Splinter Hemorrhages Research Articles

Nail Psoriasis: A Narrative Review of Manifestations, Diagnosis, and Management

Psoriasis is a common, chronic inflammatory dermatosis, and patients with psoriasis often develop nail involvement. It is estimated that up to 90% of patients experience nail lesions at least once in their lifetime. Nail psoriasis (NP) occurs when psoriatic inflammation affects the nail matrix, nail bed, or both. The clinical manifestations of NP vary depending on the location and severity of the inflammation. Common signs include pitting, splinter hemorrhages, salmon patches, and distal onycholysis. Although cutaneous psoriasis is considered more severe in individuals with nail involvement, there is no clear relationship between the duration, severity, and clinical presentations of cutaneous psoriasis and NP patterns. NP is notable for an increased prevalence of arthritis among patients and is considered a significant clinical burden due to its association with arthritis and its slow or poor response to many therapeutic agents. Effective reassurance and patient education are essential components of NP management. This review summarizes clinical manifestations and diagnostic and therapeutic strategies for NP.

Cabozantinib Cutaneous Toxicity-Comprehensive Review.

In the context of modern cancer therapy, the management of adverse effects of systemic therapies can lead to the avoidance of underdosing and withdrawal and increases in the quality of the therapeutic act and the quality of life. This review offers an overview of the skin-related toxicities associated with Cabozantinib, a multikinase inhibitor (MKI) that is approved for treating advanced kidney cancer, hepatocellular carcinoma, and medullary thyroid cancer. It covers the most common dermatological side effects, such as palmar-plantar erythrodysesthesia, stomatitis, hair alterations, xerosis, scrotal erythema, and subungual splinter hemorrhages. Additionally, this review includes suggested preventive strategies and management approaches based on the severity of these adverse effects.

Celebrating Diversity: Unveiling the Characteristics of Nail Psoriasis and Nail Lichen Planus in 30 Patients With Skin of Color.

Dermatological conditions affecting the nails can manifest differently in individuals with distinct skin tones. This often leads to difficulty in the recognition of nail diseases, especially in people with skin of color (SoC), who are not well represented in the literature. Our aim was to provide dermatologists with useful clues for prompt recognition and diagnosis of nail psoriasis (NPso) and nail lichen planus (NLP) in people with SoC. We described the ungual manifestations of NPso and NLP in a population of 30 patients with SoC. Diagnosis was primarily based on clinical examination; in cases of diagnostic uncertainty, a biopsy of the nail matrix was performed to obtain histological conclusive evidence. Of the 30 people with SoC in the analysis, 24 patients had NPso with a median Fitzpatrick phototype of 4.77, and six patients had NLP with a median Fitzpatrick phototype of 5. Regarding the 24 patients with NPso, 10 presented with trachyonychia, nine displayed nail pitting, eight showed onycholysis, and 12 had subungual hyperkeratosis, while splinter hemorrhages were visible in two patients, and activation melanonychia was discernible on the nail plates of eight patients. Of the six patients diagnosed with NLP, all had post-inflammatory pigmentation on the proximal nail, with three patients exhibiting trachyonychia and three others having longitudinal fissures; subungual hyperkeratosis was found in five patients, while three patients displayed activated melanonychia. People with SoC exhibit a peculiar clinical presentation of both NPso and NLP, and a better understanding is essential to providing timely and effective care.

