Spectrum of Skin Manifestations in CKD: A Tertiary Care Center Experience from North India

Introduction: Dermal manifestations in chronic kidney disease (CKD) patients may range from mild ones, like xerosis, skin pallor, pruritus, coated tongue, superficial infections and hair and nail changes, to severe life-threatening ones, like nephrogenic systemic fibrosis, which is a rare entity in current times. The present study was done to evaluate the spectrum of mucocutaneous manifestations in patients with CKD and to look for an association between them and various biochemical parameters and inflammatory markers. Material and methods: This study was a 1 year prospective, observational study conducted on adult patients with CKD who presented to the Nephrology clinic in Pt. BD Sharma PGIMS, Rohtak. Patients between the ages of 17 and 75 years with CKD stages II or more with dermatological conditions were included in this study. Each participant was subjected to detailed clinical, biochemical, radiological and dermatological examination by same consultants in order to avoid interpersonal variations. Various skin, mucosal, nail and hair manifestations along with cutaneous infections were analyzed across the spectrum of CKD. Results: Among cutaneous infections, fungal infections predominated, amongst which, onychomycosis was the most common. Xerosis was the most common dermatological disease and the prevalence of xerosis, skin pallor and pruritus was found to increase significantly from Stage II to Stage V and VD of CKD in a statistically significant manner. An association was found between xerosis and decreasing levels of hemoglobin and while ferritin was not different between patients with and without xerosis, high-sensitivity C-reactive protein (hs-CRP) was significantly higher in patients with xerosis. Similarly, hs-CRP levels were significantly elevated in patients with xerostomia and nail pallor as compared with those who did not have these conditions. Lastly, patients with nail pallor had significantly lower albumin. Conclusion: It was observed in our study that in CKD patients on hemodialysis and on conservative management, xerosis, pruritus, pigmentation, nail changes, oral mucosa changes and cutaneous infections were the predominant cutaneous manifestations. In patients with CKD, mucocutaneous manifestations progressively worsened as renal function deteriorated.

An Epidemiological Study Of 104 Cases Of Papulosquamous Disorders In South India

BACKGROUND: Papulosquamous disorder is heterogeneous group of diseases characterised by scaly papules and plaques. AIM OFTHE STUDY:To observe the recent trends in age and sex distribution ,co-morbidities and associated nail changes in a sample of patients with Papulosquamous disorders. MATERIALS AND METHODS:In a Tertiary care centre in Tamilnadu , 104 patients with Papulosquamous disorders were selected over a period of one year and studied clinically with special attention to nail changes. RESULTS: The male: female ratio was 1.2:1. Age group commonly affected was 31-45 years. Psoriasis was most common followed by Lichen planus and Pityriasis rubra pilaris. Pityriasis Lichenoides chronica and parapsoriasis were least common. 61.5% of the total patients had nail changes with nail pitting being the most common change. The common co-morbidities observed were diabetes mellitus, hypertension and atopy. . CONCLUSION: More detailed studies are required for effective management of this subset of skin disorders.

Visual Outcome among Patients Undergone Manual Small Incision Cataract Surgery Following their Identification in Screening Eye Camp in Jammu Province.

