Nail Ridging Research Articles

The Zitelli bilobed flap for soft tissue coverage after mucoid cyst resection: a retrospective cohort study

Purpose: Digital mucoid cysts are frequently found at the distal interphalangeal (DIP) joint in patients with degenerative osteoarthritis. In complicated cases, surgical treatment with mucoid cyst resection is considered, and soft tissue is covered with one of various local flap techniques. Among these, bilobed flaps are reliable and aesthetically favorable, with primary healing of the donor site. In this study, we investigated a case series of bilobed flaps for digital mucoid cysts.Methods: We retrospectively reviewed our electronic medical records and found 26 digital mucoid cysts treated with bilobed flaps at our facility between July 2022 and February 2024. We extracted data from the records of these patients on sex; age; time to surgery; clinical findings including nail ridging, the presence of osteophytes, cyst size and location, and additional procedures (arthrodesis); and follow-up data including the occurrence of complications, such as delayed wound healing, infection, stiffness, and recurrence.Results: Among the 26 patients in our sample, 19 were female and seven were male. The average age was 62.2 years, and the average time to surgery was 10.8 months. Preoperatively, the average cyst measured 6.9×8.3 mm. Nail ridging was found in 19 patients (73.1%) and osteophytes in 22 patients (84.6%). The most commonly affected digit was the middle finger, which accounted for 10 cases (38.5%). All the flaps totally survived, without major complications.Conclusion: Based on our series, a bilobed flap for soft tissue coverage after mucoid cyst excision can achieve high-quality surgical results.

Nail ridging in rheumatoid arthritis patients and relation to disease activity: An integrated rheumatology-dermatology multi-centre study

Aim of the workTo evaluate the frequency of nail ridging (NR) in patients with rheumatoid arthritis (RA) and to study its relation to disease activity. Patients and methods230 RA patients and 97 matched controls from Helwan, Ain Shams and Mansoura university hospitals were studied. Disease activity score (DAS28) was assessed. NR has been searched for in all patients. The number of affected fingers was recorded. NR was determined by a magnifying lens, seen by naked eye or seen and felt. Dermoscopic photography of the NR using Dermalite DL4 3Gen dermatoscope has been recorded. ResultsThe median age of patients was 49 years (42–58 years); they were 221 females and 19 males (F:M 11.1:1) with a disease duration 9 years (5–11 years). Their DAS28 was 3.6 (2.9–4.6). NR was significantly increased in RA cases vs. control; 73% vs 20%; p < 0.001. In patients, NR was detected by a magnifying lens in 32.6%, seen in 27% and seen and felt in 13.5%. Joint deformities were significantly higher in those with NR. DAS28 was a significant independent predictor of NR; for every one-point increase in DAS28, there was a 153 times higher odds to exhibit NR at a sensitivity of 93.5%, specificity 80.3% and at a diagnostic accuracy of 90%. ConclusionNR is a frequent finding in RA. An integrated rheumatological- dermatological clinical evaluation may be helpful and further studies are required to prove the importance of this sign for follow up of RA patients.

A comparative study of Fractional co2 laser combined with topical methotrexate versus Fractional co2 laser combined with topical [Calcipotriol + Betamethasone] in the treatment of nail psoriasis

Abstract Background Nail psoriasis is a distressing clinical condition as it is known that psoriasis on visible areas of the skin, such as the face, hands and nails, may have a substantial negative impact on physical, psychological, and social dimensions of quality of life. The additional negative consequences of nail involvement in psoriasis are pain, inability to grasp small objects, tie shoe laces or button clothes, and cause an altered sense of fine touch. Objective To evaluate and compare the efficacy, safety and side effects of co2 laser combined with topical methotrexate in one side and topical (calcipotriol +betamethasone) in the other side of the patient for the treatment of nail psoriasis. Patients and Methods This comparative pilot study included 20 patients with nail psoriasis. They were recruited from the dermatology out-patient clinic of Ain–Shams University Hospitals, during the period from March 2019 till October 2019. The study was approved by Research Ethical Committee of Ain Shams University (FMASU M S 71/2019) and fulfilled all the ethical aspects required for a human research. Results Our study revealed that both medications showed marked statistical and clinical improvement of the nail condition in a period of 2 months when applied topically after nail exposure to fractional co2 laser which facilitated the delivery of both medications through the nail plates to the site of the psoriasis inflammation in therapeutic concentrations by creating pores through the nails. There was no statistical or clinical difference between both medications regarding the improvement of the NAPSI scores or the level of patient satisfaction. However, there were some nail symptoms that didn’t show any improvement as (sub-ungual hyperkeratosis and nail ridging). Conclusion Our treatment protocol’s side effects based mainly on the action of fractional co2 laser which caused pain and nail bleeding during sessions for some of the patients in each group, while topical methotrexate caused nail yellowish discoloration for the all involved group. However, these side effects lasted for very short time and didn’t have any impact on the level of the patient satisfaction. There was no statistical difference in the level of the patient satisfaction between both groups.

