Lesiones de punta de dedo: experiencia en el manejo en los últimos 5 años en un centro pediátrico / Fingertip injuries: experience in handling the last 5 years in a pediatric center

Las lesiones de punta de dedo son comunes en pacientes pediátricos que acuden a salas de Emergencia; son causadas por accidentes en el hogar y con aplastamiento en puerta como principal mecanismo de trauma. El tratamiento se realiza individualizado por cirujanos plásticos y cirujanos pediátricos en dependencia de la herida y el compromiso tisular. El propósito de este estudio es describir el manejo de pacientes con lesiones de punta de dedo en un centro pediátrico. Se realizó un análisis de historias clínicas en el período entre enero 2015 y diciembre 2020, se evaluaron 228 pacientes atendidos en el Hospital de Niños Dr. Roberto Gilbert Elizalde, en Guayaquil, Ecuador. Los resultados incluyen un predominio de pacientes en edad preescolar (67%), masculinos (56%) y de mano derecha (53%). Los dedos más afectados fueron el medio y anular. Los procedimientos fueron realizados por cirujanos plásticos (55%) y la técnica electiva fue bajo anestesia general. La extensión del daño involucró tejidos blandos (92%), avulsión de uña (29%) y fracturas asociadas (15%). El 3% de los pacientes presentó complicaciones que requirieron seguimiento. El tipo de reparo se seleccionó en dependencia de la extensión de la herida, se realizaron suturas simples (37%) y suturas complejas con reparo de la uña (27%). Nuestros datos son similares a los descritos en la literatura internacional, con buenos resultados a largo plazo, menor tasa de complicaciones y respuestas similares en los reparos realizados por cirujanos plásticos y cirujanos pediatras.

Fingertip injuries are common in pediatric patients who present to the emergency room. They are usually caused by accidents at home, being door-crush the main mechanism. Treatment is performed on an individual basis, by a Plastic or General Pediatric Surgeon, according to the wound findings and tissue involvement. The purpose of this study is to describe the management on a pediatric center in patients with a fingertip wound. A descriptive and retrospective analysis of medical records was carried out from January 2015 until December 2020. In this period 228 patients were seen in the Dr. Roberto Gilbert Elizalde Children´s Hospital in Guayaquil, Ecuador. A high incidence was found in the preschool age with 67% of cases. The injuries were more common in males (56 %) and more predominant on the right hand (53%). The most affected fingers were the middle and annular. Procedures were mostly performed by Pediatric Surgeons (55%) and the elective technique was under general anesthesia. Damage extension of the fingertip included soft tissues in 92% of patients, nail avulsion in 29% and associated fractures in 15%. Only 3% of patients developed complications that required follow up. The type of repair was selected according to the extension of the injury. Mostly simple sutures (37%) and complex sutures with nail repair (27%)were used.Our data is similar to the one found in international literature, with good long-term outcomes, minor complications and similar results when the repair was performed by a Plastic or Pediatric surgeon

Paquioniquia congénita tipo I o síndrome de Jadassohn- Lewandowsky: un caso de presentación familiar / Congenital pachyonychia type I or Jadassohn-Lewandowsky syndrome: a familial case

La paquioniquia congénita es una rara genodermatosis de herencia autosómica dominante, que produce alteración de la queratinización a nivel de piel, uñas y mucosas. El primer caso fue descrito por Jadassohn y Lewandowsky en 1906, y actualmente afecta a miles de personas en el mundo. El Registro Internacional de Investigación de Paquioniquia Congénita (IPCRR, del inglés, International PC Research Registry) ha identificado a nivel mundial hasta enero de 2020, 977 individuos en 517 familias con paquioniquia congénita, confirmadas genéticamente. Esta condición es considerada en nuestro país como una enfermedad huérfana, y previamente solo hay un reporte en la literatura de un caso en 2009. Se presenta el caso clínico de un paciente masculino de 23 años de edad procedente del área rural del municipio de Timbío, Colombia, con historia clínica de distrofia ungueal hipertrófica en todas las uñas de manos y pies, queratodermia palmoplantar y dolor plantar moderado a severo. Además, presentaba leucoqueratosis oral, hiperqueratosis folicular en muslos e hiperhidrosis palmoplantar. No presentaba quistes foliculares ni antecedente de dientes natales. Sus manifestaciones clínicas se catalogaron como propias de la paquioniquia congénita tipo I. Sumado a lo anterior, se identificaron características clínicas similares en otros miembros de la familia en tres generaciones, incluidos un hermano, la madre y la abuela materna, lo cual evidenció un patrón de herencia propio de esta enfermedad.

