Normal Nails Research Articles

Treatment of brittle fingernails and onychoschizia with biotin: Scanning electron microscopy

Pathologic hoof changes in horses and swine can be normalized by administration of biotin. This vitamin has been given orally to women with brittle fingernails or onychoschizia. The aim of the study was to test whether the favorable clinical results could be corroborated by scanning electron microscopy. We investigated the distal ends of the fingernails from 32 persons. They were placed into three groups: group A consisted of 10 control subjects with normal nails, group B comprised eight patients with brittle nails studied before and after biotin treatment, and group C was 14 patients with brittle nails in whom the administration of biotin did not coincide exactly with the initial and terminal clipping of the nails. The thickness of the nails in group B increased significantly by 25%. In group C, the increase was 7%. Splitting of the nails were reduced in groups B and C and the irregular cellular arrangement of the dorsal surface of brittle nails became more regular in all nails of group B and in 8 of 11 nails of group C.

Nail matrix kinetics of oral terbinafine in onychomycosis and normal nails

Nail matrix kinetics were studied in 12 patients with onychomycosis taking terbinafine (Lamisil) 250 mg daily for up to 48 weeks. Terbinafine was first detected in distal nail clippings from affected nails 3–18 weeks after starting therapy. During the study the mean terbinafine nail levels ranged from 0.25 to 0.55 ng/mg, rapidly reaching a stable level within this range. The kinetics profile of terbinafine in unaffected fingernails was not significantly different from that of affected nails. The kinetics of demethyl terbinafine in nail plate closely paralleled that of terbinafine.

The Indentation and Nailing of Cellular Materials

AbstractAn experimental study was carried out on the indentation of cellular materials under quasi-static conditions. The study concentrated on a closed cell rigid polyurethane foam, but other cellular materials were tested. Load (F) - penetration depth (x) curves were obtained for various types of indenters which fall into two main types: sharp indenters (e.g. normal nails) and blunt indenters (e.g. flat ended nails). The F(x) curves are similar for the two types with an initial high slope region followed by a lower slope region in which F increases linearly with x. Nevertheless, the mechanisms of indentation are completely different, with a blunt indenter pushing the material under it and a sharp indenter pushing it radially as it penetrates. The effect of dimensions and shape of the indenters on the F(x) curves was investigated and scaling relations could be derived. Penetration-removal cycles clarify the differences between the two types of indenters, and give additional information on the mechanics of indentation. The experiments were complemented with scanning microscope observations of sections of the indented material. Two approaches are advanced for modelling indentation: a discrete approach in which the cellular structure is taken into account and a continuum approach.

Treatment of dermatophyte infection of the finger- and toe-nails with terbinafine (SF 86-327, Lamisil), an orally active fungicidal agent

We report on the use of a new orally active fungicidal agent, terbinafine (SF 86-327, Lamisil) in the treatment of patients with dermatophyte onychomycosis. Twenty patients with toe-nail, and 10 with finger-nail infection received 250 mg of terbinafine daily: finger-nail infections were treated for 6 months and toe-nail infections for 12 months. All 24 patients who completed the course of therapy achieved mycological cure, as did two subjects who dropped out of the trial. All but two patients had clinically normal nails at the end of the study period. The mean time for mycological cure was 12.5 weeks for finger-nail infection, and 24 weeks for toe-nail infections. The time for a clinical cure with normal nails was 20.5 weeks for finger-nail infection, and 44 weeks for toe-nail infection. An exacerbation of pre-existing dyspepsia occurred in three of the six patients who did not complete the trial but there were no other significant adverse reactions.

Nailing Down a Diagnosis

Nails can act as a barometer of an individual's health, offer clues to nutritional disturbances and serve as windows through which to view capillary changes associated with constitutional disease. Understanding growth and development of normal nails is essential to the identification and interpretation of nail pathology. Causes of onychopathology include genetic disease, trauma, tumors, dermatologic disease, miscellaneous acquired disorders and generalized systemic disease. Diagnosis is aided by the realization that the nails have a limited number of reaction patterns when disturbed by disease. Any of these reactions may manifest a host of disorders. Clinicians should remember to include the nails in patient assessment. The nails are interesting anatomical and physiological areas that can help make a diagnosis.

Abnormal amino acid composition of nails in Bazex´s paraneoplastic acrokeratosis

Bazex´s paraneoplastic acrokeratosis is a syndrome with psoriasiform acral hyperkeratosis and nail changes associated with carcinoma of the upper respiratory or alimentary tract. We report here a case where amino acid analysis of the hyperkeratotic and friable nails differed from normal and other diseased nails investigated by us, but they were similar to those reported in trichothiodystrophy or the BIDS syndrome.