AB0956 VERTICAL NAIL RIDGING IN PATIENTS WITH FIBROMYALGIA: FREQUENCY, PROPOSED GRADING AND CORRELATION WITH OTHER DISEASE FEATURES

Background:The vertical nail ridging (VNR) has long been reported to be related to stressful conditions1Objectives:to evaluate the frequency of VNS in FM patients and its relation to other disease parameters depending on a proposed grading.Methods:VNR has been searched for in 212 FM patients (2016 criteria). The number of fingers, the degree of VNR according to this proposed grading (0: no ridging, 1: ridging only detected by a magnifying lens, 2: ridging seen by naked eye and 3: ridging that can be seen and felt) and other FM features according to the new and old ACR criteria have been recorded. 80 subjects of those consulting for knee osteoarthritis have been examined for VNR and those found positive were asked about the FM features and examined for tender points. Patients aged &gt;50 years and those with psoriasis and fungal infections were excluded.Results:the mean age of patients was 32.4±9.9 (73.6% were female). The mean disease duration was 5.8±3.7, while the means of WPI, SSS and tender points were 9.4±2.9, 7.3±1.2 and 14.7±2.3 respectively. VNR was found in 209 patients (98.6%). Of 80 controls, VNR has been found in 61 subjects, of whom FM has been diagnosed in 32 patients (52.4%) by 2016 FM criteria and in 46 (75.4%) by 1990 criteria. The number of fingers with VNR has been found only correlated with the disease duration (r= 0.276, P = 0.000). The severity of VNR was significantly correlating with fatigue (P= 0.002), sleep disturbance (P= 0.001), awaking unrefreshed (P = 0.000), WPI (p = 0.01) and mean tender points (P =0.02). Considering the 2016 criteria as a gold standard, the sensitivity of VNR was 98.37%, the specificity was 9.68% and the diagnostic accuracy was 82.8%.Conclusion:vertical nail ridging is a frequent finding and can be considered helpful for diagnosis of patients with FM. Further studies are needed to validate this sign for diagnosis and follow up of FM patients.