Pachyonychia congenita is a rare genodermatosis of autosomal dominant inheritance pattern that affects keratinization at the level of skin, nails and mucous membranes. The first case was described by Jadassohn and Lewandowsky in 1906 and it affects thousands of people around the world. The International Pachyonychia Congenita Research Registry (IPCRR) has identified until January 2020, worldwide, 977 individuals in 517 families with pachyonychia congenita genetically confirmed. This condition is considered in our country as an orphan disease and there has only been one previous case report in 2009. We present a case of a 23-year old male patient from the rural area of Timbio, Colombia, with a history of hypertrophic nail dystrophy in all nails and toenails, palmoplantar keratoderma and moderate plantar pain. In addition, he presented oral leucokeratosis, follicular hyperkeratosis in the thighs, and palmoplantar hyperhidrosis. No follicular cysts were present nor history of natal teeth. Clinical manifestations were classified as typical of congenital pachyonychia type I. Furthermore, similar clinical manifestations were identified in other family members from three generations, including his brother, mother and maternal grandmother, a characteristic inheritance pattern of this illness.

Características epidemiológicas de las onicomicosis en la consulta dermatológica / Epidemiological characteristics of onychomycosis in dermatological consultation

Introducción: la onicomicosis es la infección del aparato ungueal causada por hongos dermatofitos, no dermatofitos o levaduras. Constituye una enfermedad frecuente en la práctica médica, con impacto considerable en lo emocional, social, laboral y económico. Objetivo: describir las características epidemiológicas de la onicomicosis en pacientes que consultaron en un servicio dermatológico. Materiales y Métodos: estudio observacional retrospectivo de corte transverso, donde se analizaron fichas epidemiológicas de pacientes que acudieron al servicio de Dermatología del Hospital Nacional de Itauguá y el Centro de Especialidades Dermatológicas en el periodo comprendido entre julio del 2016 a agosto del 2019. Resultados: se analizaron 464 pacientes con onicomicosis. El cultivo fue positivo en el 83 % (385/464) de los casos. Se observó preferentemente en mujeres 72 % (276/385), franja etaria entre los 31 y 65 años 70,1 % (270/385), de procedencia urbana 76 % (292/385) y actividad quehaceres domésticos 41 % (157/385). El 23 % (87/385) presentó una o más comorbilidades asociadas a la aparición de onicomicosis, siendo la diabetes en el 70 % (61/385) de éstas. La localización fue en uñas de pies en 58,2 % (259/ 400), uña de manos en 31,2 % (141/400) y en el 10,1 % (45/400) de los casos se observó onicomicosis en ambas localizaciones. Los géneros aislados con mayor frecuencia fueron Trichophyton y Candida, y las especies fueron T. rubrum y Candida parapsilosis. En las onicomicosis de uñas de los pies se aislaron dermatofitos en un 63,7 % (165/259), mientras que en uñas de las manos se aislaron Candida spp. en el 77,3 % (107/141). Conclusión: la onicomicosis produce una afectación que se observa mayoritariamente en pacientes adultos, generalmente mujeres que se dedican a los quehaceres domésticos, procedentes de áreas urbanas, con afectación principal de las uñas de los pies, siendo los agentes causales más frecuentes, T. rubrum y C. parapsilosis.

Introduction: onychomycosis is an infection of nails caused by dermatophyte fungi, not dermatophytes or yeasts. It constitutes a frequent disease in medical practice, with considerable emotional, social, labor and economic impact. Objective: to describe the epidemiological characteristics of onychomycosis in patients who attended in a dermatological service. Materials and Methods: a retrospective cross-sectional observational study, where epidemiological records of patients who attended the Dermatology service of the Itauguá National Hospital and the Dermatological Specialties Center in the period from july 2016 to august 2019 were analyzed. Results: 464 patients with onychomycosis were analyzed. The culture was positive in 83 % (385/464) of the cases. It was mainly observed in women 72 % (276/385), age group was between 31 and 65 years 70.1 % (270/385), of urban areas 76 % (292/385) their activities were house as and household chores activity 41 % (157 / 385). 23 % (87/385) presented one or more comorbidities associated with onychomycosis, with diabetes in 70 % (61/385) of these. The location was in toenails in 58.2 % (259/400), fingernail in 31.2 % (141/400) and in 10.1 % (45/400) of the cases onychomycosis were observed in Both locations. The most frequently isolated genera were Trichophyton and Candida, and the species were T. rubrum and Candida parapsilosis. In the onychomycosis of the toenails, dermatophytes were isolated in 63.7 % (165/259), while in the fingernails, Candida spp. in 77.3 % (107/141). Conclusion: onychomycosis produces an affectation that is mostly adult patients, usually women who are engaged in household activities, from urban areas, the main involvement were toenails, being the most frequent agent isolated were, T. rubrum and C. parapsilosis.

