Onicomadesis asociada a la enfermedad de boca, mano, pie / Onychomadesis associated to mouth, hand, and foot disease

Introducción: la onicomadesis es el desprendimiento completo y espontáneo de la uña desde su extremo proximal, sin dolor o inflamación, consecutivo a la detención mitótica de la matriz ungular que conlleva a un cambio de su función. Objetivo: describir una serie de casos de onicomadesis atendidos en la consulta de Dermatología del Hospital Pediátrico Docente del Cerro, entre noviembre y diciembre del año 2017, después de presentar un cuadro clínico compatible con enfermedad boca, mano, pie, con la finalidad de contribuir al conocimiento de esta patema. Presentación de los casos: las edades estuvieron comprendidas en un rango entre 1 y 12 años, con solo 3 pacientes correspondientes al sexo masculino y solo uno con el color de la piel negra. Los días previos al padecimiento de la enfermedad boca, mano, pie se enmarcan entre 15 y 47 días de haber tenido los síntomas que indujeron al diagnóstico del citado morbo. El estudio virológico se efectuó en dos pacientes con presencia del Coxsackie A6. La evolución resultó satisfactoria en todos los casos. Conclusiones: los hallazgos, en general, coinciden con los mencionados en la literatura. Todos los pacientes presentaron semanas anteriores signos y síntomas compatibles con enfermedad boca, mano, pie. Es necesario orientar a los padres de los enfermos con este morbo, la posibilidad de la ocurrencia de onicomadesis como complicación, cuyo tratamiento es sintomático, seguido de buen pronóstico, para evitar la ansiedad familiar y los gastos de recursos innecesarios(AU)

Introduction: onychomadesis is the total and spontaneous detachment of the nail from its proximal end, without pain or inflammation, and following the mitotic halting of the nail matrix that leads to a change in its function. Objective: to describe a series of cases of onychomadesis attended in the Dermatology clinic of the Pediatric Teaching Hospital of Cerro, in the period of November to December of 2017, after presenting clinical manifestations compatible with mouth, hand, and foot disease, and in order to contribute to the knowledge of this pathology. Presentation of cases: ages were among 1 and 12 years old, with only 3 patients corresponding to the male sex and only one with black skin. The days before presenting symptoms of mouth, hand, and foot disease were between 15 and 47 days after having the symptoms that led to the diagnosis of the aforementioned disease. The virological study was carried out in two patients with the presence of Coxsackie A6. The evolution was satisfactory in all cases. Conclusions: in general the findings coincide with those mentioned in the literature. All patients presented previous signs and symptoms compatible with mouth, hand, and foot disease in the previous weeks. It is necessary to guide the parents of patients with this disease on the possibility of the onychomadesis occurrence as a complication, whose treatment is symptomatic, followed by a good prognosis to avoid family anxiety and the expense of unnecessary resources(AU)

Onychomycosis: A study of self-recognition by patients and quality of life.

Background: Onychomycosis accounts for approximately half of all nail disorders and is usually asymptomatic. Objectives: To evaluate patients’ recognition of fungal nail disease, concomitant fungal skin diseases, complications, and quality of life. Methods: Patients from the fungal nail clinic were enrolled between May 2011 and April 2012. Patients’ awareness of diseased nails was evaluated and the Dermatology Life Quality Index (DLQI) questionnaire was used to evaluate the impact of dermatologic disease on quality of life. Results: A total of 110 patients with onychomycosis were enrolled in the study, of which 64 (58.2%) were female and the mean age was 60.8 years. The number of patients who were able to recognize the presence of onychomycosis was 71 (64.5%), while 32 (29.1%) and 7 (6.4%) were diagnosed by a dermatologist and other physicians, respectively. Multivariate analysis showed that patient recognition of the disease was signifi cantly associated with female sex and young age. The mean DLQI score was 3.6. Limitation: Patient recall bias including the duration of fungal nail infection, long-term past history and previous treatment was a limitation of this study that affected DLQI scores. Conclusion: About half of onychomycosis patients, especially elderly males, could not recognize the disease by themselves. It is important for physicians to educate patients with risk factors for onychomycosis to recognize this condition early to prevent concomitant infection and complications, and to improve patients’ well-being.

As diferenças do Doppler espectral, na artrite psoriática e onicomicose / Differences of spectral Doppler in psoriatic arthritis and onychomycosis