Single Agent Ibrutinib in CLL/SLL Patients with and without Deletion 17p

INTRODUCTION: Ibrutinib is FDA approved for patients (pts) with CLL who are previously treated or have deletion (del) 17p. Data on depth and durability of response beyond the first 2 years of therapy are limited. Here we compare the response of pts with and without del17p with long follow-up(f/u).PATIENTS AND METHODS: This investigator-initiated phase II trial (NCT01500733) enrolled 86 pts (Cohort 1: no del17p, n=35; Cohort 2: del17p n=51). Both treatment (tx) naïve (TN) and relapsed refractory (R/R) pts with active disease were eligible. Response was assessed by computed tomography (CT), physical exam, bone marrow (BM) biopsy, and routine clinical and laboratory studies. Spleen volume (SV) was calculated from CT scans using a General Electric Advanced Workstation Server. Eight color flow cytometry (FC) on peripheral blood (PB) and BM was performed at yearly intervals. Wilcoxon rank-sum test was used to examine the differences between the two cohorts.RESULTS: Median f/u for all pts currently on study was 36 months (mo). Among pts with no del17p 24 (69%) pts completed 2 years(y) and 12 (34%) pts completed 3y. 33 (65%) pts with del17p completed 2y and 18 (35%) pts completed 3y. Median age was 66y (33-85) and 70% had Rai stage III/IV. Most adverse events were grade ≤2, most commonly (>25%) diarrhea, nail ridging, arthralgias, rash, bruising, and cramps. Tx-related non hematologic toxicities grade ≥3 occurred in <15%, and grade ≥3 infections or cytopenias were reported <25% of pts.The estimated progression free survival and overall survival at 36 mo is 82% and 88%. A total of 81 pts (n=33 (no del17p), n=48 (del17p)) were evaluable for response (2 enrollment deviations, 1 malignancy, 2 deaths before 6 mo). 5 (6%) deaths occurred on study (4 infections not tx-related, 1 possibly tx-related sudden death). 2 (2%) pts were primary refractory and 7 (8%) pts had progressive disease (PD) after initial response (3 CLL, 2 PLL, 2 Richter's transformation). Best response was complete response (CR) in 17 (21%) pts, partial response (PR) in 60 (74%), and stable disease (SD) and progressive disease (PD) each in 2 (2%) pts. Median time to best response was 2y. Responses for TN vs R/R pts were: 20 vs 23% CR, 78% vs 68% PR, 0% vs 6% SD, 2% vs 3% PD, and for no del17p vs del17p: 21% vs 21% CR, 73% vs 75% PR, 3% vs 2% each with SD and PD. There were no statistically significant differences in response rates by prior tx or del17p status.Disease control in all evaluable tissue sites were compared between the two cohorts based on del17p status (no del17p vs del17p) (Table): median reduction in lymphadenopathy 89% (59-100) vs 82% (22-100), median reduction in SV 94% (26-100) vs 98% (37-100), median reduction in tumor infiltration in the BM was 90% (11-99) vs 88% (28-100), and ALC response showed a median reduction of 97% (range: +44% to -99%) and 95% (range: +119% to -99%).TableMedian tumor reduction at best response.CompartmentAll ptsNO DEL17pDEL 17pPNodal85% (n=79)89% (n=32)82% (n=47)0.01Spleen98% (n=67)94% (n=28)98% (n=39)0.3BM89% (n=73)90% (n=31)88% (n=42)0.6ALC96% (n=81)97% (n=33)95% (n=48)0.16We quantified depth of response by measuring the degree of flow cytometric minimal residual disease (MRD) (CLL % of leukocytes). The median MRD at 1y (n=51), 2y (n=46), and 3y (n=24) in PB was 41%, 12%, and 8% respectively. Median MRD values at 1y (n=17), 2y (n=32), and 3y (n=15) in BM was 12%, 8%, and 7%. There was no significant difference in MRD levels in pts by prior tx status. However, pts with no del17p tended to have less residual disease measured by FC than pts with del17p. For example, at 2y MRD levels in PB were 6.4% vs 16% and in BM 4.7% vs 11.1%, respectively (P =0.02). At 3y one patient with no del17p achieved near MRD negativity in PB at 0.018%, and MRD negativity in the BM at 0.007%.CONCLUSION: With continued therapy 95% of pts achieved a response by iwCLL criteria and the depth of response improved with 21% CRs irrespective of the presence of del17p. However, all patients remained MRDpositive. With a median f/u of 36 mo, responses were durable in the majority of pts, with secondary resistance developing in 8% of pts.Research supported by the Intramural Research Program of NHLBI. We thank our patients for participation. We acknowledge Pharmacyclics for providing study drug. DisclosuresOff Label Use: Ibrutinib is approved for CLL patients with relapsed refractory disease and patients with deletion 17p CLL. Some of the patients on this abstract from this clinical trial are treatment naive CLL patients without 17p deletion. . Wiestner:Pharmacyclics: Research Funding.

Patient-based outcomes following surgical debridement and flap coverage of digital mucous cysts

Purpose: The purpose of this prospective cohort study was to evaluate patient-based outcomes and complications following excision of mucous cysts, joint debridement, and closure with one of three types of local flaps. Methods: From 2000–2011, 35 consecutive patients with 37 digital mucous cysts were treated surgically. The surgical procedure included excision of the cyst together with the attenuated skin, joint debridement on the affected side including capsulectomy, and removal of osteophytes. Depending on the size and location of the cyst, the skin defect was covered by a transposition flap (31 cysts), an advancement flap (two cysts), or a rotation flap (four cysts). Results: At an average follow-up time of 4 years, 4 months, there was no wound infection, flap necrosis, or joint stiffness. Preoperative nail ridging resolved in seven of nine fingers, and no nail deformities developed after surgery. One cyst, treated with a transposition flap, recurred 10 months after surgery. The average satisfaction score for the affected finger significantly improved from 4.3 to 6.8, and the average pain score decreased from 4.7 to 2.3. Conclusion: This treatment protocol provides reliable results. Patients were satisfied with the reduction of associated pain and the postoperative appearance of the treated finger, and postoperative complications were minimal.