Dermatoscopic Evaluation of Nail Changes among End Stage Renal Disease Patients

Abstract Background Nail changes observed in end stage renal disease (ESRD) patients undergoing regular hemodialysis (HD) are polymorphic and diverse. HD causes heterogeneous pathology of nail which may be related to renal condition itself, complications related to it and drugs. Aim of the Work To study nail changes in ESRD patients undergoing regular HD by clinical and dermoscopic examination and to correlate these changes with age of patients, duration of hemodialysis, laboratory investigations, etiology of renal failure and type of vascular access. Patients and Methods The study consists of 100 ESRD patients on regular hemodialysis. Nails of these 100 patients were examined clinically and by dermoscopy. Different nail changes were detected and their frequencies were noted. Also, we correlated these changes with age of patients, duration of hemodialysis, laboratory investigations, etiology of renal failure and type of vascular access. Results Nail changes found in ESRD patients on HD were scales, leukonychia, thickening and crumbling, longitudinal striations, transverse striations, onycholysis, splinter hemorrhage, subungual hematoma, trachyonychia, subungual hyperkeratosis, Terry’s nail, onychomycosis, pincer nail, melanonychia, pitting, Lindsay nail, onychomadesis, dilated nail bed capillaries, Beau’s lines, Muehrcke’s lines, onychodystrophy, Mee’s line, loss of lunula, koilonychia and onychogryphosis in decreasing manner. Also, we found statistical significant correlation between some of these changes and age of patients, duration of hemodialysis, laboratory investigations, etiology of renal failure and type of vascular access. Conclusion Nail changes that were seen on examination of ESRD patients undergoing regular HD were very frequent and the dermoscopic examination helped us to detect nail changes not seen by clinical examination.

Assessment of visual function in patients with posterior fossa tumours

Introduction. Posterior fossa tumours (PFTs) frequently present with ophthalmic complaints. The literature is mainly focused on PFTs affecting the pediatric age group, and the post-treatment visual outcomes (VOs) are scarcely reported. Objective. To evaluate the VOs at 6 months following the index surgery in patients with PFTs. Materials and methods. This retrospective study involved 50 patients of all age groups who underwent surgical resection of PFTs in the Department of Neurosurgery. The patients with PFTs, except those with low-grade tumours, received concurrent chemo-radiotherapy. Pre- and postoperative (6 months after the index surgery) ophthalmic examinations were done and compared. VOs included colour vision, night vision, visual acuity (VA), pupillary function (size, reactivity), papilledema grade, splinter haemorrhage, retinal venous dilatation, strabismus (esotropia and hypertropia), and nystagmus. Results. The patients were mainly aged 1–10 years (22%) with slight female predominance (52%). The most common PFTs were brainstem glioma and pilocytic astrocytoma (each 18%). At 6 months, there was no significant change in colour and night vision, pupil size and reactivity, splinter haemorrhage, and hypertropia (all p-values>0.05). A significantly lesser proportion of patients had moderate VA (p-value=0.013), retinal venous dilatation (p-value=0.001), and grade 1 (p-value=0.005) as well as grade 4 papilledema (p-value=0.041). Moreover, a significantly greater proportion of patients had grade 0 papilledema (p-value<0.0001). While the incidence of nystagmus and esotropia increased significantly (both p-values<0.0001). Conclusion. At 6 months, the majority of the patients had good VOs, including significant improvement in moderate VA, papilledema, and retinal venous dilatation. While nystagmus and esotropia increased significantly.

Nail Disorders in Patients Living with HIV Coinfected with Monkeypox: A Clinical Study in 69 Mexican Cases

Introduction: Several infectious diseases can present nail manifestations, which may be useful for diagnosis and prognosis, and only a few reports have been made regarding monkeypox (mpox). The objective of this study was to describe the clinical characteristics of nail alterations in patients living with HIV coinfected with mpox. Methods: A prospective, cross-sectional study included patients living with HIV/AIDS, coinfected with mpox. We examined all 20 nails in search of nail plate alterations. Patients were divided into two groups, with and without nail disease, and the CD4 count was noted according to the Centers for Disease Control and Prevention (CDC) classification. A χ2 or Fisher’s exact test for qualitative variables and Mann-Whitney U and Kruskal-Wallis tests with post hoc Bonferroni test for quantitative variables were used to compare them. Data were analyzed with the SPSS Statistics 25 software. Results: Sixty-nine patients were included. The frequency of nail involvement was 58%. Papulonodular lesions were the most frequent type identified, with 21 cases (30.4%). A significant difference was observed between patients with nail disease versus median CD4 count (160 vs. 700/mm3; p = 0.002) and median HIV viral load (45,000 vs. 900/mL; p = 0.009). When comparing the characteristics of the nail lesions with the CDC Classification System for HIV infection by the CD4 count, a significant difference was observed in foot involvement, splinter hemorrhages, papulo-nodular lesions, anonychia, onychomadesis, acute paronychia, and nail bed ulcer-atrophy (p < 0.05). Conclusions: The frequency of nail lesions is high in patients living with HIV coinfected with mpox. In addition, they tend to be more destructive in patients with lower CD4 counts and higher viral loads.

