Toe Nails Research Articles

Relapses of ingrown toenail: causes and treatment features

Introduction.The recurrent course of an ingrown toenail remains a serious problem to this day, despite the centuries-old history of its study. Among outpatient patients, the incidence of this disease reaches 10% and does not tend to decrease, and among the population, the incidence of ingrown toenail is 3.4%. Theaimof the work was to study the causes of recurrent ingrown toenail and the effectiveness of using a laser beam in the treatment of this pathology.Material and methods.The authors analyzed the causes of recurrent ingrown toenail in 66 patients after various surgical interventions for the period from 1990 to 2020.Results and discussion.The following causes of relapse of the disease were identified: removal of the entire nail plate not according to indications, carrying out marginal resection of the nail on the affected side with the preservation of the nail plate matrix, performing removal of granulations in the nail roller area with the preservation of the nail, underestimating the importance of anti-inflammatory drug treatment in the postoperative period, as well as the importance of correcting metabolic processes in patients with concomitant pathology. A clinical case is presented: a patient with a non-healing wound after four surgeries due to an ingrown toenail with a recurrent course. The patient underwent a Schmiden surgery with resection of the “ingrown edge” of the right first toe nail and removal of infected granulations using laser irradiation of the wound and careful treatment of the matrix area in the projection of the removed part of the nail. In the postoperative period, bandages with ointment based on chloramphenicol and methyluracil were used for local treatment. Recovery occurred on the fourteenth day.Conclusion.In order to reduce the number of relapses of the disease, it is recommended to perform a matrixectomy of the bed of the removed nail plate using laser or radio wave radiation.

Scissors and tweezers: A skin-picking disorder case report

IntroductionSkin-Picking Disorder (SPD) is psychiatric condition characterized by recurrent and excessive picking of the skin. There are several attempts to stop the behavior and it causes negative consequences such as dermatological complications and functional impairment.ObjectivesThe aim of this study is to describe a case report of SPD.MethodsData was collected retrospectively from case notes.ResultsA 30 year-old male, married with 2 children, currently on sick leave, was admitted to the Day Hospital at Centro Hospitalar Psiquiátrico de Lisboa (CHPL) with worsen skin-picking behaviour and functional impairment. During childhood the patient would “cut my toe nails the wrong way so that I could fix them”. By adolescence the patient suffered from acne and felt the need to “solve” them and take out the pus. Over the years the skin-picking behaviour spread to other areas of the body, mainly dorsal and chest areas. Before being admitted to the Day Hospital the episodes were daily and had 2-3 hours duration, using scissors and tweezers and evolving his family, asking his wife’s help with picking. He is being treated with fluoxetine 80 mg, risperidone 2 mg and N-acetylcysteine 1200 mg and Cognitive Behavioural Therapy. He is also participating in the Day Hospital activities that include occupational therapy, movement therapy, psychoeducation. After 2 months he has a few 20 minutes episodes per week, spends more time with his children and thinks about coming back to work.ConclusionsSPD is a severe and debilitating illness that benefits from a multidisciplinary approach.DisclosureNo significant relationships.

Maternal transmission of a mild Coffin\u2013Siris syndrome phenotype caused by a SOX11 missense variant

Here we report for the first time on the maternal transmission of mild Coffin–Siris syndrome (CSS) caused by a SOX11 missense variant. We present two sisters with intellectual disability and muscular hypotonia born to non-consanguineous parents. Cogan ocular motor apraxia was present in both sisters. Body measurements were in a normal range. The mother and both daughters showed hypoplastic nails of the fifth toes. A missense variant in SOX11 [c.139 G > A; p.(Gly47Ser)] in both sisters and their mother was identified. Since 2014, variants in SOX11 are known to cause mild CSS. Most described patients showed intellectual disability, especially concerning acquired language. All of them had hypoplastic nails of the fifth toes. It is of note, that some of these patients show Cogan ocular motor apraxia. The facial dysmorphic features seem not to be specific. We suggest that the combination of Cogan ocular motor apraxia, hypoplastic nails of fifth toes, and developmental delay give the important diagnostic clue for a variant in the SOX11 gene (OMIM 615866, MR 27).