A novel closed reduction with extension block and flexion block using Kirschner wires and microscrew fixation for mallet fractures

BackgroundSome patients with mallet fractures who undergo extension block pinning complain of exposed wires, which delay their return to sports and causes inconvenience while performing tasks that require the use of hands during the early postoperative period. The purpose of this retrospective study was to present and evaluate a novel surgical procedure for mallet fractures. MethodsWe treated 20 patients (14 males and six females; mean age, 38.4 years; range 17-68 years) with displaced mallet fractures involving >30 % of the articular surface using the closed reduction and microscrew fixation between January 2009 and January 2012. The distal interphalangeal joint (DIP) joint was immobilized with a splint for 1-3 weeks on an individual case basis. According to Wehbe and Schneider’s classification, there were 12 type IB, six type IIB, and two type IA fractures. The mean follow-up duration was 12.6 months (range 6-31 months). ResultsBone union was achieved in all patients within a mean period of 6.8 weeks, with no incidence of infection, skin necrosis, permanent nail deformity, or secondary osteoarthritis. Only two complications—temporary nail ridging in one patient and a dorsal bump caused by the screw in one patient—were observed. Minimum postoperative displacement was observed in one patient, for whom immobilization with a splint was continued for 4 weeks. Articular incongruity was <1.0 mm in four patients and 1.0-2.0 mm in two patients. Mean DIP joint extension loss was 6.5° and mean flexion was 67.8°. The surgical outcomes were excellent in seven patients, good in nine, and fair in four according to Crawford’s evaluation criteria. ConclusionOur novel surgical procedure combining closed reduction with extension block and flexion block using Kirschner wires and microscrew fixation produces good clinical results with relatively few complications.

Cryotherapy for docetaxel-induced hand and nail toxicity: randomised control trial

This study investigated the efficacy and safety of cryotherapy, in the form of frozen gel gloves, in relation to docetaxel-induced hand and fingernail toxicities. After piloting with 21 patients, a consecutive series sample of patients (n=53) prescribed docetaxel every 3 weeks, for a minimum of three cycles, was enrolled in this randomised control trial. Participants acted as their own control, with the frozen gel glove worn on one randomised hand for 15 min prior to infusion, for the duration of the infusion, and for 15 min of after completion of treatment. Hand and nail toxicities were evaluated by two blinded assessors according to CTCAE.v4 criteria. To assess the potential for cross-infection of multi-use gloves, microbial culture and sensitivity swabs were taken of each glove at every tenth use. Of the 53 participants enrolled in the main study, 21 provided evaluable data. There was a 60 % withdrawal rate due to patient discomfort with the intervention. The mean incidence and severity of toxicities in all evaluable cycles in control and intervention hands respectively were erythroderma grade 1 (5/5 %), nail discolouration grade 1 (81/67 %), nail loss grade 1 (19/19 %) and nail ridging grade 1 (57/57 %). No significant differences were determined between hand conditions in terms of time to event, nor in terms of toxicity in gloved and non-gloved hands. While cryotherapy in the form of frozen gloves for the cutaneous toxicities associated with docetaxel is safe, its limited efficacy, patient discomfort and some logistical issues preclude its use in our clinical setting.

Mucocutaneous disorders in renal transplant recipients receiving sirolimus‐based immunosuppressive therapy: a prospective, case–control study