Visual Outcomes in Malignant Hypertensive Retinopathy Cases: A Clinical and Spectral Domain Optical Coherence Tomography Study.

Objective The objective is to correlate visual outcomes in malignant hypertensive retinopathy with changes in systemic causative factors and spectral domain optical coherence tomography (SD OCT) morphologic parameters. Materials and methods This is a prospective observational study including patients presenting within two weeks of acute rise of systolic blood pressure (SBP) ≥ 180 mm Hg or diastolic blood pressure (DBP) ≥ 120 mm Hg and with posterior segment involvement in both eyes. Baseline SBP, DBP, mean arterial pressure (MAP), best corrected visual acuity (BCVA), and SD OCT parameters such as central macular thickness (CMT), subfoveal choroidal thickness (SCT), and sub-retinal fluid (SRF) height were measured at presentation and followed monthly up to three months. These variables at baseline and three months were compared and correlated. Results Thirty-three patients (66 eyes) having malignant hypertension were included in the study. Diverse clinical presentations noted among patients were optic disc edema, hard exudates in the macula, peripapillary splinter hemorrhage, cotton wool spots, Elschnig spots, exudative retinal detachment, optic neuropathy, and severe exudative retinopathy. SD OCTshows hyperreflective dots and intraretinal fluid with or without SRF.At three months, the mean SBP, DBP, MAP, CMT, SRF, and SCT all decreased significantly from baseline (p<0.001). Changes in SBP, DBP, MAP, and SCT correlated significantly with changes in BCVA (p<0.001). Conclusion In malignant hypertensive retinopathy, macular edema with SRF is the major cause of mild-to-moderate decrease BCVA at presentation, but macular ischemia, exudative RD, and optic neuropathy can cause a significant decrease in vision. A decrease in SBP, DBP, MAP, and SCT correlatesignificantly with visual outcomes.

Multiple Onychopapillomas and BAP1 Tumor Predisposition Syndrome

BRCA1-associated protein (BAP1) tumor predisposition syndrome (TPDS) is a cancer genodermatosis associated with high risk of uveal and cutaneous melanoma, basal cell carcinoma, and multiple internal malignant neoplasms, including mesothelioma and renal cell carcinoma. Early detection of the syndrome is important for cancer surveillance and genetic counseling of family members who are at risk. To determine the prevalence of nail abnormalities in individuals with pathogenic germline variants in BAP1. In this prospective cohort study, individuals who were known carriers of pathogenic BAP1 germline variants were consecutively enrolled between October 10, 2023, and March 15, 2024. Dermatologic evaluation for nail abnormalities was performed, including a history of nail abnormalities and associated symptoms, physical examination, medical photography, and nail biopsy for histopathology. This was a single-center study conducted at the National Institutes of Health Clinical Center. Primary outcomes were the prevalence and spectrum of nail changes and histopathologic characterization. Among 47 participants (30 female [63.8%]; mean [SD] age, 46.4 [15.1] years) ranging in age from 13 to 72 years from 35 families, nail abnormalities were detected in 41 patients (87.2%) and included leukonychia, splinter hemorrhage, onychoschizia, and distal nail hyperkeratosis. Clinical findings consistent with onychopapilloma were detected in 39 patients (83.0%), including 35 of 40 individuals aged 30 years or older (87.5%). Nail bed biopsy was performed in 5 patients and was consistent with onychopapilloma. Polydactylous involvement with onychopapillomas was detected in nearly all patients who had nail involvement (38 of 39 patients [97.4%]). This study found that BAP1 TPDS was associated with a high rate of nail abnormalities consistent with onychopapillomas in adult carriers of the disease. Findings suggest that this novel cutaneous sign may facilitate detection of the syndrome in family members who are at risk and patients with cancers associated with BAP1 given that multiple onychopapillomas are uncommon in the general population and may be a distinct clue to the presence of a pathogenic germline variant in the BAP1 gene.

