Treatment Of Nail Disorders Research Articles

Nail health in women.

Healthy nails are functionally and cosmetically important to the daily work of women. The globally increasing market for nail cosmetics reflects the importance of the appearance of nails. This article details the composition of a healthy nail, diagnosis and treatment of nail disorders, use of nail cosmetics and their risks, the impact of the aging process on nails, and the relative risks to nail salon workers. Knowledge of these issues will prepare health care providers and patients to maintain healthy nails throughout their lives.

Determining the Prevalence and Types of Nail Involvement in Patients with Severe Acne Vulgaris Who Referred to Clinic of Dermatology of Rasoul-e-akram Hospital During 2010-2011

Introduction: Various skin diseases such as psoriasis, lichen planus, and alopecia areata can be associated with structural nail lesions. However nail lesions prevalence in patients with severe acne vulgaris is not determined. This study aimed to determine the frequency and types of nail lesions in patients with severe acne vulgaris.Methods: In this cross-sectional study, 235 patients with severe acne vulgaris were included from the clinic of dermatology of RasoulAkram Hospital during the years 2010 and 2011. The patients had no history of treatment for acne vulgaris. Patients initially underwent clinical examination, and severity of acne was determined among them. Demographic characteristics such as gender, age, and blood type, and Nail disorders including brittleness, Onycholysis, and Leukonychia were investigated in these patients. Data were analyzed using SPSS 18 software.Results:In this study79 patients with severe acne vulgaris (33.6%) had nail involvement and the frequency of nail lesions in this study was as follows: brittle nails 26.8% (63 cases); Leukonychia 18.2% (43 cases); Parrot beaked nails 3.4% (8 cases) and Onycholysis 1.3% (3 cases). Nail disorders in patients with severe acne vulgaris was not associated with sex, blood group, and the severity and distribution of acne lesions. But the lower age of the patients was associated with the incidence of nail disorders.Conclusion: According to high prevalence of nail involvement, especially brittle nails in patients with severe acne vulgaris, investigation and treatment of nail disorders in these patients have a great importance.

The Diagnosis and Treatment of Nail Disorders.

Nail disorders can arise at any age. About half of all nail disorders are of infectious origin, 15% are due to inflammatory or metabolic conditions, and 5% are due to malignancies and pigment disturbances. The differential diagnosis of nail disorders is often an area of uncertainty. This review is based on publications and guidelines retrieved by a selective search in PubMed, including Cochrane reviews, meta-analyses, and AWMF guidelines. Nail disorders are a common reason for derma - tologic consultation. They are assessed by clinical inspection, dermatoscopy, diagnostic imaging, microbiological (including mycological) testing, and histopathological examination. Some 10% of the overall population suffers from onychomycosis, with a point prevalence of around 15%. Bacterial infections of the nails are rarer than fungal colonization. High-risk groups for nail disorders include diabetics, dialysis patients, transplant recipients, and cancer patients. Malignant tumors of the nails are often not correctly diagnosed at first. For subungual melanoma, the mean time from the initial symptom to the correct diagnosis is approximately 2 years; this delay is partly responsible for the low 10-year survival rate of only 43%. Evaluation of the nail organ is an important diagnostic instrument. Aside from onychomycosis, which is a common nail disorder, important differential diagnoses such as malignant diseases, drug side effects, and bacterial infections must be considered.

Clinical application of lasers in the treatment of nail disorders

Nail disorders, including onyxis, onychomycosis and onychodystrophy, are usually difficult to treat in clinical practice, and often bother both patients and clinicians. With the application of lasers, much progress has been made in the treatment of nail diseases. CO2 laser exerts a favorable therapeutic effect on onyxis by quickly damaging local tissues, resecting hypertrophic nail folds, and instantly coagulating small vessels. Nd: YAG laser, fractional CO2 laser and diode laser provide new options for the treatment of onychomycosis. Moreover, fractional CO2 laser could evidently enhance penetrance and absorption of topical agents into nails by forming microscopic treatment zones, and have shown definite efficacy in the treatment of onychodystrophy. Key words: Nails; Laser therapy; Mycoses; Malnutrition; Safety

Update: nail unit dermatopathology

Nail unit dermatopathology is a growing field filled with many challenges. Many advances in this field have been made in the last 5 years. This review article provides an update on new information and studies published in that period of time. We divided these works into different sections, including clinical and pathologic challenges in diagnosis and treatment of nail disorders, nail unit biopsy and processing techniques, normal nail unit histology, nail plate structural and growth pathology, metabolic disease, inflammatory conditions, onychomycosis, benign growths, malignant growths, and dyschromias. Specific highlights include advances in the marking and orientation of nail unit biopsies for improved histologic interpretation, improved nail plate softening techniques, new methods for histologic evaluation of onychomycosis, descriptions of newly described benign growths unique to the nail unit, and the morphologic and immunohistochemical distinction between benign and malignant pigmented lesions of the nail unit.

