Transverse Leukonychia Research Articles

Unilateral Transverse Leukonychia in a Patient Receiving Isotretinoin Treatment with Concomitant Renal Impairment: A Case Report

Aims: Leukonychia is a white discoloration of nails. Although it is usually clinically insignificant, it can serve as a clue for systemic diseases that is sometimes life-threatening. Case Report: A 24-year-old male patient, with resistant acne vulgaris not responding to topicals nor systemic antibiotics and with a history of renal impairment and untreated recurrent high blood pressure readings, was started on isotretinoin. Three months later, he presented with a unilateral true transverse leukonychia with a worsening renal impairment. The patient was started on antihypertensive medications. The patient was seen two months later with unilateral transverse leukonychia fading (moving distally). Results: Repeated laboratory tests showed slightly increased serum creatinine, improved but still high protein/creatinine ratio. The fading of leukonychia while continuing isotretinoin treatment and after starting antihypertensive medication that has a renal protective effect may indicate a renal-associated leukonychia. Conclusion: This is probably the first reported unilateral leukonychia without identified local/unilateral causes.

Nail involvement in autosomal recessive congenital ichthyosis

Autosomal recessive congenital ichthyosis (ARCI) is a clinically and genetically heterogeneous category of nonsyndromic ichthyosis. Nail changes in ARCI are generally frequent but have been rarely reported and studied in the literature. This stimulated us to conduct a study to describe nail changes in ARCI using a combined literature review and prospective examination from March 2019 to August 2019 (6 months) in the Dermatology Department of Habib Thameur Hospital, Tunis, Tunisia. A total of 25 patients with ARCI had a clinical and dermatoscopic review. The mean age was 19.8 years (range, 1-43), with a female predominance (17 women [68%] and 8 men [32%]). Seventy-two percent had nail unit changes involving more than one nail, none had single nail disease, 64% had involvement of fingernails, and 68% had involvement of toenails, with cases including periungual hyperkeratosis (64%), xanthonychia (40%), pachyonychia (40%), macrolunula (36%), digital clubbing (32%), and onychomycosis (24%). Rarer findings included pseudoainhum, transverse leukonychia, longitudinal melanonychia, and subungual hemorrhages, each in one patient (4%). There was a statistically significant increased frequency of nail changes in adults over children (P = .001). Nail abnormalities statistically associated with ARCI were macrolunula, periungual hyperkeratosis, xanthonychia, and pachyonychia. A comprehensive review of the literature was performed, creating the first comprehensive review addressing nail disease in ARCI.

Diseases of the Nail Unit

The human nail is a complex unit that includes five major modified cutaneous structures: the nail matrix, nail bed, nail plate, nail folds, and cuticle (eponychium). This chapter discusses the function and structure of the five nail components and the pathophysiology affecting each. Also reviewed are nail findings associated with underlying systemic and dermatologic conditions: splinter hemorrhages, koilonychia, transverse nail-plate depressions (Beau’s lines), onycholysis, leukonychia, clubbing, nail-plate pitting, and longitudinal pigmented bands. Infections of the nail are discussed, which include bacterial paronychia, chronic paronychia, and onychomycosis. Figures illustrate the longitudinal section of the fingernail, multiple pigmented longitudinal bands, psoriasis involving the fingernail, late-stage lichen planus of the fingernail, transverse linear grooves, Pseudomonas aeruginosa causing a green nail, psoriasis of the nail, melanonychia striata, and a nail specimen for potassium hydroxide preparation. Tables describe antifungal treatment for toenail onychomycosis as well as selected dermatologic disorders that affect the nail unit. This chapter contains 50 references.

