Onychomatricoma on the fourth toenail: A rare tumor in a rare localization

Onychomatricoma is a rare benign tumor of the nail matrix, characterized by finger-like projections that invade the nail plate. The fingernails of Caucasian women are most commonly affected. Because this tumor can easily mimic other more prevalent ungual diseases, it is crucial to be acquainted with its characteristic clinical and histopathologic features. The authors present a case of a 40-year-old man with an onychomatrichoma in the fourth left toenail, which was initially misdiagnosed and treated as onychomycosis

Onicomatricoma: puntos clínicos claves de una enfermedad infrecuente / Onychomatricoma: Key clinical points of an unfrequented disease

Resumen Introducción: el onicomatricoma es un tumor fibroepitelial originado en la matriz ungular, es infrecuente y suele presentarse alrededor de la quinta y sexta década de la vida. Métodos: se presenta el caso de un paciente masculino de 57 años, sin antecedentes patológicos, quien consultó por una lesión no dolorosa en la uña del tercer dedo de la mano derecha. Al examen físico presentaba cromoniquia amarilla longitudinal, estrías blanquecinas y hemorragias en astilla. Se realizó onicectomía y matricectomía proximal y se envió el especimen resecado a estudio histopatológico. Resultados: el examen histopatológico reportó una lesión fibroepitelial, con invaginaciones del epitelio y ausencia de la capa granulosa. En el estroma se observaban células ondulantes y fusocelulares acompañadas de mastocitos. Se realizaron tinciones de inmunohistoquímica, confirmando el diagnóstico de onicomatricoma, variante micropapilifera. Conclusiones: debido a los múltiples diagnósticos diferenciales de esta condición, es importante para el dermatólogo familiarizarse con la clínica, hallazgos dermatoscópicos y manejo de esta entidad.

Abstract Introduction: onychomatricoma is a fibroepithelial tumor originating in the nail matrix, it is infrequent and usually presents around the fifth and sixth decades of life. Methods: we present the case of a 57-year-old male patient, without relevant past medical history, who complained of a non-painful lesion in the nail of the third finger of the right hand. Physical exam revealed longitudinal yellow chromonychia, whitish striae, and splinter hemorrhages. Onychectomy and proximal matricectomy were performed and the resected specimen was sent for histopathological study. Results: the histopathological study reported a fibroepithelial lesion, with invaginations of the epithelium and absence of the granular layer. Undulating and spindle cell cells accompanied by mast cells were observed in the stroma. Immunohistochemical staining was performed, confirming the diagnosis of onychomatricoma, micropapiliferum variant. Conclusions: due to the multiple differential diagnoses of this condition, it´s important for the dermatologist to become familiar with the clinic, dermoscopic findings and management of this entity.

Profile of Nail Disorders in Patients Presenting to a Tertiary Care Hospital in Kashmir Valley

Introduction: Nail disorders comprise about 10% of alldermatological conditions. They may get involved invarious systemic diseases, infectious processes, nutritionaldeficiencies, ageing, genetic disorders, and neoplasms.Current study objective was to see the clinical pattern of nailchanges in patients presenting with various nail disorders andto determine the clinical pattern of nail involvement in variousdermatoses.Material and methods: This was a cross sectional study inwhich patients presenting to our department with any naildisorders were examined. A proper history, examination andthe relevant investigations like KOH, nail culture, and nailbiopsy were also done.Results: A total of 500 patients were screened, 282 femalesand 218 males. The most common nail change observed waslongitudinal ridging (45.6%), followed by distal subungualhyperkeratosis (35.8%) and cuticular changes (35.2%).Onychomycosis was the most common nail disorder observed,constituting 36.2% of all nails diseases. Among non infectivediseases, nail psoriasis was the most common nail disorderfollowed by nail lichen planus.Conclusion: A variety of nail changes can occur in variousdermatological and various other systemic disorders. So athorough clinical examination of nails is of prime importanceto correlate all these nail changes and to make dermatologiststo reach a conclusive diagnosis.

Various Nail Disorders Misdiagnosed and Treated as Onychomycosis / 대한피부과학회지

BACKGROUND: Treatment of onychomycosis should be commenced after mycological confirmation due to the side effects and long duration of oral antifungal agents. However, many doctors treat patients with nail disorders that resemble onychomycosis without any mycological examination (ME) in clinical practice. OBJECTIVE: To investigate the various nail disorders misdiagnosed as onychomycosis and to evaluate the performing ratios of appropriate diagnostic procedures of onychomycosis. METHODS: The study was performed in a total of 48 patients who had a history of being misdiagnosed and treated for onychomycosis. We investigated the characteristics of each patient, the specialty of their previous doctor, and their previous treatment modality and duration. Whether or not they had previously received proper diagnostic procedures was also investigated. All of the data were collected by questionnaires, and their final diagnoses were also recorded. RESULTS: Among the 48 patients, 31 (31/48, 64.7%) were female, and the mean age of the patients was 45.5+/-15.7. Eighteen patients (18/48, 37.5%) were referred from dermatologists and 30 (30/48, 65.2%) from non-dermatologists. The results of the questionnaires revealed that only 10 of the dermatologists (10/18, 55.6%) performed ME before initiating treatment for onychomycosis, and none of the non-dermatologists did it. The duration of incorrect previous systemic anti-fungal treatment was also significantly longer when administered by non-dermatologists as compared with dermatologists (p=0.042), and over half of the patients (30/46, 65.2%) were treated with fluconazole. Onycholysis (22/48, 45.8%) and trachyonychia (18/48, 37.5%) were the most common final diagnoses, but various nail disorders such as pitting nail, median nail dystrophy, and subungual melanoma were also included. CONCLUSION: To avoid misdiagnosis and incorrect anti-fungal treatment, people with nail disorders that resemble onychomycosis should be recommended to visit dermatologists, and the doctors should perform appropriate mycological examinations in these patients.