Onychoscopy and nailfold capillaroscopy in leprosy: A case–control study

Objectives: Studies have reported significant number of individuals with leprosy develop nail changes of heterogeneous variety. Direct or indirect damage secondary to neural damage, repeated trauma, vascular injury, anemia or following drug therapy have been implicated. In this study, we compared nail changes in cases of leprosy with controls to determine leprosy specific nail changes through detailed onychoscopic evaluation along with nailfold capillaroscopy. Materials and Methods: We performed a case–control study in a tertiary care institute with 30 leprosy patients and 30 age- and sex-matched controls. The study was done over a period of three months from June 2023 to August 2023. Patients were classified as per Ridley-Jopling classification. A detailed clinical examination followed by onychoscopy and proximal nailfold (PNF) capillaroscopy using Dermlite DL4 was done in all the nails of cases and controls. Results: A total of 600 nails of 30 leprosy patients on treatment attending our outpatient department were studied over a span of three months. Nail changes were seen in 26 (86.6%) out of 30 patients of leprosy disease compared to 10 (33.3%) of the controls. The most common nail finding seen in leprosy patients was longitudinal melanonychia followed by leukonychia. Transverse lines, leukonychia, subungual hyperkeratosis, nail discoloration, nail pallor, onychochauxis, subungual hematoma, splinter hemorrhage, and brachyonychia were seen more in cases than in controls, and the difference was statistically significant. The PNF capillaroscopy showed microhemorrhages in eight patients of leprosy while none in controls. Conclusion: Nail changes seen in leprosy are multifactorial. The PNF capillaroscopy showed microhemorrhages, which could be an early feature of vascular changes in leprosy.

Nail involvement in connective tissue diseases: an epidemiological, clinical, and dermoscopic study.

The assessment of nail changes in connective tissue diseases (CTD) has been rarely explored in previous studies. The use of dermoscopy to study vascular changes in nailfolds is an interesting diagnostic technique. The aim of the study was to describe the epidemiological, clinical, and dermoscopic features of nail lesions in CTD. A prospective study was performed at the Dermatology Department of Habib Thameur Hospital (Tunis, Tunisia) in collaboration with the Internal Medicine Department over a period of 15 months, from July 2020 to September 2021, including patients diagnosed with systemic sclerosis (SS), systemic lupus erythematosus (SLE) and dermatomyositis (DM). Our study included 48 patients. Nail involvement was found in 44 cases. Dermoscopic nailfold abnormalities were identified in 37 cases. The most common clinical features were ragged cuticle, nailfold erythema, and onycholysis. Additionally, splinter hemorrhage, longitudinal ridging, lunula abnormalities, melanonychia, trachyonychia, leukonychia, increase in transverse curvature, parrot beak nail, half and half nails, and onychorrhexis were described. Nailfold dermoscopy showed a normal pattern in 10 cases, a nonspecific pattern in nine cases (SLE), and a scleroderma pattern in 29 cases (SS and DM). The scleroderma pattern was further categorized into an early pattern (6), an active pattern (14), and a late pattern (9). Normal pattern was observed solely in patients in remission. The late scleroderma pattern was associated with disease duration and systemic involvement. In SLE, disease activity correlated with onycholysis, nailfold erythema, and pathologic pattern in dermoscopy. However, patients with DM displayed a positive correlation between pulmonary involvement and scleroderma pattern. Nail involvement in CTD includes a diverse range of abnormalities. Despite being nonspecific, it can provide crucial clues for establishing a diagnosis. Nailfold dermoscopy serves as a mirror for microangiopathy, enabling the detection of changes at an initial stage, and thus, it becomes a diagnostic and prognostic tool.