Sirolimus (SRL) has some dermatologic complications including acneiform eruptions, edema, aphthous ulceration, and onychopathy. However, controlled studies reporting the prevalence and clinical characteristics of mucocutaneous disorders are scarce. To investigate the prevalence and clinical spectrum of mucocutaneous disorders in renal transplant recipients (RTRs) receiving SRL and to compare the findings with those in RTRs not receiving SRL. Fifty RTRs (35 men, 15 women; mean age, 34.6 ± 11.6 yr) receiving SRL, 50 RTRs (36 men, 14 women; mean age, 34.4 ± 11.3 yr) not on SRL were screened for mucocutaneous disorders. In RTRs receiving SRL, skin infection (78%) was the most common dermatologic disorder followed by facial hyperpigmentation (50%) and acneiform eruption (46%). Herpes simplex virus infections (14%) and seborrheic dermatitis (38%) were significantly more common in RTRs on SRL (p < 0.05); the frequencies of edema, aphthous ulceration, acne, and longitudinal nail ridging were similar in both groups (p > 0.05). This study had a small sample size. The investigator was not blinded to immunosuppressive treatment protocols. Renal transplant recipients receiving SRL are more likely to develop seborrheic dermatitis and herpes simplex virus infections than those not taking SRL. Whereas, they are not more prone to edema, aphthous ulceration, acne, or longitudinal nail ridging.

Kırıklı çekiç parmakların yivli Kirschner teli kullanılarak tedavisi

Objectives: The management of bony mallet fingers is controversial. This article describes the technique and outcome of using threaded Kirschner wire to treat mallet fractures involving more than one-third of the articular surface. Methods: Forty-seven patients were operated on between April 2004 and February 2012. The average follow-up period was 19.6 (range: 8 to 44) months. Results: According to the Crawford criteria, the results were excellent in 32 patients (69%), good in 12 patients (26%) and fair in 3 patients (6%). The mean range of motion was from 3o (extensor lag) (range: 0° to 15°) to 71o (range: 60° to 80°) flexion. As complications, five patients developed mild degenerative changes, three had pin tract infections, one had temporary nail ridging, and three had skin sloughing. None had persistent postoperative pain. Conclusion: Threaded Kirschner wire achieved good reduction during surgery and maintained reduction postoperatively for six weeks in mallet fractures.

Modified Extension-Block K-Wire Fixation Technique for the Treatment of Bony Mallet Finger

This article describes the treatment of a bony mallet finger deformity using 2 extension-block Kirschner wires (K-wires) with a transarticular K-wire fixation technique for precise alignment of the terminal extensor tendon-bone relationship and effective immobilization of the distal interphalangeal joint. Twenty-nine patients (33 fingers) with a bony mallet finger deformity and fracture fragment involving more than one-third of the articular surface were treated surgically. The fracture fragment was fixed and the mallet finger deformity was corrected in all patients using modified extension-block K-wires (2 dorsal extension-block pins) with a transarticular K-wire (volar side pin) fixation technique. Active motion of the proximal interphalangeal and metacarpophalangeal joints was not restricted. The wires are removed in the clinic 6 weeks postoperatively when the bridging trabeculae were observed in the radiographs, and immobilization in a stock splint was continued for an additional 2 weeks. According to Crawford's evaluation criteria, there were 24 (73%) excellent, 7 (21%) good, and 2 (6%) fair results. Three patients showed radiological signs of mild degenerative changes, which did not limit their daily activities. Nail ridging occurred in 3 cases (9%), which disappeared after an average of 6 months with normal growth, and mild scarring at the dorsal pin site occurred in 2 cases (6%). Modified extension-block K-wires with a transarticular K-wire fixation technique is an acceptable alternative treatment modality for the management of bony mallet finger deformities with or without subluxation of the distal phalanx.

Determination Prevalence Of Clinical Patterns Of Alopecia Areata In Relation To Some Varieties In Kerman Iran

Introduction: Alopecia areata has different clinical presenting patterns, it may starts with a self limited single or separated patches on the scalp or any area of the body and progressing to complete scalp hair loss or complete body hair loss. 0bjective:Determination prevalence of alopecia areata with clinical configurations of patients in this area and its comparison with similar studies in other parts of the world that is the base and its localization to scalp or body in relation to skin color and nail ridging or cryptic dental infection or carries. Method: 952 patients with alopecia areata were studied who has been found among of 25186 new patients in this study that had been referred from all around the Kerman a province of Iran, as out patient during 3 years by the major points of age, sex, family history, extent percent of involved area & history of any determined infection such as nail ridges and dental caries or infections who were variables that has been evaluated in this study. Results: 3.78% of all new dermatology patients had alopecia areata. Family history was seen in 3.6% of patients and male to female ratio was 2.6 & the commonest clinical patterned were either round or oval types. Hair loss configurations in 252 patients (26.5%) were only restricted to scalp, in 216 cases (22.7%) to body, and in 414 cases (50.8%) was seen in both scalp & body (bipolar) alopecia areata. Bipolar type of alopecia areata was seen mostly in the first 3 decades of life which shows a significant difference in compare to the other configurations (p<0.01). Conclusion: Prevalence of alopecia areata between new dermatologic patients during 3 years was as 3.78%. Body hair loss (bipolar type) in males and a the first 3 decades of age were significantly more than females and those who were in upper 3 decades of age respectively.

