A Case of Unexplained Long-Term Thumb Onycholysis Successfully Treated with Shimotsuto / 日本東洋医学雑誌

This report outlines the case of a 51-year-old female patient who had suffered from onycholysis of the thumbs for eight years. The patient complained of experiencing pain when she works in contact with water, affecting her quality of life. Before coming to our clinic, the patient was diagnosed and treated at three dermatology clinics. However, treatment proved ineffective and the cause was not elucidated. As the patient experienced symptoms of onycholysis and dry skin, we diagnosed her with ketsu deficiency and treated her with shimotsuto. The symptoms gradually improved with continuous oral administration, and were no longer present at eight months following the start of treatment. This case suggests that shimotsuto may be effective in treating instances of onycholysis where the cause is unknown.

Onicólisis en el curso de la artropatía psoriásica. Presentación de un caso / Onycholysis in the course of psoriatic arthropathy. Presentation of a case

Las lesiones dermatológicas que se presentan en el curso de la antipatía psoriásica son diversas, entre ellas las manifestaciones ungüeales son características y con frecuencia facilitan el razonamiento médico y ayudan al diagnóstico nosológico de esta entidad; se presenta un paciente que a punto de partida de las lesiones onicolíticas de las uñas de los pie, oriento al estudio de otros elementos de laboratorio concluyendo como una de una artropatía psoriásica con seis puntos de la clasificación de Caspar para el estudio de esta entidad.

The dermatological lesions that occur in the course of psoriatic arthropathy are diverse, among which ungüeal manifestations are characteristic and often facilitate medical reasoning and help nosological diagnosis; a patient is presented who, starting point of the onicolitic lesions of the nails of the foot, is directed to the study of other laboratory elements, concluding as one of a psoriatic arthropathy with six points of the Caspar classification for the study of this entity.

A Case of Onychomadesis and Onycholysis in a Patient with Kawasaki Disease / 대한피부과학회지

No abstract available.

Nail abnormalities in patients with vitiligo

Abstract: Background: Vitiligo is an acquired pigmentary skin disorder affecting 0.1-4% of the general population. The nails may be affected in patients with an autoimmune disease such as psoriasis, and in those with alopecia areata. It has been suggested that nail abnormalities should be apparent in vitiligo patients. Objective: We sought to document the frequency and clinical presentation of nail abnormalities in vitiligo patients compared to healthy volunteers. We also examined the correlations between nail abnormalities and various clinical parameters. Methods: This study included 100 vitiligo patients and 100 healthy subjects. Full medical histories were collected from the subjects, who underwent thorough general and nail examinations. All nail changes were noted. In the event of clinical suspicion of a fungal infection, additional mycological investigations were performed. Results: Nail abnormalities were more prevalent in the patients (78%) than in the controls (55%) (p=0.001). Longitudinal ridging was the most common finding (42%), followed by (in descending order): leukonychia, an absent lunula, onycholysis, nail bed pallor, onychomycosis, splinter hemorrhage and nail plate thinning. The frequency of longitudinal ridging was significantly higher in patients than in controls (p<0.001). Conclusions: Nail abnormalities were more prevalent in vitiligo patients than in controls. Systematic examination of the nails in such patients is useful because nail abnormalities are frequent. However, the causes of such abnormalities require further study. Longitudinal ridging and leukonychia were the most common abnormalities observed in this study.

Recurrent onycholysis in a patient with Behcet's disease / 영남의대학술지

Onycholysis is defined as a distal or distal lateral separation of the nail plate from the underlying or lateral supporting structures including nail bed, hyponychium, and lateral nail fold. Trauma, infection, psoriasis, thyrotoxicosis, and numerous drugs are common causes of onycholysis. However, there are few specific data on nail findings in Behcet's disease (BD). In this paper, we report on a 60-year-old man with BD, with no past history except BD, who developed recurrent onycholysis. The symptoms of onycholysis are considered to be recurrent depending on the activity of BD. The nail lesion showed improvement after classic treatment of BD and topical steroid ointment.