Diagnosing and treating nail trauma

Practice NursingVol. 26, No. 1 DermatologyDiagnosing and treating nail traumaJean WatkinsJean WatkinsSearch for more papers by this authorJean WatkinsPublished Online:29 Dec 2014https://doi.org/10.12968/pnur.2015.26.1.27AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Brannon H (2014) Nail anatomy. http://dermatology.about.com/cs/nailanatomy/a/nailanatomy.html (accessed 12 December 2014) Google ScholarCity Chiropody (2014) Ingrown vs involuted toenails. http://citychiropody.co.uk/blog/ingrown-vs-involuted-toe-nails.html (accessed 5 December 2014) Google ScholarDawber R et al. (2003) A Text Atlas of Nail Disorders–Techniques in Investigation and Diagnosis. 3rd edn. Martin Dunitz, London Google ScholarFeied C, Smith M, Handler J, Gillam M (2012) Finger or toenail avulsion. www.ncemi.org/cse/cse1004.htm (accessed 5 December 2014) Google ScholarFell S (2014) Subungual haematoma (bleeding under the nail). www.emedicinehealth.com/subungual_hematoma_bleeding_under_nail/article_em.htm (accessed 5 December 2014) Google ScholarGP Notebook (2008) Nail biting (onychophagia). http://tinyurl.com/k5hzc6o (accessed 5 December 2014) Google ScholarHoy N, Leung A, Metelitsa A et al. (2012) New concepts in median nail dystrophy, onychomycosis, and hand, foot and mouth disease nail pathology. ISRN Dermatology. doi: https://doi.org/10.5402/2012/680163 Crossref, Google ScholarJoint Formulary Committee (2014) British National Formulary 68. September. BMJ Group and Pharmaceutical Press, London Google ScholarKimberly L, Stashhower M (2004) Traumatic transverse leukonychia. www.medscape.com/viewarticle/467074 (accessed 5 December 2014) Google ScholarLeung A, Robson W (1990) Nail biting. Clin Paediatri (Phila)12: 690–2 Crossref, Google ScholarMayo Clinic (2014) Does nail biting cause any long-term nail damage? www.mayoclinic.org/healthy-living/adult…/nail-biting/faq-20058548 (accessed 5 December 2014) Google ScholarNHS Choices (2013) Foot problems and the podiatrist. www.nhs.uk/Livewell/foothealth/Pages/Foot-problems-podiatrist.aspx (accessed 5 December 2014) Google ScholarSentry S (2009) How fast do nails grow? www.wisegeek.com/what-is-leukonychia.htm (accessed 5 December 2014) Google ScholarWang Q, Johnson B (2001) Fingertip injuries. Am Fam Physician 63(10): 1961–6 Google ScholarWeaver B (2014) Onychogryphosis (Ram's Horn nails). www.footvitals.com/toenails/onychogryphosis.html (accessed 5 December 2014) Google ScholarWest L (2001) Onychorrexis–Brittle nails. www.medicineonline.com/topics/O/2/Onychorrhexis/Brittle-Nails.html (accessed 5 December 2014) Google Scholar FiguresReferencesRelatedDetails 2 January 2015Volume 26Issue 1ISSN (print): 0964-9271ISSN (online): 2052-2940 Metrics History Published online 29 December 2014 Published in print 2 January 2015 Information© MA Healthcare LimitedKeywordsNailsfingerstoesnail diseasesPDF download

A case of orange-brown chromonychia in a patient with kawasaki disease.