Introduction: One of the documented leading cause ofblindness in India is cataract as many patients with cataract donot have access to hospitals and surgery and to avoid blindnessdue to cataract, the only remedy is to perform hospital basedcataract surgery on a large scale. There is an increase in anumber of cataract patients due to improved quality of life,health indices and increased life expectancy. Study aimedto see the visual outcome and complications among patientsundergone manual SICS with PC-IOL implantation.Material and Methods: The present prospectiveobservational study was conducted on 72 patients who wereselected in various screening eye camps to undergo cataractextraction surgery by manual small incision cataract surgerytechnique with posterior chamber IOL implantation (MSICSwith PC-IOL).Results: Total of 72 eyes of patients who underwent manualsmall incision cataract surgery were studied. Best correctedpreoperative visual acuity of ≥ 6/60 was found in 13 patientswhile postoperatively on day1 total of 60 patients had visualacuity of ≥ 6/60. The final 6th week postoperative bestcorrected visual acuity of 6/12-6/9 was found in 65 patients.Iris prolapse was seen in 3 patients followed by posteriorcapsule rent which was seen in 2 patients. Mild postoperativeuveitis was seen in 20 followed by striate keratopathy in 8patients while hyphaema was seen in 2 patients.Conclusion: MSICS is a safe and effective procedure, due toits low rates of intraoperative and postoperative complicationswhich are easily treatable. Visual acuity is only one measureof the functional success of cataract surgery and the goodpostoperative visual outcomes achieved by our patientsfurther adds on to its benefits as a good surgical technique.MSICS can be performed as procedure of choice for largevolume cataract surgeries

Transverse Leukonychia Associated with Hypothyroidism / 대한피부과학회지

Transverse leukonychia, also termed leukonychia striata, usually occurs in association with trauma, nutritional deficiencies, exposure to toxin, and various combinations of chemotherapy. It also has been reported to be associated with various systemic diseases, including acute infection, myocardial infarction, lymphoma, hepatic failure, renal failure, and systemic lupus erythematosus. A 50-year-old woman with several months' history of nail changes presented with multiple discrete transverse white bands involving the entire width of the nail plates of her fingers. According to the patient's medical history, she had experienced fatigue, constipation, and cold intolerance for 6 months, and antithyroid antibodies were detected before noticing these nail changes. The patient was diagnosed as having an autoimmune hypothyroidism. Repeated KOH microscopic examination did not demonstrate fungal infection. We diagnosed this case as transverse leukonychia associated with hypothyroidism. This case report underlines the possible association of transverse leukonychia with hypothyroidism.

Coexistence of onychomycosis in psoriatic nails: A descriptive study.

Background: Psoriatic nail changes predispose to onychomycosis because it becomes easier for fungi to penetrate an already compromised nail plate. Moreover, some of the psoriatic nail changes closely resemble onychomycosis. Aim: To investigate cases of nail psoriasis for any evidence of onychomycosis. Methods: Seventy-two patients with psoriasis were included in the study. The patients were selected from the psoriasis clinic and dermatology in-patient ward. Direct microscopic examination with 20% KOH and culture were carried out in all patients showing psoriatic nail changes. Histopathological examination with Periodic Acid-Schiff (PAS) stain was done in cases negative by KOH examination and culture. Results: Nail changes were seen in 66.66% (48/72) of psoriasis patients. The most common fingernail changes observed were pitting, onycholysis and subungual hyperkeratosis, and the most common toenail changes were onycholysis and subungual hyperkeratosis. Nail changes were significantly more common in males. The duration of skin lesions of psoriasis and Psoriasis Area Severity Index scores were significantly higher in patients with nail changes. Out of 48 patients with psoriatic nail change, 23 (47.91%) had investigative evidence of onychomycosis. The fungal isolates on culture were non-dermatophytic molds in nine patients (18.75%) and yeast like fungi also in nine patients (18.75%). Conclusion: Coexistent onychomycosis in psoriatic nails does occur.

Unhas meio a meio e síndrome das unhas amarelas em pacientes hemiplégicos com insuficiência renal / Half-and-half nails and yellow nail syndrome in hemiplegic patient with renal failure