Objetivo Utilizar o Doppler espectral (DE) para quantificar atividade inflamatória e detectar diferenças ecotexturais ungueais em pacientes com artrite psoriásica e onicomicose. Métodos Foram incluídos dois pacientes, um com artrite psoriásica, mas sem dores nas articulações e sem alterações clínicas ungueais; e outro paciente com onicomicose e artrite reumatoide. O exame de ultrassom, pela escala cinza, demonstrou alterações na presença regular da ecotextura na inserção da unha, aumento da espessura do leito ungueal e perda do padrão trilaminar da unha. O Doppler espectral, através do índice de resistência (IR), detecta o processo inflamatório nas enteses ungueais. Resultados Sete articulações interfalângicas distais (IFD) nos dois pacientes foram avaliadas em dois planos, obtendo nove IR. O autor encontrou no paciente com artrite psoriásica: perda normal do padrão trilaminar da unha; leitos ungueais e cápsulas articulares das IFDs preservados. O Doppler espectral evidenciou IR<1, com média±DP igual a 0,50±0,75 em microcirculação nas enteses ungueais e caracterizou erosão óssea ativa em 3a IFD esquerda, com IR igual a 0,38 e 0,63 em planos transversal e longitudinal, respectivamente. O paciente com onicomicose mostrou as seguintes alterações: hipoecogenicidade na inserção ungueal; perda do formato da unha e o Doppler espectral nas enteses ungueais com IR>1, com média±DP igual a 1,71±0,98. Conclusão O uso do ultrassom pode detectar alterações nos leitos ungueais nessas doenças. Futuros estudos poderão melhor caracterizar essas mudanças. .

Objective To evaluate the use of the spectral Doppler (SDoppler) to quantify inflammatory activity and to detect nail echotextural differences in patients with psoriatic arthritis and onychomycosis. Methods Two patients, one with psoriatic arthritis but with no joint pain nor nail clinical change and the other with onychomycosis and rheumatoid arthritis were included. The gray scale ultrasound study, showed changes in the regular presence of echotexture at the nail insertion, thickening of the nail bed and loss of trilaminar nail pattern. The spectral Dopplerresistance index (RI), detects the inflammatory process in nail entheses. Results Seven distal interphalangeal (DIP) joints in both patients were evaluated in two planes, getting nine RI. In the patient with psoriatic arthritis the author found: loss of normal trilaminar nail plate aspect, and nail beds and DIP joint capsules preserved. The spectral Doppler showed RI<1, with mean±SD=0.50±0.75 in the microcirculation at nail entheses, with characterization of a bone erosion in the third left DIP joint, with RI=0.38 and 0.63 in transverse and longitudinal planes, respectively. The patient with onychomycosis showed the following changes: hypoechogenicity at nail insertion; loss of nail shape, and spectral Doppler in nail entheses with RI>1, with mean±SD=1.71±0.98. Conclusion The use of ultrasound can detect changes in the nail beds in these diseases. Future studies will further characterize these changes. .

Micosis cutáneas y manifestaciones cutáneas de las micosis sistémicas en pacientes con SIDA / Cutaneous mycoses and cutaneous manifestations of systemic mycoses in AIDS

Las micosis cutáneas adquieren en los individuos con SIDA características particulares. Las diferencias observadas son debidas al déficit inmunológico presente en estos pacientes, sobre todo en la inmunidad celular, de vital importancia en el control de éstas y otras infecciones micóticas. Las lesiones suelen ser poco inflamatorias y extendidas a regiones donde no se ubican en individuos inmunocompetentes, además de ser recidivantes y notablemente resistentes a la terapéutica antifúngica específica. El agente causal más frecuente de las dermatoficias (tineas pedis, cruris y unguium) es Trichophyton rubrum, en las pitirosporosis (dermatitis seborreica, foliculitis y pitiriasis versicolor) Pityrosporum ovale y en las candidiasis Candida albicans. Otras micosis cutáneas, formas clínicas y agentes etiológicos, si bien probables, no son frecuentes en estos pacientes. El tratamiento de todas ellas es difícil, más aún teniendo en cuenta las numerosas interacciones medicamentosas con los diferentes esquemas terapéuticos que reciben los pacientes con SIDA. También las micosis sistémicas (en nuestro medios criptococosis e histoplasmosis) se manifiestan en la piel con lesiones papulosas o moluscoides, únicas o múltiples. Su reconocimiento permite el diagnóstico temprano de estas micosis. El propósito de este trabajo es describir algunas de las características clínicas, inmunológicas, diagnósticas y terapéuticas de las micosis cutáneas en los pacientes con SIDA

Penicillium species causing onychomycosis.

Onychomycosis caused by mould infection is rare. A 40 year old male patient presented with dystrophic finger nails and multiple, erythematous lesions with slightly raised borders and scaling all over the body. The patient was a known diabetic. He did not respond to griseofulvin. Samples from nails and skin scales were cultured. From the nails, Penicillium species and from the skin scales. Trichophyton rubrum were isolated. Ketoconazole therapy (200 mg twice daily x 4 mths) led to complete cure with negative cultures and normalization of nails.

O estudo das unhas: novos aspectos após o exame de 1.100 pacientes / The study of the nails: news aspects after 1.100 patients examination

O estudo das unhas é muito pouco valorizado por nós especialistas. Despertou-nos o interesse após revisäo literária pertinente, reunir o maior número de casos possíveis para uma observaçäo detalhada das alteraçöes deste fânero. Comparamos dados obtidos com os já publicados. Correlacionamos as alteraçöes ungueais e patologias dermatológicas e ou patologias sistêmicas