Dear Editor: Kawasaki disease (KD) is an acute inflammatory syndrome of middle-sized arteries such as the coronary artery, and its pathogenesis and etiology remain unclear1. The diagnosis of classic KD is based on the presence of fever lasting longer than 5 days and four of five specific clinical criteria, including bilateral nonpurulent conjunctival injection, oral mucosal changes, redness and swelling of the hands and feet, skin rash, and cervical lymphadenopathy1. Among the cutaneous features of KD, typical nail changes have previously been described, such as transverse leukonychia, onychomadesis, and pincer nails2,3. In addition, Pal and Giri4 reported that patients with KD may show transverse orange-brown chromonychia and suggested to incorporate it as add-on clinical finding of KD. A 5-year-old Korean girl presented with transverse orange-brown discoloration of the finger and toe nails with periungual desquamation. There was no evidence of any other disease or use of drugs that could lead to chromonychia. Ten days previously, she was found to have KD, and was then treated with aspirin at a local hospital. On her visit, she showed orange-brown discoloration at the distal portion of the nail (Fig. 1). Conjunctival hyperemia, cracking of the lips, and strawberry tongue were also observed (Fig. 2). On the basis of the clinical findings, we diagnosed her nail discoloration as orange-brown chromonychia that occurred with KD on the basis of the clinical findings. Two weeks later, the almost transverse orange-brown discoloration disappeared with other symptoms. Fig. 1 (A) Orange-brown discoloration at the distal portion of the nail. (B) Closer view. Fig. 2 (A) Conjunctival hyperemia. (B) Cracking of the lips. (C) Strawberry tongue. A variety of nail abnormalities have been reported in KD. Ciastko2 reported onychomadesis in a boy with KD, that started 6 weeks after a fever. Pincer nail deformity and Beau's lines in KD were also reported2,3. These nail abnormalities commonly develop in the chronic phase and spontaneously resolve. Otherwise, Lindsley5 was the first to describe red transverse nail-bed lines in four KD patients during the acute phase. He considered that chromonychia may be related to localized vasculitis or nail-bed hyperemia, because the lines occurred during active inflammation. Thereafter, Pal amd Giri4 studied about the typical transverse orange-brown discoloration of the nails observed in KD patients, and reported that it was present in almost 75% of the patients (29 of 40). Also, they recognized that this orange-brown chromonychia started appearing between the fifth and eight day of the onset of fever and slowly faded away with time. Therefore, they suggested to include orange-brown chromonychia as an additional clinical feature in the diagnosis of KD, differently to other nail changes. Chromonychia is described after the use of antineoplastic drugs, including adriamycin, cyclophosphamide, and vincristine. In addition, thermal injury, contact exposure to elemental iron, angiotensin-receptor blockage therapy, use of a nail hardener, systemic lupus erythematosus, and hyperbilirubinemia may cause these changes. In summary, we report a case of orange-brown chromonychia in a KD patient, and suggest that it should be considered as a reference of in the diagnosis of KD, based on the basis of its appearance in the acute phase.

Idiopathic congenital true leukonychia totalis.

A 16-year-old male presented with white-colored fingernails since birth [Figure 1]. Toenails were normal. None of the family members were affected. Hematological investigations were normal. On cutaneous examination all finger nails were milky, porcelain white in color and smooth surfaced. No knuckle pads, palmoplantar keratoderma, or hearing loss was observed. General and systemic examination was normal. On clinical correlation, a diagnosis of idiopathic congenital true leukonychia totalis was made. Figure 1 Milky, porcelain, white-colored smooth-surfaced finger nails Leukonychia is the white discoloration of nail that loses its normal pink color, with disappearance of the lunula. It is the commonest chromatic abnormality of the nail apparatus. It is also referred to as white nail, milk spots, and fortune or gift spots. It is derived from the Greek word “leukos” means white and “onyx” means nail.[1,2] Leukonychia is classified as: [Table 1]. Table 1 Classification of leukonychia The proposed white discoloration of the nail is attributable to reflection of light from large keratohyaline granules present in the parakeratotic cells of the ventral portion of nail plate thus preventing the visualisation of normal vascular tissue underlying the nail plate.[2,3] Total congenital leukonychia is very rare hereditary condition in which all nails are milky white with an autosomal dominant inheritance but it can be autosomal recessive in few cases. Hereditary leukonychia involves whole nail plate as against acquired one which shows transverse or punctate leukonychia. Mutations in PLCD1 gene on chromosome 3p21.3-p22 was identified as cause of hereditary leukonychia. This PLCD1 gene is localized to nail matrix and encodes phosphoinositide specific phospholipase C delta 1 subunit which is important enzyme in phosphoinositide metabolism required for molecular control of color and growth of nail.[4] Leukonychia totalis is associated with multiple systemic diseases such as diabetes, liver cirrhosis, renal failure, cardiac failure, gall stones, renal calculi, duodenal ulcers, pili torti, trichilemmal cyst, sebaceous cyst, congenital hyperparathyroidism, Hodgkin's lymphoma, Leopard syndrome, epiphyseal dysplasia syndrome, Bart Pumphrey syndrome, mental retardation, etc., However, there are very few reports in the literature on sporadic congenital leukonychia totalis without any systemic abnormalities.[1,3] Treatment is usually supportive with detailed investigation to check for association of any systemic or genetic disorders.