Insuficiência renal crônica tem sido associada com várias alterações ungueais, devidas à condição renal ou ao tratamento. Unhas meio-a-meio constituem o achado mais comum. A síndrome das unhas amarelas se caracteriza por unhas amarelas, edema linfático e distúrbios respiratórios. Além disso, alterações ungueais podem desenvolver com o envelhecimento, incluindo-se modificações na velocidade de crescimento, cor, contorno, superfície, e espessura. Unhas meio-a-meio e unhas amarelas são descritas em um homem de 85 anos, com seqüela de hemiplegia direita e insuficiência renal. As unhas meio-a-meio foram observadas exclusivamente na mão paralisada. É possível que fatores patogênicos da síndrome tiveram influência de distúrbios vasculares locais no leito ungueal, secundários à hemiplegia. Assim, os dedos da mão direita poderiam ser poupados das alterações de unhas amarelas, desenvolvendo características de unhas meio-a-meio. Embora ambas condições ocorram em idosos e em renais crônicos, a coexistência de síndrome das unhas amarelas e unhas meio-a-meio é muitíssimo rara.

Chronic renal failure has been associated with several nail changes due to renal condition or to the treatment. Half-and-half nails constitute the most common finding. The yellow nail syndrome is characterized by yellow nails, lymph edema and respiratory disturbances. Moreover, nail disorders may develop with ageing, including changes in the growth rate, color, contour, surface, and thickness. Half-and-half nails and yellow nails are described in 85-year-old male with brachial sequel of right hemiplegia and renal failure. The half-and-half nails were exclusively observed in the paralyzed hand. It is possible that pathogenic factors of the syndrome were under the influence of local disturbances in nail-bed vessels secondary to hemiplegia. Thus, the right fingers could be spared of yellow nail changes and developed the half-and-half nail features. Although both conditions may occur in elderly and chronic renal patients as well, yellow nail syndrome coexistent with half-and-half nails is exceedingly rare.

Hand-Foot Syndrome with Nail Changes Induced by Fluorouracil / 대한피부과학회지

Many chemotherapeutic agents induce both local and systemic cutaneous toxicity. Among them, Fluorouracil (5-FU) induces various cutaneous reaction, including hand-foot syndrome, hypersensitivity, hyperpigmentation and nail changes. We describe a male patient with rectal cancer, who developed combined features of hand-foot syndrome and nail changes during chemotherapy with 5-FU.

Keratosis Lichenoides Chronica with Pachyonychia Congenita-like Nail Changes

A 26-year-old man presented with a 7-month history of hyperkeratotic skin lesions on both elbows and heels. He also had marked subungal hyperkeratosis and splinter hemorrhage on the finger and toe nails. A biopsy specimen from the elbow revealed lichenoid re-actions with areas of epidermal atrophy with alternating acanthosis and foci of parakeratosis. We made a diagnosis of keratosis lichenoides chronica based on the characteristic clinicopathologic findings. We have treated the patient with etretinate, but only the skin lesions on the elbows and heels responded to treatment.

Clinical Investigation of Nail Changes in Psoriatic Patients / 대한피부과학회지

This study was aimed to investigate the clinical manifestation of nail changes in psoriasis and was based on analysie of 205 p oriatics visited the department of dermatology, Seoul National University Hospital from November, 1984 to June, 1985. The results were summerized as follows: Nail changes were noted in 78(38. 0%) out of 205 patients in the finger nails. Toe nails were involved in 26(12 7%) cut of 205 patients. 2 Nail changes in male were noted in 49 (46, 7%) out of 105 patients and in female, 29(29%) out of 100 patients. 3. The peak incidence of nail changes according, to age group was over 40 years (45. 1%.) and the lowest incidence, under 9 years(26. 7%). 4, Pitting(57. 7%) was the commonest change ii the finger nails and subungal keratosis(50. 0%) and discoloration(46 2%) in the toe nails. 5 Incidence of nail changes according to psoriatic type was 23. 7% in guttate type, 42. 6% in nummular type, 53 3% in annular type. 6 The patients with the more severe degrees of psoriasis had a higher incidence of nail involvement. Mean duration of psoriatics with nail change and without nail change was 6. 3 years and 6. 5 years, respectively, 8 Among 65 patients with psoriatic nails, onychomycosis was noted in 9 patients(13.8%).