The use of ultrasonography in the diagnosis of nail disease among patients with psoriasis and psoriatic arthritis: a systematic review

Abstract Background: Nail involvement has been described as a key clinical feature for both psoriasis (PsO) and psoriatic arthritis (PsA) and is an important risk factor in PsA. Thus, early diagnosis of nail involvement may be essential for better management of PsO and PsA. Ultrasonography is considered a highly promising method to visualize nail disease. The main aim of this review was to evaluate the use of ultrasonography for the diagnosis of nail disease in patients with PsO and PsA by reviewing ultrasound parameters with the best diagnostic accuracy. Main body of the abstract: A systematic search was performed in MEDLINE via the PubMed and LILACS databases. Conference proceedings of relevant rheumatology scientific meetings were also screened. Results: After applying eligibility criteria, only 13 articles and 5 abstracts were included in this review. The selected studies showed a huge variability in evaluation methods (and therefore in the results) and were mainly focused on the assessment of nails ultrasound parameters that may differ among patients and healthy controls, especially the morphological aspects in B-mode ultrasonography and vascularization of the nail bed by Doppler ultrasonography. Our research indicated that the evaluation of nail disease in PsO and PsA is still underrepresented in the literature, probably reflecting a restricted use in clinical practice, despite the widespread use of ultrasonography in the management of chronic arthritis. Short conclusions: Despite the potential relevance of ultrasonography for the diagnosis of nail disease, additional studies are needed to determine which features are more reliable and clinically pertinent to ensure accuracy in the evaluation of nail involvement in PsO and PsA.

Diagnóstico molecular de paquioniquia congénita / Molecular diagnosis of congenital pachyonychia

La paquioniquia congenital (PC) es una genodermatosis poco frecuente, caracterizada por presentar queratodermia palmoplantar dolorosa y debilitante, uñas hipertróficas, hiperqueratosis folicular, quistes epidérmicos, leucoqueratosis oral y ocasionalmente hiperhidrosis, ronquera y dientes natales. Está asociada a mutaciones heterocigotas en los genes que codifican queratinas 6a, 6b, 6c, 16 y 17. Se presenta una familia con dos miembros en dos generaciones afectados por PC: un niño de 2 años de edad con alteración de la coloración, hiperqueratosis de las 20 uñas, con dolor periungueal, múltiples pápulas foliculares color piel en tronco y dientes natales y su madre, con alteración del esmalte dentario, distrofia hipertrófica de las 20 uñas, cromoniquia, queratodermia plantar dolorosa y múltiples esteatocistomas de distribución generalizada.En ambos, se realizó el diagnóstico molecular por secuenciación masiva de exoma clínico, el cual confirmó el diagnóstico clínico y permitió determinar inequívocamente el tipo de PC en el niño, motivo de ésta presentación.

Pachyonychia congenital (PC) is a rare genodermatosis characterized by painful palmoplantar keratoderma, hypertrophic nail dystrophy, follicular hyperkeratosis, epidermal cysts, oral leukokeratosis and, less commonly, palmoplantar hyperhidrosis, hoarseness and natal teeth. PC is caused by mutations in keratin 6a, 6b, 6c, 16 and 17 genes. We report a family with two members in two generations affected by PC: a two-year old boy, presenting abnormal pigmentation and hyperkeratosis of the 20 nails, perionychium pain, multiple skin-colored follicular papules on the trunk and natal teeth. His mother has dental enamel defects, hypertrophic dystrophy of the fingernails and toenails, chromonychia, painful plantar keratoderma and generalized steatocystoma multiplex. We performed the molecular diagnosis by clinical exome massive sequencing which allowed us to confirm the clinical diagnosis and to determine the specific type of PC in our patient.

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.