Muehrcke’s lines (Leukonychia striata) due to transretinoic acid therapy for acute promyelocytic leukemia

Transverse leukonychia (Leukonychia striata or Muehrcke's lines) has been described with the use of several drugs in oncology, mainly chemotherapeutic agents. This condition is thought to represent an abnormality of the vascular nail bed. As the diagnosis is clinical and the condition is self-limited, referral to other specialists is usually not required. We report the first case of transverse leukonychia related to the use of transretinoic acid for acute promyelocytic leukemia. Physician awareness of transverse leukonychia is important in order to reassure the patients and avoid unnecessary (and often not inexpensive) diagnostic work-up.

Diseases of the Nail Unit

The human nail is a complex unit that includes five major modified cutaneous structures: the nail matrix, nail bed, nail plate, nail folds, and cuticle (eponychium). This chapter discusses the function and structure of the five nail components and the pathophysiology affecting each. Also reviewed are nail findings associated with underlying systemic and dermatologic conditions: splinter hemorrhages, koilonychia, transverse nail-plate depressions (Beau’s lines), onycholysis, leukonychia, clubbing, nail-plate pitting, and longitudinal pigmented bands. Infections of the nail are discussed, which include bacterial paronychia, chronic paronychia, and onychomycosis. Figures illustrate the longitudinal section of the fingernail, multiple pigmented longitudinal bands, psoriasis involving the fingernail, late-stage lichen planus of the fingernail, transverse linear grooves, Pseudomonas aeruginosa causing a green nail, psoriasis of the nail, melanonychia striata, and a nail specimen for potassium hydroxide preparation. Tables describe antifungal treatment for toenail onychomycosis as well as selected dermatologic disorders that affect the nail unit. This chapter contains 50 references.

A Case of Beau's Lines at Even Intervals and Onycholysis Caused by Chemotherapy

We report a case of Beau's lines at even intervals and onycholysis caused by chemotherapy. The patient with a diffuse large cell B cell lymphoma (DLBCL) stageA underwent combination chemotherapy consisting of R-CHOP (Ri- tuximab, cyclophosphamide, doxorubin, vincristine, predonisolone) every three weeks (21-day intervals) six times. As he was treated with R-CHOP, he noticed each Beau's lines (transverse groove ) on all 20 nails each time. In addition, he had onycholysis caused by cyclophosphamide and doxorubicin treatment. Two months after discontinuation of chemotherapy, Beau's lines disappeared. Beau's line are transverse grooves on the nail surface. They are observed in severe systemic diseases such as measles, Stevens- Johnson syndrome, zinc deficiency, pustular psoriasis, chemotherapy, Kawasaki's disease, pneumonia, telogen efflvium and so on (1). The distance of groove from nail fold is related to the onset of growth disturbance. The depth and width of the groove may be re- lated to the severity and duration of the disturbance (2). The pathomechanism of Beau's line is attributable to temporary arrest of nail matrix formation (1). There are several reported cases of Beau's lines (3, 4) and transverse leukonychia (4) induced by chemotherapy. The 74-year-old man with a history of diffuse large cell B cell lymphoma (DLBCL) was treated with R-CHOP (Rituximab, cyclophosphamide, doxorubin, vincristine, predonisolone) therapy every three weeks. After three cycles of R-CHOP chemotherapy, he noticed transverse grooves on the nail plates and paronychial erythema. At the first dermatological consultation, physical examinations revealed five transverse grooves (Beau's lines) and paronychial erythema (Fig. 1) on all 20 nails after six cycles with R- CHOP chemotherapy. The grooves were 1 to 2mm width with regular borders completely transverse each affected nails. Because he had diabetes mellitus, predonisolone was prescribed 20 mg/day. Laboratory fidings were normal. The patient was diagnosed as Beau's line due to chemotherapy (probably due to cyclophosphamide and doxorubicin). Chemotherapy was discontinued after six cycles. He was treated with topical betamethasone valerate ointment. After two months of discontinuing chemotherapy, the paronychial erythema disappeared. The nail plate was separated from nail bed (onycholysis). Subsequently, Beau's lines disappeared, and then newly nail plate grew. As differen- tial diagnosis, Muehrcke's line was considered. Muehrcke's