Alterações ungueais nos pacientes portadores de insuficiência renal crônica em hemodiálise / Nail disorders in patients with chronic renal failure undergoing hemodialysis

FUNDAMENTOS: A insuficiência renal crônica atinge quase todos os sistemas do organismo, inclusive pele e anexos. As alterações ungueais mais observadas nos pacientes com insuficiência renal crônica são: unhas meio a meio, ausência de lúnula e hemorragia em estilhas. OBJETIVOS: Avaliar o espectro e a frequência de alterações ungueais nos pacientes com IRC, submetidos à hemodiálise (HD), e compará-los com uma amostra pareada da população geral. MÉTODOS: Realizado um estudo caso- controle, pareado por gênero e idade, onde 2 grupos foram estudados com relação às alterações ungueais presentes. RESULTADOS: 86 por cento dos pacientes em HD e 75 por cento do grupo controle tiveram, pelo menos, uma alteração ungueal.Ausência de lúnula (62,9 por cento) e unha meio a meio (14,4 por cento) as alterações foram estatisticamente relevantes no grupo HD, em relação ao grupo controle (p < 0,05 por cento). Estrias longitudinais foram mais comuns nos controles em relação ao grupo HD (24,1 por cento). CONCLUSÕES: Ausência de lúnula e unha meio a meio as alterações ungueais foram mais encontradas nos pacientes em HD, corroborando com achados relatados, em estudos anteriores. Estrias longitudinais foram mais observadas no grupo controle e estudos posteriores poderão elucidar se alterações estruturais, tal qual a ausência de lúnula, poderiam relacionar-se a este achado.

BACKGROUND: Chronic renal failure affects almost all the systems of the body, including the skin and appendages. The nail disorders most commonly found in patients with chronic renal failure are half and half nails, absent lunula and splinter hemorrhages. OBJECTIVES: To evaluate the spectrum and the frequency of nail disorders in patients with chronic renal failure submitted to hemodialysis and compare them with a paired sample from the general population. METHODS: A case-controlled study paired for gender and age was conducted in which nail disorders were investigated in the two groups. RESULTS: At least one nail disorder was found in 86 percent of the hemodialysis patients and in 75 percent of subjects in the control group. Absent lunula (62.9 percent) and half and half nails (14.4 percent) were more common in the hemodialysis group compared to the control group and this difference was statistically significant (p < 0.05). Longitudinal striae were more common in the control group compared to the hemodialysis group (24.1 percent). CONCLUSIONS: Absent lunula and half and half nails were the most common nail disorders found in patients on hemodialysis, corroborating the findings of previous studies. Longitudinal striae were more common in the control group and future studies may clarify whether structural abnormalities such as absent lunula may be related to this finding.

Tratamento cirúrgico da paroníquia crônica. Estudo comparativo de 138 cirurgias utilizando duas técnicas diferentes / Surgical treatment of chronic paronychia: a comparative study of 138 surgeries using two different techniques

Introdução: A paroníquia crônica é uma doença infl amatória da prega ungueal proximal (PUP) com duração maior que seis semanas. Esta condição representa 18% das distrofi as ungueais. Caracteriza-se clinicamente por infl amação da PUP, ausência de cutícula e distrofi a da placa ungueal. O tratamento clínico é frequentemente insatisfatório. Já o tratamento cirúrgico consiste na retirada da PUP, que pode ser realizada pelas técnicas de incisão oblíqua ou perpendicular. Objetivo: Comparar a efi cácia entre as técnicas cirúrgicas oblíqua e perpendicular para o tratamento da paroníquia crônica. Material e métodos: Sessenta e dois pacientes com paroníquia crônica em um ou mais quirodáctilos (em um total de 138 casos operados) foram divididos de forma randomizada em dois grupos, conforme a técnica utilizada. A avaliação pós-operatória foi realizada após seis meses e foi utilizada uma escala de três pontos: sem melhora, melhorado e curado. Resultados: Cento e trinta e quatro casos (97,1%) foram considerados curados e quatro (2,9%), dois de cada grupo, foram considerados melhorados. Conclusão: Concluímos em nosso estudo que o tratamento cirúrgico é efetivo na paroníquia crônica, a despeito da técnica empregada.

Background and Objectives: Chronic paronychia is an infl ammatory disorder of the proximal nail fold (PNF) lasting more than six weeks, and accounts for 18% of nail dystrophies. Clinically, it is characterized by infl ammation of the PNF, absence of the cuticle, and dystrophy of the nail plate. Clinical treatment is, frequently, unsatisfactory. Surgical treatment consists on the removal of the PNF, which can be done using the oblique or perpendicular incision technique. The objective of the present study was to compare the effi cacy of oblique and perpendicular surgical techniques in the treatment of chronic paronychia. Methods: Sixty-two patients with chronic paronychia, in one or more fi ngers (for a total of 138 surgeries), were randomly divided in two groups according to the surgical technique used. Postoperative evaluation was done after six months using a three-point scale: absence of improvement, improved, cured. One hundred and thirty-four cases (97.1%) were considered cured, and 4 (2.9%), two in each group, were considered as having improved. Conclusion: In the present study, we concluded that the surgical treatment of chronic paronychia is effective, regardless of the technique used.