Familial median canaliform dystrophy of heller affecting multiple nails: a rare clinical entity

<p class="abstract">Median canaliform dystrophy (MCD); first described by Heller in 1928 is characterized by a midline or paramedian split in the nail plate. Mostly idiopathic, some identifiable causes include habitual picking of the nails, oral isotretinoin use and positive family history. The familial occurrence of MCD has rarely been described. Till date, no therapy has proven to be consistently successful in effectively managing the condition. Commonly utilized treatments have been intralesional triamcinolone acetonide injections into the dystrophic nail, topical 0.1% tacrolimus ointment and topical tazarotene 0.05% ointment. Despite available treatment options, the condition has a tendency to recur. Here; we report a case of a 14‑year‑old male presenting with familial MCD affecting multiple finger and toe nails.</p>

Trachyonychia in a child with concomitant alopecia areata and lichen planus

<p>Trachyonychia of nails has been found to be associated with dermatoses such as lichen planus, psoriasis, alopecia areata etc. When involving all the finger and toe nails bilaterally, it is referred to as ‘twenty nail dystrophies. We, hereby, report a case of trachyonychia in an 8-year-old boy, with concomitant lichen planus and alopecia areata. He was successfully treated with biweekly pulse systemic corticosteroid therapy for duration of 6 months. Significant response was noted at the end of 6 months in terms of hair re-growth; improvement of nail texture, thickness and subungual hyperkeratosis; and resolution of skin lesions.</p>

Toe nail changes in diabetes mellitus

Introduction: Diabetes is a metabolic disorder caused by abnormal release of or sensitivity to the insulin hormone, with loss of blood glucose control. Un controlled diabetes can have devastating effects on many organ systems including cardiovascular, neurologic, ocular, and renal, with its impact on skin, hair, and nail. diabetes mellitus is a predisposing factor for onychomycosis (OM),paronychia and ingrowing toe nail defects. In the present study evaluation of the prevalence and types of nail changes was done. Materials and Methods: During a 1 year study period (June 2018 to May 2019), patients with diabetes mellitus were screened for toenail changes. Demographic, social, and clinical data were recorded. Informed written consent was taken. Fungal infection was confirmed by nail clippings microscopy. Results: Of the 60 patients most common nail changes are subungual hyperkeratosis, onycholysis, and onychomycosis, and less common changes are Twenty nail dystrophy, Dorsal pterygium, Terry’s nail in liver disease and diabetes mellitus and Subungual wart. Conclusions: Physicians who care for diabetic patients should not ignore nail changes. Careful global evaluation of patients with diabetes should include observation of nail changes. Keywords: Nails, Diabetes mellitus.

Dual approach transformation of human finger and toe nail pruning into MgO/CaO nanoalloy

Interventions of biological entities mediated nanobiotechnological syntheses, in the strive to adapt inexpensive green approaches for constructing materials in the nanodimension for achieving targeted applications with improved performances, are being increasingly preferred. In context, this research article reports to bring into existence applaud able technique, concerning waste utilization for conversion into value added nanomaterial, to manage environmental issues as well as suffice biomedical demands and meet tough challenges from several domains. Pruning nail plates of the fingers and toes, has been a routine affair for the maintenance of personal care, in human civilization. Here we focus the bioengineering of MgO/CaO nanoalloy, by transforming remnant vestigial human finger and toe nail pruning, through dual approach protocols. Obtained yields through direct heat and following chemical treatment protocols were around 61.9% and 62.0%, respectively. Noticeable, quadrangular nanostructural arrangement in sequential array was observed for the MgO/CaO nanoalloy engineered through sol-gel chemical processing prior to thermal decomposition. Chemical treatment of the precursor enabled, formation of large stretches of uniform nanopattern and homogenous distribution to a great extent, from hydroxides of Mg and Ca instead of their salts. The scalable self-assembly with imparted ordered alignment shall inevitably manifest improved nanoalloy activity rather than the randomly distributed nanostuctures attained from direct thermal decomposition of their salts. The multifunctional green MgO/CaO nanoalloy, having tested thermal stability, consisting substantive Ca and Mg, incorporates the dual advantageous of nano MgO and nano CaO, logistically rendering superior benefits. Required characterizations were performed for the investigation of the significant nanostructures, comprising magnificent quadrangular nanobricks, nanorods and nanospheres, derived from the renewable bioresource.