Breaking the mould: An essential need in optic neuritis management

Aims/Purpose: To present a clinical case to highlight the importance of ophthalmological examination in the management of optic neuritis.Methods: Case report.Results: A 45‐year‐old woman with Sjögren's syndrome and a family history of MS presents to the emergency department. She complains of decreased vision OD for the past 4 days, with exacerbated‐by‐eye‐movements retroocular pain and migraine‐like headache. BCVA is amaurosis OD and 1 OI, with right RAPD and no colour vision impairment in OI. Except for optic disc oedema with splinter haemorrhages in OD the rest of the ophthalmological examination is normal. RNFL‐OCT reveals thickening in the OD (220 μm/110 μm). Brain CT and laboratory tests, including D‐dimers, are normal. A LP is performed to rule out infectious causes is normal. Neurofilament and ESR are also normal. Brain and spinal MRI show no abnormalities. Due to the severity, methylprednisolone therapy is initiated. One week later, her symptoms are stable, except for headache and retroocular pain improvement. Upon reassessment, despite preserved BCVA and Ishihara in OI, an increase in RNFL thickening is noted in OI (120 μm), with partial arcuate defect in visual field. Anti‐MOG, AQP4 and a panel of autoantibodies including anti‐Ro and anti‐La, are still pending. Considering the bilateral involvement, plasma exchange therapy is initiated. 14 days after, BCVA OU has improved to 1, and the visual field and Ishihara test have normalized. RNFL thickening is still observed OU (161/120 μm) and there is persistent optic disc edema OD. Anti‐MOG are positive, AQP4‐Ab are negative, and both negative in CSF.Conclusions: The coexistence of other autoimmune diseases, can lead to attributing the ON to that disease rather than considering the neuroinflammatory aetiology, leading to delayed diagnosis. The detection of subclinical bilateral involvement was crucial in escalating the therapeutic regimen. Seropositivity is the confirmatory diagnostic marker, but in many centres, it may be difficult to obtain reliable biomarker data.

Nail Psoriasis: Clinical Features and Severity Assessment.

The nail is an important characteristic in the context of psoriasis. Nail psoriasis exhibits several clinical manifestations. Since the development of the Nail Psoriasis Severity Index (NAPSI) score assessment tool for evaluating the severity of nail psoriasis, nail matrix symptoms such as pitting, leukonychia, crumbling, and red spots have been observed in the lunula. Nail bed symptoms include onycholysis, subungual hyperkeratosis, oil spots, and splinter hemorrhage. However, Beau's lines and nail fold psoriasis, which are not included in this assessment tool, should be considered essential symptoms for indicating the activity of nail psoriasis. Although NAPSI is the most widely used tool for assessing the severity of nail psoriasis, it has uncontrolled limitations. Although other assessment tools have been developed, none have successfully replaced the NAPSI. In clinical trials for nail psoriasis, the NAPSI is used in various forms, such as improvement rates, changes in the mean NAPSI score, and achievement rates of NAPSI 75. Consequently, caution is warranted when interpreting the clinical trial results related to nail psoriasis improvement.

Pellagroid rash secondary to cabozantinib

Abstract Cabozantinib is a tyrosine kinase inhibitor used to treat advanced renal cell carcinoma, hepatocellular carcinoma, and medullary thyroid cancer. Adverse cutaneous events include hand-foot skin reaction, generalized pigment dilution and/or hair depigmentation, xerosis, scrotal erythema/ulceration, and nail splinter hemorrhages. Here we discuss a case of pellagra like rash in a 61 year old man having renal cell carcinoma induced by cabozantinib not described in literature so far.

Nail psoriasis in China: A prospective multicentre study.

Data on nail psoriasis (PsO) in China are scarce. To provide nail PsO-related data regarding epidemiologic characteristics, manifestations, fungal infections, arthritic complaints and treatments that may facilitate improved patient management globally. From August 2021 to August 2022, patients with nail PsO were enrolled in a prospective multicentre observational study at 25 hospitals in China. We collected and analysed data concerning nail PsO demography, clinical signs, fungal detection, arthritic symptoms and treatment. A total of 817 patients with nail PsO were involved, with a mean body mass index of 24.13 ± 2.93. In addition, 71.41% of the patients were male. The Nail PsO Severity Index score was weakly positively correlated with body surface area. The percentage of nail involvement was 95.29% for fingernails and 57.18% for toenails, with pitting (67.11%) and subungual hyperkeratosis (60.40%) being the most prevalent manifestations, respectively. Toenails showed a significantly higher frequency of nailfold scales, subungual hyperkeratosis and nail plate crumbling and a lower frequency of splinter haemorrhages, pitting and erythema of the lunula. A total of 13.26% of the PsO patients had onychomycosis, and 77.08% were observed in the toenails. Articular symptoms were reported by 12.17% of the patients, with the peripheral type being predominant. Significant associations between articular symptoms and nailfold swelling, subungual hyperkeratosis, nailfold scales, onycholysis and longitudinal ridges were found. Only 2.30% (20 out of 871) of patients with nail PsO received treatment. The most frequently employed therapy for cutaneous PsO with nail involvement was biologic therapy (n = 366). PsO showed distinct manifestations in the toenails and fingernails. Additionally, toenail PsO combined with onychomycosis requires special attention. Articular symptoms in psoriatic patients are associated with specific nail changes. It is important to research and advocate for more potent treatments for nail PsO.