Nutrition and nail disease

The nail is a specialized keratinous skin appendage that grows approximately 2 to 3 mm per month, with complete replacement achieved in 6 to 9 months. Although this structure can be easily overlooked, nail disorders comprise approximately 10% of all dermatologic conditions. This contribution first provides an overview on the basic anatomy of the nail that will delineate between the nail unit (eg, hyponychium, nail bed, proximal nail fold, and matrix) and anatomic components not part of the nail unit (eg, lateral nail folds, nail plate, and eponychium). The function of each nail structure will also be presented. The chemical profile of the normal nail plate is reviewed with a discussion of its keratin content (hair type keratin vs epithelial type keratin), sulfur content, and mineral composition, including magnesium, calcium, iron, zinc, sodium, and copper. The remainder will focus on nail manifestations seen in states of malnutrition. Virtually every nutritional deficiency can affect the growth of the nail in some manner. Finally, the discussion will include anecdotal use of nutritional and dietary supplements in the setting of brittle nail syndrome as well as a brief overview of biotin and its promising utility in the treatment of nail disorders.

Clinical pathologic correlations for diagnosis and treatment of nail disorders

Clinicopathologic correlation is crucial to the correct diagnosis of disorders of the nail unit. This chapter will explore four common clinical scenarios and how pathology can help differentiate between their various etiologies. These include: dark spot on the nail plate (melanin versus heme), subungual hyperkeratosis (onychomycosis versus psoriasis), longitudinal melanonychia (benign versus malignant), and verrucous papule (verruca versus squamous cell carcinoma). Consideration must be given to both when to perform a biopsy and the location of the biopsy site, which must be based on an understanding of the origin of the changes. An overarching principle is that lesions within the same differential diagnosis may be present concomitantly, such as malignant melanoma of the nail unit associated with hemorrhage. Therefore, even with a biopsy-proven diagnosis, the clinician must always monitor lesions of the nail unit for appropriate response to treatment and consider an additional biopsy for recalcitrant lesions.

Efficacy of Triamcinolone Acetonide in Various Acquired Nail Dystrophies

The treatment of nail disorders is currently an unsatisfying exercise. Isolated nail involvement generally does not warrant any systemic therapy. At the same time, treatment is requested because of significant cosmetic and functional handicap. Intralesional triamcinolone acetonide (TA) in the proximal nail fold was evaluated as a treatment modality in 30 patients with twenty-nail dystrophy, 14 with nail lichen planus, and 6 with nail psoriasis. The number of involved nails varied from 1-20, and 1-10 nails were treated with TA. Fourteen patients discontinued treatment after 1-2 sittings. Out of the 28 patients completing the treatment protocol, 16 showed 75-100% improvement. Predominant side effects included pain, subungual hematoma formation, proximal nail fold hypopigmentation, and atrophy. TA given as a single injection in the proximal nail fold produced good improvement in a significant number of patients completing the treatment protocol. Lower concentrations of TA (5 mg/ml) were quite effective in treating various dermatoses affecting the nail unit. Our technique had fewer side effects than needle-less injection or multiple injection techniques. Careful attention to injection technique further minimized the side effects associated with the procedure. Sixteen patients completed the six-month follow-up and a relapse of nail changes was seen in 10. The relapses were equally responsive to retreatment. TA injected into the proximal nail fold area is a useful, cheap and efficacious treatment for dermatoses affecting the nail unit.

Treatment of nail disorders

There are several reasons that make the nail unit difficult to treat. It is necessary to wait for several months before seeing the results of treatments in nail disorders, as the nail plate grows very slowly (average nail growth is 3 mm/month in fingernails and 1–1.5 mm/month in toenails). It is very important to give the patients this information, as they may otherwise discontinue the treatment feeling it to be ineffective. Delivery of topical drugs through the nail is difficult, as vehicles utilized for enhancing penetration of drugs through the skin are not effective in the nail. Most topical drugs are therefore ineffective in the treatment of inflammatory nail disorders, since the nails are largely exposed to environmental hazards and nail disorders are commonly precipitated or worsened by physical traumas. Thus, clinicians often do not prescribe systemic treatment when the disease is limited only to the nails.

Treatment of nail disorders

Treatment of nail disorders

The diagnosis and treatment of nail disorders: systemic antifungal therapy

Systemic antifungals have been used in the treatment of fungal infections since the introduction of griseofulvin in 1958. Since then, new antifungal medications have been introduced, broadening the spectrum of therapies available. Onychomycosis is one of the most common complaints presented to the dermatologist. Fungal infection of the nails, though usually not an urgent medical condition, can be extremely distressing to the patient. Since current topical antifungal medications have little or no efficacy in the treatment of fungal infections of the nail, it is incumbent upon the dermatologist to be familiar with the use of systemic antifungals in the treatment of onychomycosis. In this article, the treatment of fungal infections of the nail with systemic antifungals is discussed. A brief review of the most common types of nail fungal infection is presented and the use of systemic antifungals relevant to dermatology is addressed.