Intra-individual Right-Left Comparative Study of Combined Therapy of Intramatricial Triamcinolone and Platelet-Rich Plasma vs. Intramatricial Triamcinolone Only in Lichen Planus-Associated Nail Dystrophy.

Background:While intramatricial triamcinolone is the most commonly used treatment option for onychodystrophy due to lichen planus, the role of platelet-rich plasma (PRP) in the treatment of onychodystrophy is not established. So we combined the two treatment modalities to assess the synergistic action on nail dystrophy.Aims and Objectives:The aim of this article is to compare the effect of combination of intramatricial triamcinolone and PRP vs. intramatricial triamcinolone alone in the treatment of onychodystrophy.Materials and Methods:This study was done in 26 and 25 pairs of symmetrical dystrophic nails in hands and feet, respectively. The patients received intramatricial injection of triamcinolone and PRP on one side of finger and toe nails and triamcinolone on the contralateral side.Results:Statistically significant improvements in grades of dystrophy according to the Nail Dystrophy Grading System (NDGS) in the finger and toe nails treated with combined therapy were obtained (P < 0.001 and = 0.002, respectively). According to the physician global assessment, response to combination therapy was statistically significant between the two comparison groups of finger and toe nails (P = 0.001 and = 0.004, respectively). Similarly, according to the patient satisfaction score, statistically significant difference was found between the comparison groups of combination therapy and single therapy (P < 0.001).Conclusion:Addition of PRP significantly improved the nail quality. Intramatricial PRP is a safe and effective therapeutic modality in refractory nail dystrophies.

Epidemiology of dermatophytoses in paediatric population in Southwestern Poland, 2011-2016.

IntroductionDermatophytoses are the most common superficial fungal infections in paediatric population. Its pathogen pattern has changed over years.AimTo analyse the spectrum of dermatophytoses in children living in Southwestern Poland, in the years 2011–2016.Material and methodsA total of 1705 patients were diagnosed with fungal skin infection in the Mycological Laboratory, Dermatology Department of the Wroclaw Medical University. Of them, 163 were under 18 years of age.ResultsIn 105 cases, dermatophytoses were detected. The collected specimens were examined using direct microscopy examination, staining, culture on specific media and PCR technique. The most common dermatophytes were Trichophyton rubrum and Trichophyton tonsurans (31.4% each), followed in the descending order by Trichophyton mentagrophytes (21.9%), Microsporum canis (13.3%) and Epidermophyton floccosum (1.9%). The most commonly affected body sites were glabrous skin of the trunk and extremities (41.7%), followed by face (22.2%), scalp (15.7%) and toe nails (14.8%).ConclusionsThis study revealed the most common types of dermatophytoses and their pathogens in children in Southwestern Poland. In comparison to earlier data obtained from this region, new epidemiological trends have been revealed. We observed the shift towards anthropophilic dermatophyte infections and an increasing number of onychomycosis in children. Because of climatic variations, migration, and changing lifestyle practices, further studies on dermatophytoses are necessary to improve our knowledge on the epidemiology of fungal infections.

Yellow Nail Syndrome

The ‘Yellow Nail Syndrome’ is a condition characterized by yellowish-brown finger and toe nails, lymphedema of the legs and pleural effusion. It is a rare condition, reported infrequently in literature. This report is of a case of yellow nail syndrome in a 32-year-old female, native of Maldives. She had noticed yellowing of nails along with symptoms of allergic rhinitis ten years ago. She was diagnosed to have asthma with cor-pulmonale from elsewhere. She came here for surgical treatment of leg edema. She was also found to have yellow nails with allergic rhinitis and asthma. There was no evidence of bronchiectasis or pleural effusion which are the usual reported associations. Cardiac evaluation done revealed no abnormality. Bilateral inguinal nodo-venous shunt was done which relieved her edema to a large extent. Her diagnosis was delayed for nearly ten years entailing a lot of financial burden and mental strain.