Talla baja e hipotiroidismo en un niño con Síndrome de Nail-Patella. Reporte de un caso clínico / Short stature and hypothyroidism in a child with Nail-Patella Syndrome. A case report

Resumen: Introducción: El síndrome de Nail-Patella (NPS) es un desorden autosómico dominante caracterizado por anomalías esqueléticas, displasia ungueal, alteraciones renales y oculares. El diagnóstico se sospecha con la clínica y radiología y se confirma por la identificación de una variante patogénica en el gen LMX1B. El manejo de estos pacientes implica un seguimiento continuo y el tratamiento de las posibles complicaciones ortopédicas, oculares y renales. Objetivo: Describir un caso de NPS con talla baja e hipotiroidismo, asociación que no ha sido descrita en la literatura. Caso clínico: Adolescente de 11 años con talla 130 cm (-2,01 Desviaciones Estándar [DE]) fue referido a Endocrinología a los 2 años de edad por pruebas tiroideas alteradas. Se detectaron uñas displásicas y talla baja despro porcionada, además de anormalidades radiológicas sugerentes de displasia esquelética. Se confirmó hipotiroidismo primario, con anticuerpos negativos y ecografía normal, por lo que se inició trata miento con levotiroxina. El diagnóstico de NPS fue confirmado mediante estudio genético de ADN constatándose una variante patogénica en el gen LMX1B. Su padre presentaba un fenotipo similar, con estatura normal. Su edad ósea era acorde con la cronológica. Tanto el estudio general de talla baja como un test de clonidina para estimulación de GH fueron normales. Conclusión: Presentamos un paciente con NPS confirmado, asociado a talla baja e hipotiroidismo. No hallamos publicaciones en la literatura que describieran esta triple asociación. No se descarta que podría haber una relación entre el NPS y las alteraciones tiroideas halladas en este paciente.

Abstract: Background: Nail-Patella syndrome (NPS) (OMIM: 161200) or hereditary onycho-osteodysplasia is an autosomal dominant disorder characterized by skeletal anomalies, nail dysplasia, renal and ocular abnor malities. The diagnosis is based on clinical and radiological findings and confirmed by the identification of a heterozygous pathogenic variant in the LMX1B gene. Management of these patients involves conti nuous follow-up and treatment ofthe orthopedical, ocular and renal problems that mayoccur. Objective: To describe a case of NPS with short stature and hypothyroidism, an association that has not been described in the literature. Case report: An eleven-year-old boy with a height of 130 cm (-2.01 Stan dard Deviations [SD]) was referred to the Endocrine Unit at the age of 2 years due to altered thyroid tests. At that time, dysplastic nails and disproportionate short stature were detected. Radiological abnormalities initially suggested a skeletal dysplasia. A primary hypothyroidism was confirmed, without anti-thyroid antibodies and with a normal thyroid ultrasound. Levothyroxine treatment was initiated. The diagnosis of NPS was confirmed by a genetic study with a single pathogenic variant in the LMX1B gene. His father presented a similar phenotype with normal stature. His bone age was equivalent to his chronological age. Laboratory screening for short stature and a GH stimulation test were normal. Conclusion: We present a child with proven NPS with short stature and hypothyroi dism. We did not find publications that described this triple association. It can't be ruled out that there could be a relationship between NPS and the thyroid alterations found in this patient.

Fenómeno de Raynaud asociado a ácido nítrico: reporte de un caso / Raynaud's phenomenon associated with nitric acid: Case report

RESUMEN El fenómeno de Raynaud es un trastorno clínico, caracterizado por ataques episódicos de vasoespasmo de arterias y arteriolas periféricas, causando así isquemia tisular de porciones distales del cuerpo, como manos y pies, produciendo cambios en la coloración de la piel como: palidez, cianosis e hiperemia. Se ha asociado la aparición del fenómeno de Raynaud en personas que manipulan solventes orgánicos o herramientas vibratorias por un largo período, incluso se ha descrito que los solventes pueden ser gatilladores de algunas enfermedades inmunológicas como la esclerodermia, sin embargo, hasta donde conocemos no existen reportes de la exposición de compuestos químicos utilizados en la metalurgia, como el ácido nítrico y el desarrollo de enfermedades de espectro esclerodérmico. En el presente artículo se presenta un caso clínico relacionado con la aparición de fenómeno de Raynaud frente a la exposición a compuestos químicos utilizados en la metalurgia, en especial al ácido nítrico.

ABSTRACT The Raynaud phenomenon is a clinical disorder, characterized by episodic attacks of vasospasm of peripheral arteries and arterioles, causing tissue ischemia of distal portions of the body, such as hands and feet, causing changes in skin color such as pallor, cyanosis and hyperemia. The occurrence of the Raynaud phenomenon in people who handle organic sol vents or vibratory tools has been associated for a long time, and it has even been described that the solvents may be triggering some immune diseases such as scleroderma, however, as far as we know there are reports of exposure of chemical compounds used in metallurgy, such as nitric acid and the development of scleroderma-spectrum diseases. This article presents a clinical case related to the appearance of Raynaud s phenomenon against exposure to chemical compounds used in metallurgy, especially nitric acid.

