Toe Nails Research Articles

Non dermatophytic molds causing onychomycosis: a rising trend in North India

Background: Onychomycosis is rarely life threatening but can affect patient’s quality of life by its associated morbidity and cosmetic disfigurement that makes it an important public health problem. So the current study was undertaken to look for causes of onychomycosis including the non-dermatophytic molds that are normally considered as contaminants. Methods: A total of 100 nail samples from clinically suspected cases of onychomycosis, were processed by direct microscopy of the KOH mount followed by two sets of culture on Sabourauds’ Dextrose Agar and incubated at 25ºC and 37ºC and were examined once a week for a period of 4-6 weeks, to look for the fungal causative agent. Results: Infection was more common among males and amongst age group 21-30 years (31%). The finger nails (57%) were more commonly involved than toe nails (43%). Onychomycosis was mostly caused by molds (55%), followed by dermatophytes (15.8%) and yeasts (9.3%). Aspergillus niger and A. flavus (13% each) were the most common molds, T. verrucossum (4.6%) was the most common dermatophyte, while Candida albicans (6.5%) was the most common yeast isolated. Conclusions: There is a rising trend of non dermatophytic molds causing onychomycoses, Thus microbiologists should look for all the possible causes of superficial fungal infection.

278 Nail dystrophy in patients with atopic dermatitis and its association with disease

Nail dystrophy arises from various inflammatory dermatologic diseases. However, there have been few reports on the prevalence of nail abnormality in atopic dermatitis (AD) or on the relationship of this condition with the severity of the disease. Therefore, This study was intended to determine the prevalence and types of nail abnormalities associated with AD and to evaluate the relation between nail abnormalities and the severity of AD. AD patients aged 2 to 19 who visited the outpatient clinic were thoroughly examined for nail abnormalities. Demographic information was collected and eczema area and severity index (EASI) score for severity of AD were checked. A total of 235 AD patients (children and adolescents) were investigated. There were 24 (10.2%) patients with nail abnormalities: transverse groove (Beau’s line) (25%), nail pitting (16.7%), koilonychia (16.7%), trachyonychia (12.5%), leukonychia (12.5%), brachyonychia (8.3%), melanonychia (8.3%), onychomadesis (8.3%), onychoschizia (8.3%), and onycholysis (8.3%). There was no statistically significant difference in the total EASI score associated with development of nail abnormalities (p = 0.236). However, when the EASI score was confined to the lower extremities, it showed a relation to the prevalence of toe nail dystrophy (odds ratio: 1.115; 95% confidence interval: 1.01–1.32; p = 0.03). In conclusion, Nail abnormalities in AD are thought to be caused mainly by pathologic change in the nail matrix region, and the EASI score, if confined to lower limbs, might be used as a predictor of toe nail changes in patients with AD.

Tinea pedis: a clinico mycological study

<p class="abstract"><strong>Background:</strong> To study the varied clinical presentations, the predominant etiological agent and incidence of tinea pedis in relation to sex, age group, occupation and aggravating factors among the patients. Also an attempt was made to know if any significant association is there with blood group and the occurrence of tinea pedis.</p><p class="abstract"><strong>Methods:</strong> A study was conducted among 75 patients who attended Mycology clinic in tertiary care hospital. Detailed history was taken along with complete physical examination and local examination. All cases of tinea pedis were first confirmed by KOH examination. Isolation of the agent was done in Modified SDA medium with cycloheximide. Differentiation of the species was done by culturing on corn meal agar.<strong></strong></p><p class="abstract"><strong>Results:</strong> Prevalence of tinea pedis infection was more common among males with male: female ratio of 2.26:1. The 21- 30 years age group was commonly affected by tinea pedis. The distribution of blood groups reflected the general distribution pattern of the population. Culture positivity was recorded in 81.3%.</p><p><strong>Conclusions:</strong> More incidences of bilateral involvement and recurrent episodes were noted among the shoe wearing population than in the non-shoe wearing population. Any patients diagnosed with tinea pedis should be screened for diabetes as implied by the outcome of the study. Infected toe nails may be the site of primary infection and fungal disease can spread to other body areas from these primary sites. <em>Trichophyton rubrum</em> happened to be the chief isolate. <br /><br /></p>

Modified method of Hallux toe nail flap for finger tip reconstruction and donor site repair

