cream, applied with or without occlusion, and methylprednisolone 1-2 mg/nail, injected into the involved nail matrix, or oral cyclosporine 3 mg/kg. Complete response (over 90% improvement) and partial response (over 50% improvement) were assessed. A total of 43 patients with trachyonychia were included [mean age 10.0 years (±5.7), 69.8% males, mean disease duration 4.7 years (±3.0)]. In 90.7% of the cases, topical fluocinonide\bifonazole cream was prescribed. Under-occlusion topical application was found to be highly effective, achieving complete response in 35.3% and partial response in an additional 52.9% of the patients. Occluded application was also found to be significantly more effective than non-occluded application. Treatment efficacy was not affected by the severity of nail roughness, trachyonychia morphology, or whether trachyonychia was idiopathic or coexisted with other dermatological conditions. Occluded application of fluocinonide plus bifonazole cream is efficient for the treatment of trachyonychia and should be considered a first line of treatment.

POSB157 Demographics and Treatment Patterns of Onychomycosis Patients Claiming Efinaconazole: A Canadian Retrospective Claims Analysis Stratified By Diabetes Status

Onychomycosis is a fungal infection that begins in the nail bed and progresses to the nail plate, and with time may involve the nail matrix. The prevalence of onychomycosis is higher among patients with diabetes, a special population for which foot complications are a major cause of morbidity and mortality. Currently there are four onychomycosis treatments available in Canada (ciclopirox, efinaconazole, itraconazole and terbinafine). This research aims to compare the utilization of topical efinaconazole for onychomycosis between diabetic and non-diabetic patients in Canada.

Asimetrična melanonihija prouzrokovana hemioterapijom

Introduction: Chemotherapy may cause various nail damages, including chromonychia, melanonychia, onycholisis, and onychomadesis. Melanonychia is characterized by melanin-derived brown-to-black nail pigmentation. It may occur as a result of nail matrix melanocytic activation or melanocytic hyperplasia, and nail invasion by melanin-producing pathogens. Case report: We present a case of a patient who developed an extremely rare event of asymmetric melanonychia during systemic treatment of non-Hodgkin lymphoma. The melanonychia developed in dose-dependent manner after 500 mg of doxorubicin. One of the most incriminating agents for melanonychia development are doxorubicin and to a less extent cyclophosphamide. Our patient received both drugs as combined chemotherapy. After treatment completion, the phenomenon disappeared. An extremely unexpected event was skin melanoma occurrence. Conclusion: It has not been clarified yet whether this event was causally related to previous nail-related melanocyte activation or it was just a coincidence.

Onychomadesis following frostbite: Hitherto unknown

Onychomadesis is an anomaly of nails characterized by shedding of nail plates due to temporary arrest in the activity of the nail matrix. Systemic or local factors ranging from acute febrile illnesses, auto-immune diseases, drugs, chemotherapy, trauma, etc., have been known to cause onychomadesis. We report a unique case of onychomadesis following frostbite in a serving soldier posted at high altitude and extreme cold climate area.

Nail Changes With Chemotherapeutic Agents and Targeted Therapies.

Patients on Cancer chemotherapeutic agents often develop nail changes most of which are only cosmetic concern and disappear on drug withdrawal. But some nail changes can be painful and disabling thereby affecting quality of life substantially. Different components of the nail unit include the nail matrix, nail bed, nail plate, the hyponychium, lunula, the proximal and lateral nail folds. In this article we review the nail changes induced by chemotherapeutics and targeted anticancer drugs, preventive measures and treatment options available.

The hypervascularization of the nail matrix and nail bed as a predictor of nail psoriasis.

The hypervascularization of the nail matrix and nail bed as a predictor of nail psoriasis.

Overall Prevalence and Prevalence Compared among Psoriasis Treatments of Onychomycosis in Patients with Nail Psoriasis and Fungal Involvement.

Background Whether nail psoriasis can increase the risk of onychomycosis is still being debated, and data relating to the prevalence of onychomycosis among psoriasis patients receiving different treatments is limited. Objectives To investigate the overall prevalence and prevalence compared among psoriasis treatments of onychomycosis in patients with nail psoriasis and fungal involvement. Methods A prospective study of three groups of nail psoriasis being treated with only topical medication, methotrexate, or biologics (25 patients per group, 150 nails) was conducted at Siriraj Hospital (Bangkok, Thailand) during November 2018 to September 2020. Demographic data, psoriasis severity, and nail psoriasis severity were recorded. The nail most severely affected with psoriasis on each hand was selected for mycological testing. Potassium hydroxide, periodic acid-Schiff stain, and fungal culture were performed. Results The prevalence of onychomycosis in nail psoriasis was 35.3%. Among the treatment groups, the prevalence of onychomycosis was significantly higher in the methotrexate group than in the topical treatment and biologic treatment groups (p = 0.014). Candida spp. was the main causative organism, followed by Trichophyton rubrum. Thumb was most commonly affected (59.3%). The most common abnormality of the nail matrix and the nail bed was pitted nail (71.3%) and onycholysis (91.3%), respectively. Multivariate analysis revealed diabetes, wet-work exposure, and methotrexate treatment to be predictors of onychomycosis. Conclusions Several factors, including psoriasis treatment, were shown to increase the risk of onychomycosis in nail psoriasis. Further research is needed to determine whether biologic agents, especially interleukin-17 inhibitors, can increase risk of onychomycosis and Candida infection/colonization of the nails.

