Osteocondromas: presentación del osteocondroma subungueal / Osteochondromas: introducing the subungual osteochondroma

Resumen: Introducción: Los osteocondromas subungueales son tumoraciones benignas de la región sub- o periungueal que ocasionan elevación, ulceración y deformidad a dicho nivel. Objetivos: Investigar la incidencia de osteocondroma subungueal en un segmento de población pediátrica. Material y métodos: Estudio retrospectivo, transversal, descriptivo y observacional, basado en la revisión de expedientes con resultado histopatológico de osteocondroma de 2001 a 2014. Resultados: Cuatro de los osteocondromas correspondieron a la presentación subungueal, con una distribución por sexos de 1:1 y un promedio de edad de 9.5 años, relación 3:1, derecho:izquierdo; el cuarto dedo fue el más afectado. Discusión: El osteocondroma sunbungueal presenta una incidencia de 8.5% de todos los osteocondromas.

Abstract: Introduction: Subungual osteochondromas are benign tumors of the sub- or periungual region, causing lifting, ulceration and deformity at that level. Objective: To research the incidence of subungual osteochondromas in a specific pediatric population. Material and methods: Retrospective, transversal, descriptive and observational study based on the review of records with a histopathological result of osteochondroma from 2001 to 2014. Results: The pathological assessment featured four osteochondromas that corresponded to the subungual presentation, with an equal gender distribution of 1:1, an average age of 9.5 years, right: left ratio of 3:1; the 4th finger was the most affected. Discussion: Subungual osteochondroma has an incidence of 8.5% of all osteochondromas.

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.

Incidence, clinical manifestations and clipping of nail psoriasis in the dermatology center of the Hospital Universitário Evangélico de Curitiba

Abstract: Background: Psoriasis is a chronic inflammatory skin disease that often progresses with nail alterations. It is suspected that there is a correlation between nail psoriasis and enthesitis of the distal interphalangeal joint, seeming to serve as a predictor. Objectives: To analyze the profile of patients with nail psoriasis and correlate the presence of nail alterations with psoriatic arthritis, quality of life, extent of psoriasis and the histopathology of the nail. Methods: An observational cross-sectional study with 40 patients with a diagnosis of psoriasis and without systemic treatment. The patient profile was researched, including quality of life and evaluated for the presence of psoriatic arthritis. The severity of the skin psoriasis and the presence of nail lesions were evaluated. Nail fragments were collected and analyzed through clipping. It obtained 100% of positivity for psoriasis in the histopathology exam of the nail plate. Results: Of the 40 patients, 65% were diagnosed with nail psoriasis. Suggestive findings of psoriatic arthritis in hands were present in 33%, being more frequent in those with nail alteration (p = 0.01). In 92.3% of patients diagnosed with psoriatic arthritis in the hands there was some nail injury. The most frequent injuries were pitting and onycholysis. Conclusions: Patients with nail psoriasis are usually men, with worse quality of life and higher chance of psoriatic arthritis. The correlation between the nail involvement of psoriasis and psoriatic arthritis in hands confirms the association between these two forms. The clinical diagnosis of nail psoriasis did not correlate with the histological diagnosis.

Distribución de especies y susceptibilidad antifúngica de Candida spp. causantes de micosis superficiales. Coro, estado Falcón, Venezuela / Species distribution and antifungal susceptibility of Candida spp. causing superficial mycosis. Coro, Falcon state, Venezuela.