Nail Patterns in Papulosquamous Disorders- An Observational Study from Southern India

Introduction: Nail changes are always a cause of physical handicap and psychological stress in this era where utmost importance is given to cosmetic appearance. Other than trauma and infections, Papulosquamous disorders are major contributor to nail changes. Thorough knowledge of their patterns will aid in early detection and treatment before irreversible damage to nails occurs. Aim: To observe the clinical patterns of nail changes in various papulosquamous disorders. Materials and Methods: This observational descriptive cross- sectional study was conducted in a tertiary care set up at Government Coimbatore Medical College, Coimbatore from June 2016 to June 2017. The study group comprised of 104 cases of various papulosquamous disorders. The type of papulosquamous disorder, presence of nail changes, their onset, duration, various patterns and associated co-morbidities were noted in detail. The observed data were entered in Microsoft Excel and data analysis was done in Epi Info system. Results: Out of the 104 cases taken for study 71 (68%) had nail changes. Majority of them were in 31-45 years age group (n=29; 41%). More of males (n=38, 54%) had nail changes than the females (n=33, 46%). Psoriasis (n=47; 66%) was the most common papulosquamous disorder with nail changes followed by lichen planus (n=9; 13%) and pityriasis rubrapilaris (n=7; 10%). Pitting of nails was the most common nail pattern (n=44; 62%), followed by subungual hyperkeratosis (n=24; 34%), thickened nail plate and longitudinal striations (both n=19; 27%). Finger nails were more affected than toe nails. Psoriasis and pityriasis rubrapilaris had 100% nail involvement. The patterns of nail changes were maximum in psoriasis and lichen planus. Beaus lines was observed in most of the papulosquamous disorders except Lichen nitidus and Lichen striatus. The time gap for onset of nail changes was longer for psoriasis (4.2 years) and shorter for pityriasis rosea (two months). In lichen striatus and lichen nitidus, nails were involved only in children. Minimal nail changes were observed in para psoriasis and pityriasis lichenoides. More number of co-morbidities like diabetes, hypertension, atopy and arthritis were seen in psoriasis. Conclusion: In the present study, it was observed that the nail changes were more common in psoriasis, lichen planus and pityriasis rubra pilaris among the papulosquamous disorders. The highly frequent nail patterns were pitting and subungual hyperkeratosis.

Which would you like to use Tsume-flat or Tsume-cap, for the treatment of ingrown/incurvated nails of great toes?

Which would you like to use Tsume-flat or Tsume-cap, for the treatment of ingrown/incurvated nails of great toes?

16221 Nail and skin changes on long second toes: A study of 118 pairs of toes

Background: Nail can be affected by trauma, infection, and systematic disorders. In particular, the toe nails are exposed to the repeated and cumulative minor traumas, which usually result in thickened, splitted, and discolorated nails. Considering these, it can be inferred that the long second toe can be related to various nail and skin changes by repeated minor traumas such as friction in shoes, but the study or report on this topic hasn’t been done yet. The purpose of this study was to introduce various nail and skin changes on long second toe.

A psoriasis és az onychomycosis együttes előfordulása

In a three year period, authors observed 16 cases whith plaque psoriasis accompanied with nail symptoms characteristic for typical psoriasis. Microscopy examinations were positive in cases of 7 in fingernails, and in 3 cases of toe nails. In cultures, pathogenic agents were grown in 4 cases from finger nails, in 2 cases from toe nails. Considering the 16 psoriasis cases out of the 1087 mycotic tests carried out in the 3 years period, onychomycosis occurred only in 1,5% of the cases. Therefore further studies are needed for the assessment of onychomycosis in psoriatic cases.