Onychomycosis in patients with psoriasis

The frequency and type of fungal infections of the finger- and toenails was studied prospectively by direct microscopic and culture examinations in dermatological out-patients without psoriasis (n = 41), in patients with psoriasis but no nail involvement (n = 39), and in patients with both psoriasis and nail involvement (n = 39). In these three matched groups the frequencies of dermatophytic nail infections were 10%, 13%, and 13%, respectively, and the frequencies of yeast infections 10%, 10%, and 15%, respectively. These figures were not significantly different. It is concluded that dermatophytic invasion of involved psoriatic nails is not so rare as previously supposed. However, yeast infections are possibly more frequent in involved psoriatic nails as compared with uninvolved and normal nails.

Transmission of 12 kV Grenz rays and 29 kV X-rays through normal and diseased nails

Bucky and X-rays are used in the treatment of nailbed diseases. Transmission through normal and diseased nails has been measured. Nails of normal thickness transmit about 30% of Bucky rays and about 85% of X-rays. Bucky rays cannot be used when the diseased nails are thickened, whereas 60% of X-rays are transmitted.

Ectodermal dysplasia and abnormal thumbs

Two unrelated children, a girl and a boy, with alopecia, anomalous cutaneous pigmentation, abnormal thumbs, and endocrine disorders, including short stature and delayed bone age in one patient and juvenile onset diabetes mellitus in the other, are described. In one instance, the mother and the maternal grandmother had similar abnormalities, although of a less severe nature. Both children had normal nails and no unusual susceptibility to infections. We believe these two patients represent a previously undescribed syndrome of ectodermal dysplasia that may be inherited as an autosomal-dominant trait.

Morphology of Corneocytes from Human Nail Plates

A technique is described which permits the isolation of individual corneocytes from the superficial layers of the human nail plates. Tesa-film D is used to strip off the cells. The tape is mounted on a glass slide, stained with a mixture of methylene blue and rhodamine B. The parameters were size (surface mu2), shape (regular, irregular), nuclear inclusions and trabeculae. Specimens were obtained from 3 groups of patients (finger- and toe nails): (1) 60 healthy subjects with normal nails, males and females, in 3 age-groups (babies, adults, aged); (2) 10 patients with fast growing nails with psoriasis vulgaris and psoriatic nail involvement; (3) 9 patients with slow growing nails with lichen planus with nail involvement including one patient with Zinser-Engman-Cole-syndrome (dyskeratosis congenita). The nail growth rate was determined with a dissecting microscope-technique. Corneocytes of the dorsal nail plates of normal nails are of irregular polyedrical shape, not nucleated and show distinct but irregular trabecular network. Within each age-group, corneocytes are of rather uniform size but increase significantly (p less than or equal to .001) with age (e.g., thumbin males: 597 vs. 920 vs. 1008 mu2). Accelerated nail plate growth results in smaller corneocytes, and slowed down nail plate growth in larger corneocytes. It is concluded that cell proliferation (and abnormal keratinization) has a measurable effect on the size of corneocytes from the nail plates.

Differentiation Between Psoriatic Arthritis And Rheumatoid Arthritis: A Biochemical And Statistical Analysis Of Fingernail Amino Acids

The differentiation between psoriatic arthritis and rheumatoid arthritis can be clinically difficult if there is no manifest psoriasis of skin or nail. In order to clarify this diagnostic problem, the amino acid patterns in seventy-five psoriatic and non-psoriatic nails have been studied. Using gas--liquid chromatographic techniques and discriminant analysis, a high degree of differentiation (96%) has been established between the normal looking nails of patients with psoriatic arthritis and those with rheumatoid arthritis. This biochemical/statistical approach to the fingernail enhances diagnosis in difficult clinical problems, particularly where there are no overt manifestations of psoriasis.

Differentiation Between Psoriatic Arthritis And Rheumatoid Arthritis: A Biochemical And Statistical Analysis Of Fingernail Amino Acids

The differentiation between psoriatic arthritis and rheumatoid arthritis can be clinically difficult if there is no manifest psoriasis of skin or nail. In order to clarify this diagnostic problem, the amino acid patterns in seventy-five psoriatic and non-psoriatic nails have been studied. Using gas-liquid chromatographic techniques and discriminant analysis, a high degree of differentiation (96%) has been established between the normal looking nails of patients with psoriatic arthritis and those with rheumatoid arthritis. This biochemical/statistical approach to the fingernail enhances diagnosis in difficult clinical problems, particularly where there are no overt manifestations of psoriasis.

On the structure of the normal nail. A scanning electron microscope study.