Las especies de Candida distintas a C. albicans se describen con frecuencia como agentes causales de micosis superficial y presentan una mayor resistencia al tratamiento con los azoles. Con la finalidad de determinar la distribución de especies y la susceptibilidad antifúngica in vitro de Candida spp., se realizó un estudio ambispectivo donde se analizaron 18 aislados de levaduras obtenidas de muestras de pacientes con diagnóstico de micosis superficial. La identificación taxonómica se realizó mediante la visualización de las características macroscópicas de crecimiento en agar cromogénico y por métodos convencionales. La susceptibilidad a fluconazol y voriconazol se evaluó por el método de difusión en disco. El 88,8% de los aislados provenía de muestras de uñas. C. parapsilosis fue la especie más frecuente, seguida de C. tropicalis, C. albicans y C. krusei, lo cual confirmó el predominio de especies no albicans como causa de micosis superficial. El patrón de susceptibilidad a fluconazol y voriconazol fue similar: todos los aislados de C. parapsilosis y C. albicans resultaron sensibles, mientras que el 83,3% de C. tropicalis mostró sensibilidad a ambos antifúngicos. C. krusei, especie resistente a fluconazol, presentó sensibilidad intermedia al voriconazol. El uso de agar cromogénico permitió detectar infecciones mixtas en muestras de uñas, involucrando en uno de los casos a Candid spp. y C.tropicalis, esta última con resistencia tanto a fluconazol como a voriconazol. Los resultados obtenidos demuestran la importancia de la identificación de especies y la realización de pruebas de susceptibilidad con el fin de evitar fracasos terapéuticos en micosis superficiales. Autor de correspondencia: Leyla Humbría-García. Laboratorio de Micología

Candida species other than C. albicans are often described as causative agents of superficial mycosis and are more resistant to treatment with azoles. In order to determine the distribution of species and in vitro antifungal susceptibility of Candida spp., one ambispective study, which analyzed 18 yeast isolates obtained from samples from patients diagnosed with superficial mycosis, was performed. Taxonomic identification was performed by macroscopic visualization of the growth characteristics in chromogenic agar and by conventional methods. The susceptibility to fluconazole and voriconazole was evaluated by the disc diffusion method. Most of the isolates (88.8%), came from nail samples. C. parapsilosis was the most common species, followed by C. tropicalis, C. albicans and C. krusei, which confirmed the prevalence of non-albicans species as a cause of superficial mycoses. The pattern of susceptibility to fluconazole and voriconazole was similar: all isolates of C. parapsilosis and C. albicans were susceptible, while 83.3% of C. tropicalis showed sensitivity to both antifungals. C. krusei, fluconazole-resistant species showed intermediate susceptibility to voriconazole. The use of chromogenic agar allowed to detect mixed infections in nail samples, involving Candida spp. and C. tropicalis in one case, the latter with resistance to both fluconazole and voriconazole. The results demonstrate the importance of species identification and susceptibility testing to avoid therapeutic failures in superficial mycoses.

Nail involvement in adult patients with plaque-type psoriasis: prevalence and clinical features

Abstract BACKGROUND: Psoriasis is a disease of worldwide distribution with a prevalence of 1 to 3%. Nail psoriasis is estimated in 50% of patients with psoriasis, and in the presence of joint involvement, it can reach 80%. OBJECTIVE: To study the nail changes - and their clinical implications - presented by patients with psoriasis vulgaris under surveillance in a university hospital from the south of Brazil. METHODS: his cross-sectional study evaluated 65 adult patients from January 2012 to March 2013. Cutaneous severity was assessed according to the Psoriasis Area and Severity Index (PASI). The Nail Psoriasis Severity Index (NAPSI) was used to evaluate patient's nails. The diagnosis of psoriatic arthritis was established according to the Classification Criteria for Psoriatic Arthritis (CASPAR). RESULTS: The prevalence of NP was 46.1%. These patients had a median [interquartilic range (IQR)] NAPSI of 1 (0-15). A total of 63.3% of patients reported aesthetic discomfort or functional impairment related to their nails. Onycholysis was the most common feature (80%). When compared with patients without nail involvement, patients with NP had lower mean age at psoriasis onset [21 (18-41) vs. 43 (30-56) years, p=0,001]; longer disease duration [15.5 (10-24) vs. 6 (2-12) years, p=0.001]; higher PASI [9.2 (5-17) vs. 3.7 (2-10), p=0.044], higher frequency of psoriatic arthritis (43.3 vs. 3.7, p = 0.002) and more often reported family history of psoriasis (40% vs. 7.4%, p = 0.011). CONCLUSION: Onycholysis was the most frequent finding and most patients feel uncomfortable with the psoriatic nail changes that they experience. .