Dermatophytes, dermatophytosis in the Caribbean and potential for herbal therapy

Introduction: Dermatophytes are a group of morphologically related keratinophilic fungi that invade keratinized tissue (skin, hair, and nails) of humans and warm-blooded animals to produce clinical lesions (dermatophytosis). Clinical lesions are traditionally divided according to the site infected, namely, scalp (tinea capitis), feet (tinea pedis, commonly called “athletes’ foot”), groin, inner thighs, or buttocks (tinea cruris, commonly called “jock itch”), beard (tinea barbae), hands (tinea manuum, toe nails or finger nails (tinea unguium, also called onychomycosis), face, non-bearded area (tinea faciei) and other parts of the body, such as arms, abdomen, or legs (tinea corporis). Dermatophytosis is common world-wide and is caused by species of three genera of dermatophytes, namely Microsporum, Trichophyton, and Epidermophyton. This study presents an update of ecology of different species of dermatophytes and epidemiology of infections caused by them in the Caribbean. Possibility of herbal therapy of these infections as an alternative treatment is also dealt with.&#x0D; Methods: A thorough search of literature was made using PubMed, MEDLINE, Biomed Lib, Med Facts, and different sets of key words, viz. dermatophytes, tineas in Caribbean, occurrence in animals, soil etc.&#x0D; Results: It was revealed that incidence of dermatophytic infections and their epidemiologic characteristics depend on social, geographic, and environmental factors and may change with passage of time. For instance, prior to year 2000, the major cause of tinea capitis in North America for 100 years was Microsporum canis followed by M. audouinii; Since 1950 Trichophyton tonsurans has advanced from Mexico and the Caribbean to be currently a major cause of tinea capitis in North America. The two dermatophytes Microsporum gypseum and M. fulvum, and several Chrysosporium species have been frequently isolated form soils in different countries in the Caribbean.&#x0D; Conclusions: There is almost complete lack of information on human infections due to dermatophytes in several Caribbean countries. The preponderant occurrence of M. fulvum in Anguilla soils with comparatively rare isolation of M. gypseum is a significant observation. The need for further epidemiological studies on dermatophyosis in the Caribbean countries cannot be overemphasized.

Anonychia Congenita in a Young Boy - A Rare Entity

Congenital anonychia in isolated form is a rare anomaly in which there is absence of nails of fingers and toes since birth. Other ectodermal and mesodermal defects in the body are absent. Here, we report a case of 16 year old male having rare congenital disorder anonychia in his hands and feet except in little finger of right hand, lateral two digits of right foot and thumbs of both hands with deformed nails. All other systemic examinations were normal. His parents and siblings were normal as were the second degree relatives.

Onychomycosis: Current Understanding and Strategies for Enhancing Drug Delivery into Human Nail Tissue.

Onychomycosis is by far the most common finger or toe nail fungal infectious disease caused by dermatophytes, non-dermatophytic molds or yeast. It accounts for 50% of the total nail disorders, and affects patients physically, socially, and psychologically and can seriously influence their quality of life. Oral antifungals are routinely used to treat the nail fungal disease; however oral therapy is associated with severe side effects and longer treatment times. In recent years, drug delivery directly into the nail or nail bed has gained attention and various topical products have been tested that can cure the disease when applied topically or transungually. Nevertheless, drug penetration into and through the nail is not straightforward and requires chemicals to improve its permeability or by applying physical stress to promote drug penetration into and through the nail. This lucid review presents an overview of various causes of onychomycosis, current therapeutic approaches, and efforts aimed at increasing the permeability of nails through various strategies such as chemical, physical and mechanical methods for permeation enhancement. Various strategies have been proposed for the treatment of onychomycosis, however, much research into a more precise and effective therapy is still required.

Treatment of idiopathic onychodystrophy with a 1064 nm picosecond neodymium-doped:yttrium aluminum garnet laser: A retrospective study.

Laser treatment has emerged as a novel treatment modality for onychodystrophy. Only a few small series have assessed the efficacy of laser treatment in onychodystrophy, most of which were case reports. The therapeutic effect of the 1064nm neodymium-doped:yttrium aluminum garnet (Nd:YAG) laser for onychodystrophy has been demonstrated. Recently, the picosecond Nd:YAG (PSNY) laser has been introduced to improve various skin disorders. The aim of this study was to verify the efficacy of a 1064nm PSNY in management of idiopathic onychodystrophy. We present a case series of dystrophic nails treated with a PSNY for onychodystrophy improvement. Planimetry using ImageJ software was used to calculate lesion reduction and proximal clear nail growth. Clinical improvement was assessed using a 5-point Global Assessment Scale (GAS). Adverse events were also assessed. Twenty-five patients (11 males and 14 females) with a total of 128 nails (94 finger nails and 34 toe nails) were treated. The mean treatment number was 8.7±6.2, and the mean total duration of treatment was 33.4±34.6weeks. The average proportion of the lesion area decreased significantly (from 65.9% to 46.6%) after PSNY treatment (P<.001). The mean GAS (3.16±1.18) exhibited fair improvement, and there were no serious adverse events. The 1064nm PSNY laser can provide fair improvement for onychodystrophy with a good prognosis at least during the follow-up period and optimal cosmetic results in Asian patients.