Cutaneous Adverse Reactions to Hydroxyurea in Patients with Intermediate Thalassemia

Although the cutaneous effects of hydroxyurea have been described for patients with sickle cell anemia, myeloproliferative disorders, and psoriasis, there are no reports of cutaneous adverse effects from hydroxyurea when used for patients with intermediate thalassemia. Therefore 43 patients with intermediate thalassemia treated with hydroxyurea were examined by a dermatologist, and pertinent cutaneous findings were recorded. These patients had received hydroxyurea for a mean of 15.5 months. Nineteen had cutaneous hyperpigmentation, eight had xerosis, and three were found to have one cafe au lait macule each. Eleven patients had nail abnormalities, including nail ridging, partial leukonychia, and longitudinal melanonychia. There were no cases of leg ulceration. It was concluded that the risk of developing leg ulcers and pigmentary disorders appears to be related to the underlying disease being treated, as well as to a patient's age, gender, and pigmentation.

Treatment of mucous cysts of the fingers: Review of 134 cases with minimum 2-year follow-up evaluation

Purpose: To evaluate the results of a single surgeon's treatment of mucoid cysts, comparing outcomes between injection and surgery. Methods: One hundred thirty-four cysts were treated, with a minimum 2-year follow-up period. Thirty-one patients had nail ridging or deformity at presentation. Eighty patients had multiple soft-tissue punctures into the cyst with a 25-gauge needle and injection with local anesthetic and steroid. Fifty-four patients had surgical excision and joint debridement. Results: In the injection group, complete resolution of the cyst occurred in 48 cases (60%). Among the 32 that recurred, repeat injections were performed in 8 cases; 3 resolved. No recurrences were noted in the surgery group. Nail ridging resolved after surgery in 25 digits; the remaining 6 digits had partial improvement or persistent ridging. Five infections occurred and were treated successfully with antibiotics (4) or debridement (1), or both. Conclusions: Aspiration and injection was convenient but had a 40% recurrence rate. Surgery provided definitive treatment with no major long-term problems. (J Hand Surg 2003;28A:519-524. Copyright © 2003 by the American Society for Surgery of the Hand.)

The Bilhaut-Cloquet Procedure Revisited

We have found the Bilhaut-Cloquet procedure, with certain modifications, to be a useful method of reconstruction of thumb duplication. Seven thumbs were reviewed at an average follow-up of two years. A thumb of normal size and stability was obtained. Interphalangeal joint motion was 50% of normal. Nail ridging was considered to be less than satisfactory in one case only.

Multiple Beau's lines due to dysmenorrhoea?

Four young women who complained of nail ridging, were found to have several evenly spaced Beau's lines. The lines appear to be related to their menstrual cycles and each one had severe dysmenorrhoea. Linear nail growth was not impaired.

Transverse Nail Ridging, Or the Dangers of Putting Faith in Prominent Neonatologists

In the May 1968 issue of Pediatrics you published an observation on transverse nail ridging in early infancy that I felt was original. However, subsequent correspondence, revealed that Dr. Bela Schick first described these ridges in 1908 (Jahrb. Kinderh., 67:146). This fact was kindly brought to my attention by Dr. Maarten S. Sibinga, who published observations on growth of fingernails in Pediatrics (24:225, 1959). It is obvious, therefore, that this observation was known to some neonatologists and careful observers for some time.

Transverse Nail Ridging in Early Infancy

A previously undetected transverse ridge the fingernails of normal infants has been described as first appearing at the proximal nail at 4 to 6 weeks of age. The ridge grows out to the free edge of the nail by 14 weeks of age. The intent of this report is to call attention to the fact that the ridge exists. The clinical significance of this finding, if any, awaits more extensive observation.