Qué debe saber el reumatólogo del compromiso de piel para el manejo de la artritis psoriática / Which must be known by the rheumatologist of the skin commitment for the management of psoriatic arthritis

La artritis psoriática es una patología inflamatoria crónica que puede afectar a articulaciones periféricas y/o axiales, las que pertenecen al “espectro psoriático”. Es una enfermedad subdiagnosticada y subtratada, que puede traer consecuencias funcionales, laborales y de calidad de vida en los individuos que la padecen. Se estima que el 30 por ciento de los pacientes con psoriasis presentan compromiso articular. Entre los factores de riesgo para desarrollarla se encuentran; psoriasis cutáneas severas, evolución prolongada de más de 10 años, obesidad y psoriasis ungueal. Esta última puede presentar alteraciones de la matriz y/o del lecho ungueal, las que se pueden manifestar aisladamente o en conjunto. El diagnóstico de la artritis psoriática y de la psoriasis ungueal puede representar un verdadero desafío. Es de gran relevancia el diagnóstico temprano y el tratamiento correcto, ya que permiten preservar una mejor funcionalidad y calidad de vida de los pacientes.

Psoriatic arthritis is a chronic inflammatory pathology that can affect both axial and peripheral joints, belonging to the “psoriatic spectrum”. It is an underdiagnosed and undertreated condition, which can bring functional, labor and quality of life consequences in individuals suffering from it. About 30 percent of patients with psoriasis also have joint involvement. Risk factors for developing the disease include severe cutaneous psoriasis of more than 10 years, obese patients and nail psoriasis. Within the nail psoriasis, there are manifestations of the nail matrix and the nail bed, which can be manifested in isolation or in conjunction. However, the differential diagnosis of these lesions and psoriatic arthritis itself can be a real challenge. Early diagnosis and correct treatment depend to a large extent on our patients having better functionality and quality of life.

Acometimento ungueal como única manifestação da psoríase e seu tratamento / Nail involvement as sole manifestation of psoriasis and it´s treatment: case report

A psoríase ungueal constitui uma das formas de apresentação da psoríase, uma doença imune inflamatória crônica, com acometimento de pele e articulações. Usualmente esta forma não apresenta uma resposta adequada ao tratamento, contudo novas estratégias terapêuticas têm sido propostas com sucesso. O acometimento ungueal é frequente, sendo descrito na literatura médica em até 90% dos casos no curso da doença, que pode preceder, ocorrer simultaneamente ou após o aparecimento das lesões cutâneas. Neste relato descrevemos um caso de apresentação atípica de psoríase ungueal adequadamente tratado com medicação tópica.

Desenvolvimento do sistema tegumentar em bovinos com idades gestacionais estimadas de 20 a 140 dias / Development of the integumentary system in bovine with estimated gestational ages from 20 to 140 days

A pele representa parte importante do sistema tegumentar, pois desempenha funções como a proteção contra desidratação, lesões e infecções, além de apresentar alto poder de renovação. Histologicamente, a pele consiste de duas camadas funcionais, morfologicamente distintas, a epiderme e a derme. As glândulas mamárias, capsula ungueal e cornos também fazem parte deste sistema. Devido à escassez de dados na literatura sobre o desenvolvimento da pele e dos anexos de natureza córnea em bovinos, o objetivo deste trabalho foi descrever as características morfológicas do desenvolvimento do sistema tegumentar durante os períodos embrionário e fetal em bovinos. Os indivíduos foram divididos em três grupos: Grupo I -embriões de 20-26 dias (n=4); Grupo II -embriões 30-47 dias (n=6) e Grupo III -fetos de 74-140 dias (n=6). Durante o desenvolvimento da pele observou-se diferentes padrões morfológicos de acordo com as regiões analisadas, apresentando índice maior de diferenciação no intervalo entre 30-47 dias de gestação. O aparelho ungueal e a glândula mamária se desenvolvem mais tardiamente entre os dias 74-140 da gestação. Em resumo, estes resultados acerca do desenvolvimento do sistema tegumentar em bovinos, poderão auxiliar na interpretação e compreensão da formação dos órgãos que o constituem, assim como para a compreensão de alterações patológicas associadas à organogênese.