Infective Endocarditis Following Aortic Valve Replacement: A Systematic Review.

Aortic valve replacement (AVR) successfully treats aortic valve stenosis and aortic regurgitation from aging or bicuspid aortic valves. The procedure intends to restore the obstructed left ventricular outflow tract (LVOT). AVR can be performed surgically (surgical aortic valve replacement (SAVR); open heart) or via transcatheter (transcatheter aortic valve replacement (TAVR)), typically done through a femoral approach as a minimally invasive procedure, allowing for quicker recovery and reduced hospital stays. AVR has many complications, including life-threatening ones, such as infective endocarditis (IE), retarding the recovery processand increasing mortality following surgery. IE is an uncommon and deadly condition that involves multiple organ systems and is caused by bacteremia stemming from amicroorganism that enters the bloodstream. Many manifestations are involved in the development of IE, such as fevers, flu-like symptoms, splinter hemorrhages, Osler nodes, abscesses, and vegetations found on the valves at the leaflets. Vegetations and abscesses tend to create further complications, such as stroke and acute kidney injury, as emboli block blood flow, leading to ischemia and damage. This paper aims to evaluate the difference in SAVR- and TAVR-associated IE, as the goal is to elucidate a danger that diminishes the positive effects of either procedure despite its rarity. Studies have been inconclusive in determining whether or not there is a trend, let alone a difference in incident rates. Both procedures share similar risk factors, but SAVR-associated IE is usually caused by Staphylococcus aureus,and studies indicate possibly Enterococcus spp. in TAVR-associated IE. Incident rates of IE are much higher than they should be, whether or not they differ between procedures, and future research needs to consider the pathways and risk factors that can be used to reduce the occurrence of AVR-associated IE.

Risk of Infective Endocarditis Post-transcatheter Pulmonary Valve Replacement Versus Surgical Pulmonary Valve Replacement: A Systematic Review.

Pulmonary valve replacement (PVR) is the most common cardiac operation in adult patients with congenital heart disease (ACHD). It can improve right ventricular outflow tract (RVOT) obstruction, typically due to pulmonary valve stenosis or regurgitation. PVR can be performed surgically (open-heart) and through a transcatheter (percutaneous) method, which is minimally invasive and is associated with shorter hospitalization stays. However, following PVR, infectious endocarditis (IE) can complicate the recovery process and increase mortality in the long term. IEis a rare but deadly multi-organ system condition caused by microorganisms traversing the bloodstream from a specific entry point. It can have many presentations, such as splinter hemorrhages, fevers, and vegetation on valves that lead to stroke consequences. This paper aims to evaluate the differences in the rate, etiology, manifestations, treatment, and outcomes of IE following surgical and transcatheter PVR, as the goal is to perform a procedure with few complications. In both approaches, Staphylococcusaureus was the most common microorganism that affected the valves, followed by Streptococcus viridians. Research has shown that surgical pulmonary valve replacement (SPVR) has a decreased risk of IE following surgery compared to TPVR. However, TPVR is preferred due to the reduced overall risk and complications of the procedure. Despite this, the consensus on mortality rates does differ. Future research should consider the type of valves used for transcatheter pulmonary valve replacement (TPVR), such as Melody valves versus Edward Sapien valves, as their IE rates vary significantly.