Psoriatic Onycho-pachydermo-periostitis of the Fingertips: A Report of Two Cases

Psoriatic onycho-pachydermo-periostitis (POPP) causes severe nail dystrophy, painful soft tissue swelling, and marked periosteal reaction of the involved distal phalanx. There are few reports of POPP involving the great toe. We report on 2 cases of POPP involving the fingertips. A 60-year-old woman presented with fusiform swelling of her right 4th fingertip with severe tenderness, and her fingernails and toenails had varying degrees of onycholysis. She had mixed multiple erosions and meta-epiphyseal periostitis at the distal phalanx of the right 4th finger but was treated successfully with methotrexate and cyclosporine. A 39-year-old woman presented with painful swelling of the left 2nd and 5th fingertip, psoriatic lesions on the knees and soles of the feet, and onycholysis without reactive periostitis of the left 2nd and 5th fingers. She was treated successfully with cyclosporine. Despite its rarity, POPP should be considered when diagnosing arthritic or infectious conditions affecting the distal interphalangeal joint.

Onicólisis exudativa y paroniquia bacteriana aguda en relación con BIBF-1120 y paclitaxel: respuesta a la terapia tópica / Exudative onycholysis and acute bacterial paronychia related to BIBF-1120 and paclitaxel: response to topical therapy

Se presenta el caso de una paciente de 50 años de edad con cáncer de mama tratada con paclitaxel y BIBF 1120 semanal. La paciente desarrolló al final del duodécimo ciclo de quimioterapia una onicólisis distal, con exudado seroso intenso en el hiponiquio, dolor y mal olor en todas las uñas de las manos. Se trató con ácido fusídico tópico y aceponato de metilprednisolona al 1% dos veces al día, con una excelente respuesta desde los tres primeros días de tratamiento. A la semana de iniciar la terapia tópica, se observó una paroniquia bacteriana con la pérdida de la uña del quinto dedo de la mano izquierda, con cultivos positivos para Staphylococcus aureus sensible a meticilina. Hay pocos casos publicados de onicólisis exudativa asociada a quimioterapia. Sin embargo, están especialmente relacionados con paclitaxel. No se observaron recurrencias de las alteraciones ungueales semanas después de culminar la quimioterapia. Los corticoides tópicos y el ácido fusídico podrían ser considerados como una opción terapéutica cuando la onicólisis exudativa relacionada con paclitaxel esté establecida.

A case of a 50 years-old breast cancer patient treated with weekly paclitaxel and BIBF 1120 is reported herein. At the end of the twelfth cycle of chemotherapy, the patient developed distal onycholysis with intense hyponychium serous exudates, pain and malodor in all her fingernails. It was treated with topical fusidic acid and 1% methylprednisolone aceponate two times daily, with an excellent clinical response from the first three days of treatment. Bacterial paronychia with nail plate loss of the fifth left fingernail was observed a week after the topical therapy was started, with positive cultures for Methicillin susceptible Staphylococcus aureus. There are few reported cases of exudative onycholysis associated with chemotherapy. However, these are especially related to paclitaxel. No recurrences of nail disturbances were observed weeks after the end of chemotherapy. Topical corticosteroids and fusidic acid could be considered as a therapeutic option when exudative onycholysis related to paclitaxel is established.

Two Cases of Onycholysis Treated with Long-Pulse Nd:YAG 1064-nm Laser / 대한피부과학회지

No abstract available.

Nail Shedding: A Case Report.

Aims: The etiology of nail shedding in an 85-year-old man as well as predisposing and precipitating factors were evaluated, focusing on whether nail loss was secondary to infection or not. Presentation of Case: An 85-year-old man was examined for complete detachment and loss of the nail plates of the index and middle fingers of his right hand. There were no previous nail disorders or a recent traumatic injury. He was non-smoker and was not receiving any drug therapy before nail loss. Clinical symptoms and signs persisted after 10 days empirical use of antibiotics and local treatment. Culture samples by that time indicated an Enterobacter cloacae local infection. He was treated with topical application of the gentamycin injection solution on the nail beds. There was normal regrowth of the nails. No abnormality of the nail unit of both fingers was evident 2 years later. Discussion: The pathogenesis of nail shedding in our patient was assessed. Although a causal relation of nail loss and a primary Enterobacter cloacae infection was highly suggestive, other causes such as missed minor trauma, ischemia or idiopathic could not be excluded. Conclusion: A primary Enterobacter cloacae infection was the most likely cause of an acute nail shedding of the index and middle fingers of the right hand in an 85-year-old man. Treatment with local use of the gentamycin injection solution was proved a welltolerated, safe and efficacious mode of treatment.