The skin is an important part of the integumentary system, which has important functions such as protection against dehydration, injury and infection, as well as present high potential of renewal. Histologically, the skin consists of two functional layers, that are morphologically distinct, the epidermis and dermis. The mammary glands, ungueal capsule and horn are also part of this system. Due the poor data available on literature about the development of skin and other cornea attachments in bovine, the aim of this study was to describe the morphological characteristics of the integumentary system development during the embryonic and fetal periods in bovine. Individuals were allocated in three groups: Group I -embryos from 20 to 26 days (n=4), Group II -embryos from 30 to 47 days (n=6) and Group III -fetuses from 74 to 140 days (n=6). During the development of the skin it was observed different morphological patterns according to the analyzed regions. Especially, a higher level of differentiation was observed during 30-47 days of gestation. The bovine claw and mammary gland develop later between 74 to 140 days of gestation. In summary, these results related to the development of the integumentary system in bovine may help the analysis and understanding of the development of their organs, as well as the pathological disorders associated to the organogenesis.

Trauma to the nail complex / Trauma do complexo ungueal

OBJECTIVE: to analyze the results from surgical intervention to treat trauma of the nail complex. METHODS: we retrospectively reviewed a series of 94 consecutive patients with trauma of the nail complex who were treated between 2000 and 2009. In 42 patients, nail bed suturing was performed. In 27 patients, nail bed suturing was performed subsequent to osteosynthesis of the distal phalanx. In 15, immediate grafting was performed, and in 10, late-stage grafting of the nail bed. The growth, size and shape of the nail were evaluated in comparison with the contralateral finger. The results were obtained by summing scores and classifying them as good, fair or poor. RESULTS: the results were considered to be good particularly in the patients who underwent nail bed suturing or nail bed suturing with osteosynthesis of the distal phalanx. Patients who underwent immediate or late-stage nail grafting had poor results. CONCLUSION: trauma of the nail complex without loss of substance presented better results than did deferred treatment for reconstruction of the nail complex...

OBJETIVO: analisar os resultados da intervenção cirúrgica do trauma do complexo ungueal. Métodos: revisamos 94 pacientes consecutivos com trauma do complexo ungueal entre 2000 e 2009. Em 42 pacientes foi feita a sutura no leito ungueal. Em 27, a sutura do leito foi posterior à osteossíntese da falange distal. Em 15, foi feito enxerto imediato e em 10, enxerto tardio do leito ungueal. Foram avaliados o crescimento, o tamanho e a forma da unha comparados ao dedo contralateral. Os resultados foram obtidos com a adição de escores e a classificação deles como bom, regular e ruim. RESULTADOS: foram julgados como bons os pacientes que se submeteram principalmente a suturas do leito ungueal e sutura do leito e osteossíntese da falange distal. Pacientes sub-metidos a enxerto imediato e enxerto posterior da unha tiveram resultados ruins. CONCLUSÃO: o trauma do complexo ungueal sem perda de substância apresentou melhores resultados comparado com a reconstrução do complexo ungueal...

Micose ungueal / Nail´s mycosis

A micose ungueal representa uma das grandes causas de procura médica por dermatoses. Acomete principalmente unhas de pododáctilos e pacientes idosos. As lesões podem causar distrofias inestéticas, predisposição a infecções bacterianas secundárias e grande prejuízo à qualidade de vida do paciente. Atualmente há um grande arsenal terapêutico disponível e o manejo de cada paciente deve ser individualizado com o objetivo de maximizar a adesão e obtenção de sucesso terapêutico.

Mimetização Ungueal / A surgical technique for nail mimicry

Nails play important roles in helping individuals pick up small objects and protecting the finger tips. However, since nails are located at the distal portion of the fingers, they are susceptible to injuries that can require their amputation. Here we present our technique for nail mimicry that aimed to provide a better aesthetic result after amputation. Methods: A total of 14 surgical procedures were performed in 10 patients over 5 years. Results: The goal of the surgery was achieved in all cases and no complications were observed. The surgery was repeated in three cases due to unsatisfactory results. Conclusions: Our technique is easy to perform. Patients were highly satisfied with the results since they no longer had the stigma of an amputated finger with a stump, which improved their quality of life...