Objective To discuss the modified method and clinical effect of free hallux toe nail flap for reconstruction of composite tissue defect at finger tip and repair of its donor site. Methods Partial nail bed at fibular side of hallux was cut and combined with toe tip skin to form hallux toe nail flap. The reconstruction of finger tip defects was achieved by free hallux toe nail flap transplantation. The donor site of hallux was sutured directly. Nail bed wound was healed by itself without skin graft or flap repair. From May 2013 to April 2015, 13 cases (15 fingers) had partial nail bed and skin defects at finger tip and no obvious distal phalanx defects, which were repaired by this method. Results All the patients were follow-up for 3 to 12 months. All the free hallux toe nail flap graft survived. The finger tip appearance and nail growth were close to normal. The function of interphalangeal joint was good. Hallux nail was nearly complete with good appearance and without obvious defect. No local pain, ulceration, and sensory disorder occurred at hallux donor site. Conclusion Hallux toe nail flap is an ideal method for reconstruction of composite tissue defect at finger tip. The improvement of donor site repair method can make better appearance of toe tip and nail without obvious sequelae. Key words: Finger injuries; Surgical flaps; Free tissue flaps; Fingertip defects

Are frailty components associated with disability in specific activities of daily living in community-dwelling older adults? A multicenter Canadian study

Current studies show the relevance of geriatric prevention and rehabilitation programs to slow down the development of disability in community-dwelling older adults who are becoming frail. This evidence reveals the importance of improving knowledge on how individual components of frailty and specific disability in basic and instrumental activities of daily living (ADL) are related, to offer early, targeted, and tailored interventions. The objective was to examine the association between each of the five frailty phenotype components (weakness, slowness, exhaustion, low physical activity, weight loss) and disability in specific ADL pertaining to physical aspects (bathing, dressing, cutting toe nails, transportation, shopping, housekeeping, food purchasing, food preparation) and cognitive aspects (finances, telephone, medication). A cross-sectional design involving 1643 community-dwelling older adults (65+) from the longitudinal multi-center FRéLE study was used. Disability was defined as needing help or being unable to perform specific ADL. Multiple logistic regressions were adjusted for socio-demographic characteristics, clinical variables, and for 4 other frailty components. Results showed that low physical activity and slowness were significantly linked to disability in all physical and cognitive aspects of ADL (OR: 1.71–9.42; p<0.05), except using the telephone. Notably, all frailty components except weight loss were associated with disability in the physical aspects of instrumental ADL (transportation, shopping, housekeeping, food purchasing, food preparation) (OR: 1.73–9.42; p<0.05). This study helped identify the relevant frailty components as targets in community-based prevention and rehabilitation programs. Easily imbedded interventions in daily routines should be promoted earlier in the frailty process to delay or reduce disability.

Low level exposure to manganese from drinking water and cognition in school-age children

BackgroundManganese (Mn) is an element found in the environment and certain geographic areas have elevated concentrations in soil and water du to natural conditions or anthropic activities. A growing body of data suggests that exposure to manganese in drinking water could be neurotoxic. ObjectiveFirstly, we aimed to examine the association between exposure to manganese from drinking water and cognition in children consuming well water. Secondly, we also aimed to examine the relation between cognition and manganese concentrations in children’s hair, nail, and saliva. MethodsA total 259 children from 189 households consuming well water were included in the present study (ages 5.9 to 13.7 years). We assessed children’s cognition with the WISC-IV, and we used five indicators of manganese exposure: concentration in tap water, intake from the consumption of water divided by child’s weight, manganese concentration in children’s hair, toe nail, and saliva. We used General Estimating Equation analysis to assess the relation between manganese exposure indicators and IQ scores, adjusting for potential confounders, and taking into account family clusters. ResultsDrinking water manganese concentrations were generally low, with 48% of children consuming water <5μg/L, 25% >50μg/L, and 4% >400μg/L. Results differed by sex. In girls, higher manganese concentration in water, hair, and toe nail were associated with poorer Performance IQ scores but this was significant only for toe nail (for a 10-fold increase in manganese, β: −5.65, 95% CIs: −10.97, −0.32). Opposite associations were observed in boys, i.e., better Performance IQ scores with higher manganese concentration hair, toe nail, and water, the latter being significant (β: 2.66, 95% CIs: 0.44, 4.89). Verbal IQ scores did not seem to be associated with manganese exposure indicators. ConclusionsDrinking water manganese levels were considerably lower than in previous studies reporting neurotoxic effects. There was no clear indication of an association between exposure to manganese and cognitive development in this sample of school-age children although the data suggest there might be sex-specific associations. Given the low levels of exposure and sex-specific associations, a larger sample size would have been required to increase the statistical power and better characterize the relations.