Transverse leukonychia (Mees' lines) associated with pleural empyema

Transverse leukonychia (Mees' lines) associated with pleural empyema

Erythema annulare versus granuloma annulare and Beau's lines versus transverse striate leukonychia differential diagnosis

A pictorial presentation to aid in the differential diagnosis of the following dermatological conditions: Erythema annulare versus granuloma annulare Beau's lines versus transverse striate leukonychia

Transverse leukonychia: a case report

A case of transverse leukonychia following chemotherapy for Hodgkin's disease in a 17-year-old white male is reported. The patient presented with multiple white bands across the fingernails, which appeared three weeks after the end of chemotherapy. The changes were almost homogeneously spread across the breadth of the fingernail plates, showing smooth borders with a rounded distal edge. Because of Hodgkin's disease in Costwold stage IE, he received sequential chemotherapy with cyclophosphamide, adriamycin, procarbazine, prednisolone, vincristine and bleomycine, and mediastinal mass irradiation. The authors emphasize that white transverse nail banding - Leukonychia striata or Muehrcke lines - constitute an aesthetical unpleasant side-effect of medication, but may represent an easily observed sign indicative of previous use of cytotoxic therapy for malignancy.

Transverse leukonychia secondary to paclitaxel-carboplatin chemotherapy in a patient with ovarian cancer

Transverse leukonychia secondary to paclitaxel-carboplatin chemotherapy in a patient with ovarian cancer

Periorbital Edema and Meesʼ Lines in Systemic Lupus Erythematosus

There are many cutaneous findings that have been described in systemic lupus erythematosus (SLE). These include disease-specific and nonspecific lesions. Periorbital edema in the absence of proteinuria or hypoalbuminemia has been only rarely described. We report three patients who developed marked periorbital edema in association with a flare of SLE. All patients were without proteinuria or significant hypoalbuminemia, and no other etiology for the periorbital swelling was identified. This occurred despite all three taking antimalarial therapy, but the edema resolved promptly and completely with glucocorticoids. One of these patients also had transverse leukonychia, or Mees' lines, present on several fingernails, that appeared to correspond with previous SLE flares.Mees' lines and periorbital edema may represent two additional nonspecific but disease-related dermatologic manifestations of SLE. Whereas periorbital edema usually develops in concert with other clinical evidence of a lupus flare and is easily treated, Mees' lines appear to serve as a time line for previous SLE activity.

Transverse leukonychia of toenails due to repeated microtrauma

Twelve women were seen with multiple transverse bands on the nail plates of the great toes. The bands were separated by normal nail, and had the same contour as the distal edge of the lunula. This disorder, which is usually bilateral, results from pressure on the free edge of the nail plate when it is not trimmed short.

Transverse leukonychia due to pellagra.

In 1915 Brownson1drew attention to the occurrence of transverse leukonychia in pellagrins. He was not able to find any previous account of such an association and concluded that sharply defined transverse leukonychia must be a very rare occurrence in pellagra. We have recently studied such a case, and a search of the literature disclosed 2 further case reports.2,3Standard reference books on pellagra either do not mention affection of the nails4or deny that any disturbance of the nails occurs in the disease.5In the monographs on nail diseases by Milian,6Heller,7Pardo Castello,8and Pfister9no new case material is discussed, but both Heller and Pardo Castello refer to Sutton's monumental textbook10which appears to have rescued Brownson's original report from oblivion. In view of the rarity of this picturesque curiosity, we desire to record a case of transverse