Clinico-epidemiological profile and onychoscopic pattern of nail disorders in geriatric population

Background: Adequate knowledge about nail changes in the geriatric population can help in the early identification and timely treatment of underlying disease adding to the quality of life of the elderly population with nail concerns. The present study is aimed to study the clinico-epidemiological profile and onychoscopic pattern of nail disorders in geriatric populations. Methods: This observational study included 100 subjects aged 60 years or more. Clinical examination and onychoscopic examination by Dermlite DL4 dermoscope with 10x magnification of the nail bed, nail plate, nail fold, and hyponychium in all the 20 nails were done. Even single positive findings in a single nail are considered in the study. If clinically suspected of onychomycosis, 20% potassium hydroxide mount was performed to identify fungal elements. Results: Mean age of the subjects was 66.27±5.546 years. Male: female ratio was 2.1:1. Mean duration of complaints pertaining to nail changes was 4.7±3.864 years. The damaged cuticles were the universal finding in all the subjects (100%) in nail fold examination, nail dystrophy and longitudinal ridges were seen in all [100.0%)] subjects of nail plate examination. The most frequently observed change in nail bed has been splinter haemorrhage [26% versus. 32%] and in hyponychium was subungual hyperkeratosis [36% versus 37.0%] clinically and dermoscopically respectively. Onychomycosis was diagnosed in 25% of total subjects. Conclusions: Onychoscopy is an important, non-invasive modality to identify and diagnose the nail changes earlier which helps in managing the disease earlier.

Melanonychia and subungual papule in a middle-aged man

Melanonychia and subungual papule in a middle-aged man

Onychoscopic Features of Nail in Chronic Plaque Psoriasis: A Cross-Sectional Study of 100 Patients

Background: Nail involvement is a feature of 30%–50% of psoriasis patients. Only 5%–10% of patients have isolated nail psoriasis. Examination of the nail unit using a dermoscope is known as onychoscopy. The usefulness of onychoscopy in the early detection of nail psoriasis needs to be evaluated. Objective: The objective of this study was to describe the onychoscopic features in chronic plaque psoriasis patients. Materials and Methods: In this cross-sectional study, 100 patients with chronic plaque psoriasis were recruited. Onychoscopy was performed, and results were compared with the same age- and sex-matched controls. The various onychoscopic features were assessed using the Chi-square test (P &lt; 0.05 was considered significant). The statistical analysis was done using the application named Epi Info™. Results: Out of 100 psoriasis patients, 39 patients showed clinically evident nail involvement on the naked eye, whereas 64 patients showed nail involvement on onychoscopic examination. The mean age of patients observed in our study was 37.5 years. Out of 64 patients, 43 were male and 21 were female. Pitting was the most common finding seen in 55 (85.93% and P = 0.0001) patients, followed by transverse groove in 18 (28.12% and P = 0.025), subungual hyperkeratosis in 16 (25% and P = 0.035), nail plate crumbling in 16 (25% and P = 0.0009), and oil drop sign in 8 (12.5% and P = 0.010) patients. Only these five parameters were statistically significant. Furthermore, other findings observed were onycholysis in 7 (10.93% and P = 0.166), leukonychia in 12 (18.75% and P = 0.614), splinter hemorrhages in 8 (12.5% and P = 0.099), pseudo-fiber sign in 4 (6.25% and P = 0.127), lunular red spots in 3 (4.68% and P = 0.242), and dilated globose vessels were seen in 4 (6.25% and P = 0.127) patients. Conclusion: Onychoscopy is a useful noninvasive method to detect subclinical nail involvement, which may not be visible to the naked eye.

Sonographic Features of Onychopapilloma: A Single Center Retrospective Observational Study

(1) Background: Onychopapilloma is a benign tumor of the nail bed and distal matrix. which usually manifests as monodactylous longitudinal eryhtronychia associated with subungual hyperkeratosis. The impossibility to rule out a malignant neoplasm is an indication for surgical excision and histological examination. Our aim is to report and describe the ultrasonographic features of onychopapilloma. (2) Methods: we conducted a retrospective analysis of patients with a histological diagnosis of onychopapilloma who underwent ultrasonographic examination in our Dermatology Unit from January 2019 to December 2021. (3) Results: Six patients were enrolled. Erythronychia, melanonychia, and splinter hemorrhages were the main dermoscopical findings. Ultrasonography detected nail bed dishomogeneity in three patients (50%) and a distal hyperechoic mass (5 patients, 83.3%). Color Doppler imaging did not show vascular flow in any of the cases. (4) Conclusions: the detection of a subungual distal non-vascularized hyperechoic mass by US, together with classical onychopapilloma clinical features, supports the diagnosis, especially in those patients who were unable to perform excisional biopsy.