A Child with Severe COVID-19 Complicated with Onychomadesis

The most common symptoms of COVID-19 infection are fever and cough; but may cause respiratory, enteric, hepatic, nephrotic, neurological, and skin involvement. Onychomadesis is the proximal separation of the nail plate from the nail matrix due to a temporary cessation of nail growth. Numerous studies about cutaneous manifestations of COVID-19 were reported; however findings of nails were limited. This paper reported a case of onychomadesis which appeared on the nails after a severe COVID-19 infection (MIS-C).

Functional Surgery for Subungual Melanoma: Surgical Tips Based on Histological Analysis of 21 Cadavers.

Amputation has been the standard treatment for subungual melanoma. Although there is growing attention toward a more conservative functional surgery, specific operative techniques are not yet available. We aimed to provide objective measurements for use in functional surgery by analyzing the anatomy of the nail apparatus obtained from 21 cadavers. Nailbed thickness was histologically measured in each subunit, and skin surface anatomy was evaluated to determine the proximal resection margin. Immunohistochemical staining was performed to analyze microvessel distribution according to the nail subunit. The nailbed thickness was the thinnest at the most proximal point of the nail matrix (thumbs, 1.10 ± 0.42 mm; big toes, 1.15 ± 0.37 mm) and the thickest at the hyponychium (thumbs, 2.86 ± 0.82 mm; big toes, 2.72 ± 0.84 mm). The distance from the eponychium to the skin surface closest to the bony cortex of extensor tendon insertion was 6.92 ± 5.13 mm in thumbs and 5.14 ± 1.59 mm in big toes. The median microvessel density was the highest at the hyponychium (25.74 vessels/mm2) and lowest at the germinal matrix (16.26 vessels/mm2) (p < .05). This histological study offers practical tips, including those to help decide the proximal and deep resection margins, in functional surgery.

Distribution of cellular remnants of melanocytes in the nail plate: Clue to the diagnosis of subungual melanoma.

Previous studies reported that cellular remnants in the nail plate could be a diagnostic clue for subungual melanoma (SUM). We sought to characterize the histopathologic features of cellular remnants in the nail plates of SUM patients. A retrospective case-control study was conducted in a single tertiary center from 2012 to 2019. Twenty-three patients with pathologically diagnosed SUM and eight nail matrix nevi (NMN) patients were recruited. The analysis of the nail plate specimens focused on large cellular remnants of melanocytes (LCRMs). Longitudinal linear density and vertical distribution pattern of the LCRMs were scrutinized for possible features distinguishing SUM from NMN. The median linear density of the LCRMs was significantly higher in the SUM samples than in the NMN samples. LCRMs in the SUM samples were more dorsally distributed than those in the NMN samples. In invasive SUM, LCRMs were more likely to be found in the dorsal part of the nail plate compared to SUM in situ. Nail plate specimens should not be overlooked in the histopathological examination of melanonychia. High-density LCRMs with more dispersion to the dorsal side might be suggestive of SUM.

Efficacy of combined fractional carbon dioxide laser and topical tazarotene in nail psoriasis treatment: A randomized intrapatient left-to-right study.

Treatment of nail psoriasis is disappointing; due to poor penetrability of topical therapies and variable efficacy of systemic therapies. Fractional carbon dioxide laser (FCL) may enhance penetration of topical therapy for nail psoriasis. To evaluate the efficacy and safety of FCL plus topical tazarotene versus tazarotene monotherapy in the treatment of nail psoriasis. Twenty-seven patients with bilateral fingernail psoriasis randomly received 3sessions of FCL at four-week interval plus once-daily tazarotene 0.1% gel for one hand, and once-daily tazarotene 0.1% gel only for 3months on the other hand. The primary outcome was modified Nail Psoriasis Severity Index (mNAPSI) at 3 and 6months compared to baseline, and the secondary outcomes included dermoscopic examination and patient global assessment. Adverse events were reported. The total, nail matrix, and nail bed mNAPSI scores were significantly improved at 3 and 6months by both regimens, but they decreased more after FCL/tazarotene combination (p = 0.001, p = 0.023, and p = 0.001, respectively). Combination therapy showed faster improvement of nail matrix signs and greater efficacy for nail bed signs. The dermoscopic features of the nail plate were the most responsive after both treatments. The combined therapy was more effective in improving the dermoscopic nail bed features. Patient's global assessment scores were significantly higher after the combined therapy. Both treatments were well tolerated. Fractional CO2 laser is an effective and well-tolerated treatment for nail psoriasis; it improves the outcomes of topical tazarotene especially in nail bed lesions.