The African Elephants' Toe Nails

Toe nails on front and hind feet of 689 culled elephants from three populations, two from Uganda and one from Kenya, were counted. Nineteen combinations were found, recorded as nails present on right front foot/left front foot/right hind foot/left hind foot. In addition, toenails from 33 foetuses are compared with their dams' toe nail combinations. The results nullify previous use of toe nail numbers for taxonomic purposes.

Combination therapy for recurrent ingrown toe nail

Ingrown toe nail is one of the commonest foot lesion affecting young individuals. The recurrence rate with a variety of treatment modalities continues to be quite significant. Hence the need to develop a comprehensive combination therapy to reduce the recurrence rate. Onychocryptosis or ingrown toe nail is a common and painful form of nail disease. It affects adolescents and young males very commonly. A combination therapy comprising of wedge resection of the nail, matricectomy, phenol cauterization and wedge excision of hyper granulations for recurrent advanced presentation of ingrown toe nail is presented. A 32-year-old male with a history of recurrent ingrown toe nail, operated twice previously presented with an advanced stage of ingrown toe nail. Hypertrophic granulation tissue covered both lateral and medial nail plates. The patient was treated with an integrated surgical approach comprising of wedge resection of medial as well as lateral border of nail ensuring removal of spicules on either side, followed by wedge resection of underlying nail bed. This was followed by phenol cauterization and elliptical excision of hypertrophic granulations. The predisposing factors, natural history and treatment modalities are discussed. Combination therapy is a safe and the best option for recurrent ingrown toe nail. It can also be used as a form of primary treatment in fresh cases to prevent recurrence.

A study on psoriasis of nails- severity scoring system

Males were more commonly affected with nail psoriasis than females. Subungual hyperkeratosis and pitting was the common nail changes observed. Toe nails were commonly affected than the fingernails. There was no correlation between the nail changes and psoriatic arthritis. There was positive correlation between the N-NAIL score and PASI score. Although NAPSI score is the most widely used method to diagnose nail psoriasis is, we found that N-NAIL score has few advantages over NAPSI score as it takes only few minutes to calculate and it includes only five nail changes. Nail psoriasis seems to be an overlooked feature of the disease and hence adequate nail psoriasis scoring system is necessary to evaluate nail psoriasis.

Ingrown toe nail as seen in Bayelsa state Nigeria

Background: Ingrown toenails are common conditions of the foot causing pain, disability, and absence from work. It has been associated with use of tight foot wears, congenital anomalies of nail folds, nail plates, and medial rotation of the great toes; other predisposing factors include diabetes, obesity and cardiac disorders. It can be diagnosed clinically, and treatments include use of antibiotics analgesia and surgery. When untreated it may be complicated by sepsis, ulceration of nail fold and excessive granulation tissue formation osteomyelitis, gangrene of the leg.Methods: We observed an increase in the number of patients visiting our clinic with ingrown toe nails, and with no known work done on this subject in our environment we therefore conducted a questionnaire based prospective study between the periods January 2014 to June 2016 to determine the pattern of presentation, predisposing factors and treatment outcome. The data collected was analyzed using SPSS Version 20 for windows.Results: Twenty-eight (28) patients with age range 9 to 65 years, and mean age of 32, and male: female ratio of 2.1:1 were reviewed. The highest incidence was seen between the ages of 11 to 40 year old, and among students 8 (28.57%). Prevalence of 28.57% (n=8) was highest in those who wore tight/short shoes. The commonest presenting complains were pain, swelling (edema) and suppuration, with most patients 10 (35.71%) being seen in the clinic between 5-6 months of development symptoms. Ingrown toenails occurred statistically significantly more in the right big toe 13 (46.43%) [χ2 (p-value) = 19.43 (0.001). Amongst those whose anatomical site was at the right big toe, the Lateral aspect was 9 (69.23%).Conclusions: Most patients received Analgesics and Antibiotics and twenty one, 21(75%) of the patients had wedge resection and surgical destruction of the nail matrix.

Polydactylous Transverse Erythronychia: Report of a Patient with Multiple Horizontal Red Bands Affecting the Fingernails.