As unhas cumprem importante papel de auxílio na pinça e proteção das extremidades digitais. Por seu posicionamento distal nos dedos, estão sujeitas a traumas que podem levar a sua amputação. Apresentamos nossa técnica de mimetização ungueal com o objetivo de melhora estética do dedo tratado. Método: 14 procedimentos cirúrgicos foram realizados em 5 anos, beneficiando 10 pacientes. Resultado: em todos os casos o objetivo da cirurgia foi atingido, sem nenhuma complicação observada. Em 3 casos a cirurgia foi repetida, devido ao resultado inicial ser insatisfatório. Conclusão: é uma técnica de fácil execução e que traz ao paciente um grau de satisfação elevado por retirar o estigma de um coto de amputação com melhor aparência para um convívio social...

Patología ungueal no micótica en pediatría / Non mycotic ungueal pathology in pediatrics

Nail alterations in children are a very frequent cause for consultation in primary care, pediatrics and dermatology. Its exact prevalence is unknown. Some of them are identical to those in adults, but there are some whose frequency is much higher in children, because they arise or develop exclusively in that period of life. Although some ungueal changes are considered isolated anomalies that have only cosmetic relevance, others might be diagnostic clues of associated diseases; they may be disabling and have a prognostic value for adult life. For that reason, good knowledge and proper management of them by specialists is fundamental. This report describes main alterations that may be observed in the ungueal apparatus during childhood, due to physiological alterations and congenital or acquired disease.

Las alteraciones ungueales en los niños representan un motivo de consulta frecuente en atención primaria, pediatría y dermatología. Su prevalencia exacta se desconoce. Algunas alteraciones son idénticas a las de los adultos, pero existen otras que se observan con mayor frecuencia en niños ya que se presentan o desarrollan exclusivamente en esta etapa de la vida. Aunque algunos cambios ungueales sean considerados como anomalías aisladas de importancia sólo cosmética, otros pueden ser claves diagnósticas para enfermedades asociadas, pueden ser discapacitantes y pueden tener importancia pronostica en la vida adulta. Por esto un adecuado reconocimiento y manejo por parte del especialista es fundamental. En este artículo se describen las principales alteraciones fisiológicas y enfermedades congénitas o adquiridas que se pueden observar en el aparato ungueal durante la infancia.

Onicomicosis: epidemiología, agentes causales y evaluación de los métodos diagnósticos de laboratorio / Onychomycoses: epidemiology, causative agents and assessment of diagnostic laboratory methods

Desde marzo de 2007 hasta marzo de 2011 se estudiaron prospectivamente 414 pacientes con onicodistrofias en un laboratorio privado de Esquel. La prevalencia de onicomicosis de pie fue del 78 %; la de mano, del 58 %. Los principales agentes etiológicos fueron Trichophyton rubrum, Candida spp. y Trichophyton mentagrophytes. El desarrollo de dermatofitos prevaleció en las onicopatías de pie y el de Candida spp. en las de uñas de mano (ambos, p < 0,05). En las onicomicosis candidiásicas predominaron especies diferentes a Candida albicans. Las onicomicosis fueron más frecuentes en los hombres que en las mujeres. A su vez, en los hombres hubo más aislamientos de T. rubrum en pies (p < 0,05) y mayor proporción de exámenes directos (ED) y cultivos positivos (ambos, p < 0,05). La correlación entre los resultados del ED y del cultivo fue del 68 %. El rédito de ambos métodos se asoció a un mayor tamaño de la lesión ungueal. El ED fue más efectivo en onicodistrofias que superaban los 5 años de evolución. La positividad del cultivo fue independiente de la cronicidad de la onicodistrofia.

Since March 2007 to March 2011, 414 patients with onychopathies were prospectively analyzed. Prevalence of the toenail and fingernail mycoses was 78 % and 58 %, respectively. The major etiological agents were Trichophyton rubrum, Candida spp. and Trichophyton mentagrophytes. Dermatophytes were more frequently cultured from toenails, whereas Candida spp. from fingernails (both, p < 0.05). In candidal onychomycosis, species different from C. albicans were prevalent. A higher prevalence of toenail and fingernail mycoses, a predominance of T. rubrum in toenails (p < 0.05), and greater positivity in the direct examination (DE) and in culture (both, p < 0.05) were more frequently observed in men than in women. The correlation between DE and culture was 68 %. DE and culture yields were associated with a greater size lesion. DE was more effective in onycodystrophies with duration of more than 5 years. Culture positivity was independent of nail affection chronicity.