INCARNATION OF NAIL PLATES IN PATIENTS WITH DESTRUCTIVE ONYCHOMYCOSIS ON THE BACKGROUND OF COMORBIDAL PATHOLOGY: SOME FEATURES OF THE CLINICAL COURSE (MANIFESTATIONS), AUTHOR'S VIEWS

The aim of the scientific work was to analyze the features of the clinical course and improve the results of complex treatment of nail plate incarnations in patients with destructive onychomycosis on the background of comorbid pathology. In the article, based on the analysis of clinical and pathomorphological material – complicated nail dystrophies and nail destructions (onychia) in 1838 patients aged 5-92 years: 1007 men and 831 women, clinical manifestations, pathomorphological changes and principles of individualized complex treatment were studied. Clinical ENMK classification of nail plate ingrowths and new methods of mobilization and removal of incarnated nail plates was proposed (through onycholyzed structures) in the presence of onychomycosis and other comorbid pathology. It has been stated that the clinical ENMK classification of nail plate ingrowths provides an opportunity for an individual choice of complex treatment. A method of access to the ingrown edge of the nail plate has been introduced – block-like eponychectomy, the effectiveness of which is determined by the total elimination of the altered eponychium from the ingrowth side, the creation of an opportunity for adequate resection, clear visualization of the growth zone and the matrix for performing the marginal nail matrix removal, the possibility of expanding access for revision of the subungual structures, including the distal phalanx. Treatment can be carried out an outpatient clinic, with minimal trauma to the patient. We recommend using effective three-component methods of surgical treatment of nail incarnation: marginal nail resection or removal of the nail plate, supplemented by excision of pathologically altered eponycheal tissues and marginal removal of the altered nail matrix in the ingrowth area. Keywords: ingrown nail, destructive onychomycosis, comorbid pathology, complex treatment, removal (resection) of affected nail plates.

The Membrane-Like Structure From Extensor Tendon to the Nail in the Distal End of Digits: An Anatomical Study of Structure, Function, and Utility.

The nail structures of 6 cadavers were investigated in each of the 10 digits of the hand. In the histological study, the thickness, length, and location of the SEP were measured in each digit of 3 cadavers. In the other 3 cadavers, the moving distance of the SEP was measured macroscopically with the distal interphalangeal joint in flexion at 0 to 60 degrees for confirmation of the function. This moving distance could be considered as an indicator of the SEP straining the surrounding (retaining) structure and improving the stability of the nail in pinches. The SEP was recognized in all the digits. The average length of the SEPs was 2.38 ± 0.11 mm (mean ± SE). The average thickness of the SEPs was 0.35 ± 0.02 mm. The nail matrix and its feeding artery were found beneath the SEP in all digits. The average moving distance of the SEP was 1.38 ± 0.06 mm. This moving distance could be considered sufficiently large to support the role of SEP in the pinches compared with the excursion of the extensor tendon at the DIP joint in a previous report. The SEP has been shown to play an essential role in fingertip stabilization in pinches. It can serve as an anatomical marker to avoid iatrogenic damage to the nail matrix in surgical approaches.

Comparison between the Efficacy of Intense Pulsed Light (IPL) versus Photodynamic Therapy with Methylene Blue in the Treatment of Nail Psoriasis

Abstract Background Nail psoriasis is often refractory to traditional treatments, and patients with nail psoriasis usually demand a therapeutic option. Both photodynamic therapy (PDT) and intense pulsed light have been evaluated in nail psoriasis. Objective The objective of this study was to evaluate and compare the efficacy of IPL and methylene blue assisted photodynamic therapy in the treatment of nail psoriasis. Patients and Methods Twenty patients (15 males and 5 females) with mild to moderate psoriasis with nail affection were included in this study. Their age ranged from 24 to 71 years. The PDT used IPL as the light source and methylene blue as photosensitizer. Sessions were applied every 2 weeks for a maximum of 3 months, treating one hand with IPL and the other with PDT. The nails treated were evaluated at baseline, after 2 sessions, after 6 sessions and 3 months after the last treatment session according to the Nail Psoriasis Severity Index (NAPSI) score. Follow-up was performed after 2 sessions, after 6 sessions, and 3 months after the last treatment session. Results A decrease in NAPSI score was observed with both treatments and in both nail bed and nail matrix involvement. No statistically significant difference was found between PDT and IPL as regarding total NPASI score. However, total NAPSI score improved by 61% in MB-PDT group versus 47% in IPL group. Patient follow-up revealed the appearance of new lesions in 3 patients in the group of IPL, and in 1 patient in the MB-PDT after 6 months. Conclusion Intense pulsed light and methylene blue assisted PDT are a promising effective modalities of treatment of nail psoriasis, which are easy to use, safe, and nearly pain-free. This was confirmed by the improvement NAPSI score.