IntroductionRedness of the nail plate—erythronychia—is a common condition involving one or multiple digits. It may affect the entire nail or present as longitudinal red bands that extend from the proximal nail fold to the distal tip of the nail plate. Rarely, red bands may traverse the nail bed horizontally. Although erythronychia is often idiopathic, it has also been associated with amyloidosis, Darier’s disease, lichen planus, and various other cutaneous conditions. We describe the clinical features of a 64-year-old Caucasian man who presented with transverse and longitudinal erythronychia affecting his fingernails. In addition, we review the classification of erythronychia and summarize the acute and chronic conditions that have been associated with this clinical finding.MethodsThe features of a man with polydactylous transverse and longitudinal erythronychia are presented. In addition, PubMed was used to search the following terms: erythronychia, longitudinal erythronychia, red lunulae, and subungual. All papers were reviewed, and relevant articles, along with their references, were evaluated. Informed consent was obtained from the patient for being included in the study.ResultsA 64-year-old Caucasian man with a past medical history significant for testicular cancer and pulmonary embolism presented with multiple horizontal pink-red bands affecting his fingernails. The discoloration was most prominent in the region distal to the lunula. In addition, the nails of the fifth digit of his left hand and third digit of his right hand featured longitudinal red bands extending from the distal curvature of the lunula to the free edge of the nail plate. A diagnosis of polydactylous longitudinal and transverse erythronychia, based on the clinical presentation, was established. Our patient’s red bands were asymptomatic and he was not concerned about the cosmetic appearance of his nails; therefore, no additional investigation or treatment was required.ConclusionPolydactylous transverse erythronychia is a rare condition characterized by the development of horizontal red bands affecting the fingernails or toe nails. It has only been previously described in a man with multiple system atrophy. In our patient, both transverse and longitudinal red bands were present simultaneously. Therefore, it is possible that horizontal erythronychia is an early clinical manifestation of longitudinal erythronychia.

Free grafting of big toe nail bed repairing defects of fingernail bed

To investigate the feasibility and indication of free grafting of split big toe nail bed for defects of fingernail bed. From September 2008 to September 2011,13 cases (4 females and 9 males) with fingernail bed defects(aged 17-38,average,32) were treated with split big toe nail bed. The split big toe nail was harvested according to the defects size without bone exposure at donor site. Three grafted nail beds were necrotic completely and reconstructed with flaps. The 2 grafted nail bed was partial loss and healed after dressing. All the other grafted nail bed survived completely with primarily healing both in donor sites and recipient sites. The patients were followed up for 6-30 months(average,14 months).The therapeutic effect was graded as excellent in 8 cases, good in 2 cases and poor in 14 cases(good rate,76.9％).The nail matrix was excellent in 8 cases,good in 1 case and poor in 1 case(good rate,90％).The toe nails in donor sites grew well. The single fingernail defect with intact nail matrix can be reconstructed by split toe nail bed graft with good cosmetic and functional effect. There is no malfunction at donor site. The indication should be selected.

Accelerated nail growth rate in HIV patients.

Many factors have been noted to alter the growth rate of both finger and toe nails, some with harder evidence than others. Infectious diseases are among the ones reported as slowing the growth rate. However, on previous studies we noticed that patients living with HIV and onychomycosis could be cured without the use of antifungal therapy, only with the immunological improvement provided by the combined antiretroviral therapy, and we wanted to prove that the growth rate is also increased in this group and thus probably contributes to the cure of onychomycosis. This was an observational, descriptive, and prospective study. We marked with a scalpel the nail plate of the first finger of the non-dominant hand and the same foot, and measured the nail growth in the subsequent medical appointments with a magnifying glass and a millimetric scale. Thirteen patients completed the study, and were paired with healthy controls by age and gender. After performing Mann-Whitney U test, our results showed statistical significance among both groups, showing that patients with HIV have faster nail growth rates than those in the HIV negative group. There is little data on HIV nail growth rate to compare our results, but what we see in the clinical practice is that this group of patients shows a faster nail growth rate, as has also been reported for longer eyelashes, and this could be an important factor in the cure rates of onychomycosis.

Reconstruction of large area defect of the nail bed by cross finger fascial flap combined with split-thickness toe nail bed graft: A new surgical method.

Fingertip injury commonly results in avulsion of the nail bed. For large area defects of the nail bed with distal phalanx exposure, methods for reconstruction of soft tissue defects are scarcely mentioned in the literature.From May 2014 to January 2016, 6 patients with large area defects of the nail bed with distal phalanx exposure were enrolled. A new surgical method, cross finger fascial flap combined with thin split-thickness toe nail bed graft, was applied in all patients.All the 6 patients were followed-up at least 3 months. Good blood supply and no infections were observed. The lengths of the thumb or fingers were preserved. Acceptable appearance and nail bed growth were noted. The donor sites showed no dysfunction or deformity.Cross finger fascial flap combined with thin split-thickness toe nail bed graft is a new and rewarding surgical method to reconstruct large area defect of the nail bed with distal phalanx exposure.