A Case of Onycholysis with Subungual Suppuration Secondary to Paclitaxel / 대한피부과학회지

Paclitaxel is one of the taxoid-antineoplastic agents. These agents are used in the treatment of breast, lung and ovary cancer. Nail changes due to treatment with the taxanes (mainly docetaxel) are reported in 30~40 percent of patients. Paclitaxel is not commonly associated with dermatological reactions, although localized skin reactions and tissue necrosis following extravasation have been reported. Reports of the incidence of nail changes associated with paclitaxel is noted as the pigmentation or discoloration of the nail bed, vary from 2~20%. We report a patient with onycholysis and subungual suppuration during treatment with paclitaxel.

A Case of Subungal Abscess and Onycholysis Induced by Docetaxel / 결핵및호흡기질환

Docetaxel is a taxoid antineoplastic drug, which is widely used to treat locally advanced or metastatic non-small cell lung cancer (NSCLC). Among the adverse dermatological reactions, nail disorders such as bending, onycholysis, hypo- or hyperpigmentation are rare. We report a case of a 62-year-old male with advanced NSCLC (cT4N3M1, stage IV), who developed purulent discharge and onycholysis in the nail of all his fingers and the left great toe after five courses of anti-neoplastic chemotherapy, which included docetaxel (cumulative dose: 370 mg/m2, 590 mg). Seven days after the final session of chemotherapy, the patient had become aware of discoloration and swelling of the nail beds with out pain. Three days later, greenish-yellow purulent discharge oozed out from the involved nails. Microbiologic studies revealed Pseudomonas aeruginosa. Intravenous and topical antibiotics (mupirocin) were applied. After 2 weeks, regrown nails were observed and the onycholysis had improved.

A Case of Taxane-induced Onycholysis and Subungual Abscesses

A 35-year-old woman with advanced lung cancer, treated with intravenous docetaxel and paclitaxel, developed subungual abscesses and secondary onycholysis involving all the finger nails. Bacterial culture demonstrated the growth of Pseudomonas aeruginosa. We report a case of onycholysis and subungual abscesses in a patient treated with docetaxel and paclitaxel.

Docetaxel-Induced Onycholysis: The Role of Subungual Hemorrhage and Suppuration

Nail changes are common side effects of taxane chemotherapeutic agents. Docetaxel (Taxotere(R)) is known to cause a great incidence of nail change. Various types of nail changes have previously been reported as a result of treatment with taxanes. We describe 2 cases of severe nail changes induced by docetaxel. The patients had previously been diagnosed with breast cancer and advanced gastric cancer, respectively. During the course of treatment with docetaxel, nail changes became apparent in both patients. Initially, they complained of nail bed purpura. Subungual hematomas with hemopurulent discharge were later observed in several fingers. Drainage of the hemopurulent material occurred spontaneously in our cases, leading to onycholysis. Following drainage, the pain in the nail with subungual hemoprulent material was relieved immediately and spontaneous healing of the patients' nails was noticed after few months. Subungual hemorrhage and suppuration therefore are considered causes of onycholysis and the pain in these patients. Although systemic or topical antibiotics were not used to treat these patients, antibiotics may be also worthwhile to hasten the drainage of the subungual hematomas and suppuration in patients for quick relief of pain.

A Case of Subungal Abscess And Onycholysis Related to Docetaxel / 대한피부과학회지

Docetaxel is a new taxoid antineoplastic drug widely used for advanced breast cancer, lung cancer, and head and neck cancer. Skin and nail change is one of the most frequent nonhematologic adverse reactions. Nail changes include dark pigmentation, subungal hemorrhage, acute paronychia, onycholysis and Beau's line. A 43-year-old woman with metastatic stomach cancer developed painful subungal abscess and secondary onycholysis of all fingernails after three courses of docetaxel chemotherapy(cumulative dose: 360mg). Puncturing under the nail plate expressed a purulent serous fluid. Microbiological cultures revealed heavy growth of Staphylococcus aureus. The docetaxel therapy was discontinused and 3rd generation cephalosporin was started. After 3-weeks antibiotic therapy, subungal abscess was improved. To our knowlege, this is the second case report of subungal abscess related to docetaxel chemotherapy.