Epidermolysis Bullosa Pruriginosa with Nail Dystrophy: A Rare Case Report.

Epidermolysis bullosa (DEB) pruriginosa is a type of dystrophic DEB wherein there is a mutation in gene COL VII A1, which encodes anchoring fibril protein Type VII collagen. Clinically, it is characterized by intensely pruritic linear lichenified or nodular prurigo like lesions over extremities with milia, nail dystrophy, and in some cases albopapuloid lesions over trunk. Here we report a case of an adult onset DEB pruriginosa with typical clinical features which was confirmed by histopathology. In any severely itchy skin lesion over pretibial region, DEB pruriginosa should be kept in mind, and DEB pruriginosa can occur for the first time in adulthood also.

Nail changes in psoriasis - a profile

Nail involvement in psoriasis is quite common and is seen in 50% of all cases. For the present study, we selected 100 patients of psoriasis with nail changes coming from various walks of life. The data was collected and statistical analysis of the data was done. Pitting was the most common finding in psoriasis, accounting for 70% cases. Next most common nail changes were onycholysis in 52% and subungual hyperkeratosis in 40%cases. Discoloration was found in 25% cases followed by paronychia in l0% cases. Splinter hemorrhages were seen in 12% and Beau's lines were observed in 14% cases. Nail changes are frequently observed in psoriatic patients which are usually pitting, onycholysis and subungual hyperkeratosis

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.

Pattern of skin disorders in Muzaffarabad: a comparison of pre- and post-earthquake scenario

Psyche and skin are closely related. The anatomical and physiological integrity is maintained when they are congruent in their functioning. Natural calamities and disasters affect this harmony adversely by causing psychological as well as physical trauma, which leads to a number of immediate as well as long term skin ailments. The study was aimed to observe any change in pattern of skin diseases in Muzaffarabad after devastating earthquake of October 8th, 2005. Patients and methods The study was carried out in CMH, Muzaffarabad from March, 2006 to August 2006. Patient's record of same six months of last year was retrieved and was compared with present record. Patients of all ages, with any cutaneous disease, attending the outpatient departments or admitted to the skin ward of Combined Military Hospital Muzaffarabad, from 1St March 2006 to 31St August 2006, were included in the study. A detailed dermatological evaluation was carried out in all patients. Relevant investigations like o scraping for fungus and biopsy were done when required. Indoor as well as outpatients' record for the same period of last year [2005] was retrieved. The information were duly documented and compiled. Prevalence of various common skin disorders was compared in pre and post earthquake scenario and statistical evaluation was done by calculating p-value after applying z-test. In post-earthquake period, overall proportion of skin patients increased when compared with similar per-earthquake period. Infections remained at the top in both scenarios but their proportion increased significantly after earthquake period. Psychocutaneous disorders like, trichotillothania and dermatitis artifacta were also frequently seen in post- earthquake period. Hair, nail, pigmentary disorders, sexually transmitted infections were statistically less frequent in post earthquake period. Eczemas, psoriasis and vitiligo were also less frequently reported. A significant increase in overall proportion of skin patients and prevalence of bacterial infections, viral infections, scabies and certain psychocutaneous disorders was probably related to compromised hygiene and sanitation and psychological trauma as consequence of devastating earthquake of October 8th, 2005