Primers used in UV-curable nail varnishes

Adhesion-promoting substances (primers) play an important role in the durability of UV-curable nail varnishes on human toe and finger nail plates. The efficacy of these substances regarding the adhesion that exists between the UV nail coating and the substratum depends on the type of primer and its method of application. In the current study, we used non-acid and acid-based primers as additives in the coating composition and as individual layers applied directly onto the substrate. Adhesion tests were performed using organoleptic, dynamic and “pull-off” methods and using different substrates. The application of adhesion promoters was found to increase the level of adhesion between the varnish formulation and substrate. The best adhesion was obtained when the primer was applied as a separate layer prior to application of the coating. To the best of our knowledge, this work is the first systematic study comparing the effect of using primers with UV-curable nail varnishes on the adhesion of the polymer to the nail plate.

A case of type 1 pachyonychia congenita with response to acitretin

An 8-year-old male born of nonconsanguineous marriage presented with multiple raised lesions all over the body, over palms and soles, and thickening of all nails of fingers and toes for 5 years. On examination, there were hyperkeratotic plaques over palms and soles with subungual hyperkeratosis of all finger and toe nails. Oral cavity revealed white hyperkeratotic plaque over buccal mucosa. There were hyperkeratotic papules distributed over dorsum of hands, feet, elbows, knees, trunk, and thighs. Biopsy taken from hyperkeratotic lesion over palms revealed findings suggestive of palmoplantar keratoderma. Considering the clinical features and histopathological examination, a diagnosis of Type 1 pachyonychia congenita was made. After hematological investigations, the patient was started on oral acitretin at a dose of 25 mg thrice a week. There was a marked improvement in the form of reduced hyperkeratosis over palms and soles and subsidence of hyperkeratotic papules and oral lesions, 2 months after treatment with acitretin.

Treatment of ingrown toe nail by using Tsume-Cap and its usefulness

Treatment of ingrown toe nail by using Tsume-Cap and its usefulness

Influence of walking condition on big toe nail strain

Influence of walking condition on big toe nail strain

Epidermodysplasia Verruciformis: a case report

Background: Epidermodysplasia verruciformis is a rare, inheritable disease characterized by an unusual susceptibility to infection with specific types of human papillomavirus and a greater propensity for developing malignant skin tumors. Case presentation: A 55-year old male was presented with complaint of painless, hard growth extending from his toe nail for the last one year. He was diagnosed as a case of Epidermodysplasia Verruciformis followed by Mohs surgical procedure. Conclusion: Epidermodysplasia Verruciformis is an autosomal recessive genetic disorder and it predisposes patients to widespread papilloma viral infection. This might be considered as a model of cutaneous human papilloma virus oncogenesis. Generally, Epidermodysplasia Verruciformis reveals an autosomal receding pattern of inheritance. Prolonged exposure to sunlight, living in high altitudes and outdoor occupations are the known risk factors to malignant deterioration of EV lesions.

A clinicomycologic study of onychomycosis at a tertiary health-care center in Chennai

Background: Onychomycosis poses to be an important public health problem. There has been a worldwide increase in the prevalence of onychomycosis with factors such as diabetes mellitus, poor peripheral circulation, indulgence in sporting activities, and prolonged antibiotic usage playing major contributory roles. Further, management of fungal infections of nails usually requires a prolonged course with a tendency for relapse. Aim: To study the clinical, epidemiologic, and demographic profile of onychomycosis and determine various organisms responsible for the same. Methods: A cross-sectional study was done over a 1-year period, wherein after patient enrollment, a thorough clinical evaluation was performed, followed by microscopically examining the infected nail specimen under 40% potassium hydroxide, which was succeeded by cultivating the organisms on fungal culture media and identifying the pathogen both by closely studying colony morphology in culture and also microscopically utilizing lactophenol cotton blue staining. Results: Females (67.3%) were more commonly affected than males (32.7%). The most common age group affected was 20-40 years(47%). Majority of patients demonstrated both finger and toe nail involvement (43.6%). Distal and lateral subungual onychomycosis (55.4%) was the most common clinical variant of onychomycosis identified in our study. Out of the 101 patients in our study, 86 demonstrated a positive fungal growth on culture. Non-dermatophyte moulds (NDM) (58.1%) were the most common fungal isolate followed by Candida species (36%) and dermatophytes (5.8%). Conclusion: Unlike most studies, NDM constituted the major pathogen among our participants.