Prevalence of Tinea unguium (Onychomycosis) in Toe Nails of boot wearing group (The Footballers) in Owerri, Imo State. Nigeria

Foot mycoses are a frequent disease that represents a public health problem worldwide. This study aims to evaluate the epidemiology of foot mycoses among footballers in Owerri, Imo State, in order to determine the fungal etiological agents and to identify possible risk factors. To investigate the treatment and preventive measures for the susceptible groups. A total of 485 samples were collected; tinea unguium were confirmed in 88.2% of cases. A prospective study of fifty footballers was undertaken during one year (2018-2019). A complete mycological diagnosis was carried out on all footballers. The results obtained showed that out of the 50 toe nails samples of footballers examined, 28(56.0%) had positive cases of the infection on direct microscopy which served as the screening test. The causative pathogens of Onychomycosis isolated from fungal culture are dermatophytes , and the most frequent pathogen was Trichophyton rubrum 15(30.0%), yeast Candida albicans 9(18.0%). Non-dermatophyte molds were observed in 8(16.0%) cases and Fusarium sp. was the frequent genus 14(28.0%)and Aspergillus sp. 4(8.0%). The main predisposing factors of fungal foot infections were practicing ritual washing (56.6%) and frequentation of communal showers (50.5%). Confirmatory test such as germ-tube test was done on the Candida albicans isolate for proper identification. The age group 31- 35 years had the highest prevalence of onychomycosis 12(92.31%) and age group 16-20 years presented the lowest prevalence of onychomycosis 4(28.57%). Proper care of toe nails and boots is necessary to prevent the increasing rate of this infection.

Clinical spectrum of nail disorders

Background: The nail disorders comprise approximately 10% of all dermatological conditions. The nail unit may reflect dermatological disorder by its own and may show specific changes that are markers for a wide range of systemic disorders. Aims: To study the clinical spectrums of nail disorders including congenital, developmental, infectious, neoplastic, degenerative, dermatologic and systemic diseases affecting the nail unit. Materials and Methods: 200 consecutive cases with nail disorders attending to the Dermatology. Complete dermatologic and systemic examinations were carried out. Hematological investigations, including hemoglobin, total leukocyte count, differential leukocyte count and urine examination were carried out in all patients. Results: In this study, the involvement of nail was more common among males when compared to females. Onychomycosis was the commonest finding (27%) followed by psoriatic nail change (14.5%), Onycholysis (5.5%), Pitting (4.5%), Onychogryphosis (4.5%), Trachyonychia (4.5%), Chronic Paronychia (4.5%), Clubbing (4%), Subungual Warts (3.5%), Clubbing with resorption of terminal fingers (2.5%) and Ingrowing toe nail (2%). The other uncommon nail changes included Onychomadesis (1.5%), Pincer nail (1.5%), Onycholysis & pitting (1.5%), Nail discoloration (1.5%), Anonychia (1.5%), Half-and-Half nail (1.5%) Koilonychia (1.5%), Longitudinal Melanonychia (1.5%), Nail biting (1.5%), Worn down nail (1%), Transverse grooves (1%), Racket nail with clubbing (1%), Idiopathic total leuconychia (1%) and Beaus lines (1%). Also observed as single cases (0.5%) were Dorsal pterygium, Macrolunula, Longitudinal grooves, Dariers disease, Pachyonychia congenita, Acute Paronychia and Acrodermatitis continua of Hallopeau. Conclusion: Study has revealed onychomycosis, onycholysis, chronic paronychia, ingrowing toenail etc, as the common nail disorders. These conditions were associated with subclinical trauma. Nail biopsy in these patients may clarify this issue further.