Psoriasis ungueal: experiencia con el tratamiento combinado de clobetasol al 8 por ciento en laca ungueal y calcipotriol / Combined clobetasol and calcipotriol treatment for nail psoriasis

La psoriasis ungueal es un problema común en los pacientes psoriáticos, con una incidencia de vida de 90%. A pesar de su alta incidencia y del gran impacto que produce en la calidad de vida, ha sido poco estudiada y el tratamiento óptimo aún no está bien dilucidado. Los corticoides tópicos y los análogos de la vitamina D son las terapias más usadas, pero no existe un esquema estándar para su uso. La combinación de estos agentes se ha estudiado en los últimos años para pacientes con afectación de la matriz y del lecho ungueal, mostrando muy buenos resultados. El caso que presentamos demuestra la sinergia entre estos agentes.

Nail psoriasis is a common problem among psoriatic patients, with a lifetime incidence of 90%. Despite its high incidence and severe impact on the quality of life, it has not been fully studied and the optimal treatment is still unclear. Topical glucocorticosteroids and vitamin D analogues are the most used therapies, but there is no standard therapeutic regimen for their use. The combination of both of these agents has been studied during the last years for the treatment of patients with matrix and bed nail compromise, showing very good results. The case that we present shows the synergy between these agents.

Paquioniquia congénita: a propósito de un caso / Pachyonichia congenita: a case report

Niña de 08 años de edad, sin antecedentes familiares que desde el nacimiento presenta distrofiaungueal hipertrófica, a los 2 años de edad se agrega hiperqueratosis plantar, cuadro compatible con paquioniquia congénita tipo 1 o de Jadassohn Lewandowsky. No hay tratamiento curativo exitoso. Se reportan terapéuticas desde amputación de las falanges distales, electrocoagulación de la matriz ungueal, medidas ortopédicas, uso de queratolíticos, etc. Según últimas experiencias, la isotretinoina oral seria una buena opción tanto para la distrofia ungueal como para la queratodermiapalmo plantar.

Girl of 08 years of age, unique in her family who from the birth presents/displays hypertrophic ungueal dystrophy, to the 2 years of age adds plantar hiperqueratosis, compatible picture with paquioniquia congenital type 1 or of Jadassohn Lewandowsky. There is no successful curative treatment. They are reported therapeutic from amputation of distales phalanges, orthopaedic electrocoagulaciónof the ungueal matrix, measures, use of queratolíticos, etc. According to you complete experiences, the serious oralisotretinoina a good option as much for the ungueal dystrophy as for queratodermiaplantar.

Afecções ungueais nas doenças sistêmicas. O que as unhas podem dizer-nos / Nail disorders in systemic disease: What the nail tell us

A aparência das unhas de mãos e pés pode sugerir uma doença sistêmica subjacente. Em geral, unha em vidro de relógio pode sugerir doença pulmonar ou doença inflamatória do intestino. Coiloníquia pode significar anemia ou hemocromatose. Na ausência de trauma ou psoríase, a presença de onicólise pode sugerir hipertereoidismo. As linhas de Beau podem indicar doença febril severa prévia, trauma ou exposição a temperaturas frias nos pacientes com doença de Raynaud. Nos pacientes com linhas de Muehrcke devemos checar os níveis de albumina. A presença nas unhas de hemorragia em estilhaço pode indicar a presença de endocardite. Pacientes com telangectasias, coiloníquia ou pitting das unhas podem apresentar doença do tecido conectivo. Neste trabalho, revemos nas unhas os sinais mais comuns, que podem auxiliar-nos no diagnóstico de doenças sistêmicas.

Liquen estriado ungueal: comunicación de cuatro casos / Nail Lichen striatus: a report of four cases

El liquen estriado es una dermatosis inflamatoria benigna y autolimitada que afecta habitualmente a niños en edad preescolar. El compromiso ungueal en esta entidad es poco frecuente y no siempre se asocia a lesiones cutáneas. Las anormalidades ungueales que pueden observarse en este cuadro incluyen: adelgazamiento de la lámina ungueal, estriaciones longitudinales, onicólisis, onicosquisis e incluso, pérdida transitoria de las uñas. Generalmente el compromiso es de una única uña. La duración promedio de las lesiones es de 14 meses y suelen resolver espontáneamente sin secuelas. Presentamos 4 casos de liquen estriado ungueal.

Lichen striatus is a benign and self-limited inflammatory dermatosis that commonly affects pre-school children. Nail compromise in this entity is uncommon and is not strictly associated to cutaneous lesions. Main nail abnormalities observed in this disease are: nail thinning, longitudinal ridging, onycholysis, splitting and even transient lost of the nail plate. Nail lichen striatus often compromises a single nail. Mean duration of nail compromise is around 14 months and lesions resolve spontaneously without cicatricial sequalae. We herein present 4 cases of nail lichen striatus.