A scanning electron microscopic (SEM) study of cut surfaces in normal human nails have confirmed the previous description of nail structure, i. e. the hard dorsal nail plate supported by the plastic intermediate nail plate.

Fingernail growth in idiopathic and psoriatic onycholysis.

Summary.— In idiopathic onycholysis, nail growth has been found to be significantly taster than normal. An increase of similar magnitude was found in psoriatic onycholysis. We are unable to say whether increased nail growth is of pathogenic importance or is simply a consequence of onycholysis. The hypothesis that idiopathic onycholysis is “pre-psoriatic” was tested by measuring growth of uninvolved nails in both idiopathic and psoriatic groups; the clinically normal nails of psoriatic patients grew significantly faster, and those in the idiopathic group marginally more slowly than normal. These findings, combined with a significant difference in the fingernails involved in the ony-cholytic process, lead us to conclude that idiopathic onycholysis is not “pre- psoriatic”.

BRACHYDACTYLY WITH ABSENCE OF MIDDLE PHALANGES AND HYPOPLASTIC NAILS

1. A seven-generation family is described which presented an autosomal dominant hereditary disorder characterised by brachydactyly, hypoplastic nails from the index to the little fingers, normal toe nails, absent middle phalanges in the fingers and lateral four toes, variable degrees of hypoplasia of the distal phalanges in the fingers with normal thumbs and normal big toes. 2. Less frequently syndactyly between middle and ring fingers on the left and narrowing of the proximal phalanges of the ring and little fingers are also found. 3. This disorder seems to represent a new hereditary syndrome.

Fingernail growth in normal and psoriatic subjects.

SUMMARY.— A study has been made of nail growth in normal healthy subjects and in patients with psoriasis. Nails with pitting grew significantly faster than clinically normal nails of psoriatic patients, which in turn grew faster than those of normal controls. Of the nails measured, those of the middle finger grew more quickly than the others, the thumb and little finger growing most slowly; right hand nails grew faster than those of the left hand.

Treatment of the Ingrown Toenail: And a New Anesthetic Method

The present study evaluated the properties of nails, frequency of ingrown nails in patients with type 2 diabetes mellitus (DM), risk factors for developing ingrown nails, and effect of diabetic polyneuropathy and vasculopathy on the development and outcome of ingrown nails. Our 6-month epidemiologic prospective study included 300 patients with type 2 DM attending a DM outpatient clinic for routine examinations. The general characteristics and foot changes of the study population were investigated. Diabetic polyneuropathy and vasculopathy were evaluated using a biothesiometer, monofilament tests, and arterial Doppler ultrasonography. The frequency of ingrown nails was 13.6%. Multivariate analysis with logistic regression showed that body mass index (odds ratio [OR] 1.077, 95% confidence interval [CI] 1.007 to 1.15; p = .03), previous trauma (OR 2.828, 95% CI 1.017 to 7,867, p = .042), a weak dorsalis pedis pulse (OR 2.72, 95% CI 1.17 to 6.30, p = .02), trimming type (OR 2.3, 95 CI 1.06 to 4.98), p = .35), onychogryphosis (OR 9.036, 95% CI 2.34 to 34.87, p = .001), and subungual hyperkeratosis (OR 4.3, 95% CI 1.99 to 9.3, p = .001) were predictive variables for ingrown nails in our population. The incidence of onychomycosis was significantly greater in patients with ingrown nails (p = .032) than in patients without ingrown nails. The nail curvature ratio was greater in the patients with ingrown nails than in the group with normal nails. Arterial Doppler ultrasound examinations showed peripheral arterial disease in 19 patients (46.9%) with ingrown nails. The prevalence of ingrown nails was greater in the patients with DM than in the healthy population. Our results indicate that nail type, nail morphology, and diabetic vasculopathy affect the formation and evolution of ingrown nails.

Green Nails

Of a total of 40 patients with discolored nails studied, 34 had definite green discoloration of one or more nails. Bacteriologic studies of 26 patients with green nails revealed the presence of Pseudomonas aeruginosa in pure or mixed culture in 23 cases. Nonpigmented onychopathic or normal nails from 50 patients were cultured with only one patient yielding Ps. aeruginosa . Of the 34 patients with green nails, 32 listed occupations in which excessive exposure to water, soap, and detergents is common, 11 patients presented evidence of mechanical trauma to the nail, and three had concurrent onychomycosis. Histologically, Gram-negative bacilli consistent with Ps. aeruginosa were demonstrated within the nail plate. It is postulated that Ps. aeruginosa was able to invade the nail plate because of a local reduction of resistance produced by trauma or concurrent pathology.