Housewife onycholysis

The aim of this study was to evaluate the clinical and microbiological aspects of onycholysis in Iraqi housewives. One hundred housewives with onycholysis of the finger nails were evaluated clinically in the Department of Dermatology and Venereology, Baghdad Teaching Hospital, Baghdad, Iraq between October 2002 to March 2003. Swabs were taken from those patients for microbiological evaluation in the Department of Microbiology, College of Medicine, University of Baghdad, Baghdad, Iraq. All cases with skin disorder related systemic diseases like anemia, hypothyroidism and drug intake like minocycline, oral contraceptives were excluded from the study. One hundred housewives with onycholysis were enrolled in the study. Their ages ranged between 17-70 years with a mean of 41.96 +/- 12.57 years. Married females were 89 [89%], while unmarried females were 11 [11%]. The site of involvement was mainly the thumb [76%] followed by the ring finger [12%], the index [7%], little [6%] and middle [5%] fingers. The pattern of onycholysis was distal in 47 [47%], lateral in 30 [30%] and both distal and lateral in 23 [23%] of the patients. Onycholysis is a major problem among Iraqi housewives, most probably caused by repetitive mechanical, chemical and physical trauma; therefore, special preventive measures should be undertaken to minimize the incidence of the disease. Housewives should be encouraged to use preventive measures like using gloves and washing machines

Envejecimiento cutáneo y dermatosis geriátricas / Cutaneous aging and geriatric dermatoses

El envejecimiento cutáneo es un proceso aún inevitable. La piel fotoenvejecida es una entidad distinta que el envejecimiento cutáneo cronológico. Las alteraciones relacionadas con el envejecimiento y sus consecuencias clínicas, en epidermis, dermis y apéndices cutáneos, son revisados en este artículo; también son analizadas las dermatosis más frecuentes de los ancianos

Growing incidence of cutaneous and ungual infections by non-dermatophyte fungi at Jabalpur (M.P.).

A random survey of skin and nail infections was done at Jabalpur (M.P.). Out of the 80 suspected cases 60 were culture positive. Out of these 25 were of dermatophyte infection followed by 21 cases of phaeohyphomycosis, 7 of aspergillosis, 4 of hyalohyphomycosis, 2 of mixed infection in which a non-dermatophyte was associated with a dermatophyte and 1 had yeast infection. Trichophyton rubrum was the only dermatophyte isolated. Among the non-dermatophyte infections cases of Alternaria chlamydospora, Cladosporium sphaero-spermum, Curvularia senegalensis, Chaetomium globosum, Scopulariopsis brumptii, Paecilomyces variotii and Aspergillus chevalieri are for the first time documented as etiologic agent of cutaneous and ungual mycosis from India.

Prevalência e tipo de lesöes ungueais em escolares de Ribeiräo Preto, SP, Brasil / Prevalence and type of ungueal lesions in schoolchildren of Ribeiräo Preto, SP, Brazil

Em sete escolas, selecionadas ao acaso, os autores examinaram 5.150 escolares, entre 7 e 15 anos de idade. A prevalência de lesöes ungueais nas mäos foi maior (56,7//) que a dos pés (29,5//). Ela foi significantemente maior no sexo masculino, com tendência a aumentar com a idade, até 14 anos no sexo masculino e até 11 anos no feminino. O tipo e a freqüência de lesöes ungeais säo indicadas em tabelas. As mais comuns nas mäos foram leuconíquia (42,13//), onicofagia (13,57//) e depressöes cupuliformes (1,16//); nos pés, onicoatrofia no 5§ artelho (9,26//), sulcos transversais (9,14//), leuconíquia (2//) e hematoma subungueal (1,53//). As alteraçöes foram habitualmente discretas. O status sócio-econômico näo pareceu influenciar significantemente a prevalência de lesöes ungueais nas diferentes escolas

Lesiones ungueales de psoriasis. Instituto Dermatológico de Santo Domingo; dicienbre, 1988-mayo, 1989

Con el objetivo de investigar las lesiones ungueales de psoriasis, se realizó un estudio prospectivo, análitico y descriptivo con 100 pacientes que asistieron al Instituto Dermatológico de Santo Domingo en el período diciembre 1988-mayo 1989 con diagnóstico clínico e histopatológico de psoriasis cutánea. De estos pacientes el 84% presentó lesiones de psoriasis ungueal; el punteado o pitting constituyó la lesion más frecuente, (90.4%). El sexo más afectado fue el masculino (53.6%) y la población más afectada estuvo comprendida entre los 20-40 y más años de edad (90.5%)