Differential diagnosis of pigmented nail lesions.

The diagnosis of pigmented nail lesions is a concern for both general practitioners and dermatologists, due to the possibility of indicating nail melanoma. The origin of the dark pigmentation can be either melanocytic or non-melanocytic (fungi, bacteria, or blood), and clinical evaluation alone may not be sufficient for differentiation, requiring additional exams. Onychoscopy provides valuable information prior to biopsy. The causes of nail pigmentation will be described to aid in the differential diagnosis.

Multiple-Digit Pigmented Bowen's Disease Induced by Human Papillomavirus in an Immunocompetent Child.

Introduction: Bowen's disease is a squamous cell carcinoma in situ, the most common malignancy of the nail unit. Presenting more frequently in the fingernails, common risk factors include ionizing radiation, oral exposure to arsenic or pesticides, dyskeratosis congenita, and quite commonly diverse subtypes of HPV. We report the first case of multiple periungual pigmented Bowen's disease in a pediatric patient. Case Presentation: A healthy 13-year-old boy presented with a 9-month history of a pigmented erythematous patch on the proximal nail fold of his 3rd right finger without associated symptoms. A punch biopsy was taken, and the diagnosis of Bowen's disease was made. The patient received photodynamic therapy and three cycles of imiquimod without response, and two new lesions appeared on the first and second right fingers. Surgical removal was performed on all lesions. A polymerase chain reaction detected an HPV type 16. Discussion/Conclusion: Multiple periungual Bowen's disease is rare, with the most frequent risk factors being HPV infection and chronic immunosuppression. Less than 10% of the cases present as longitudinal melanonychia. To date, there are no previous reports of multiple pigmented periungual Bowen's disease. HPV-induced Bowen's disease is usually present in adults aged between 22 and 89 years as persistent verrucae. In this case, koilocytosis and the fact that all lesions appeared on the right hand are suggestive of HPV infection.

Total Chemical Matricectomy With 88% Phenol: A Prospective Case Series of 37 Patients.

BACKGROUND: Definitive nail dystrophies, congenital, traumatic, or acquired, affecting mainly elderly patients, may not be sufficiently managed with a periodic conservative treatment. A definitive surgical treatment may be considered an alternative method, especially in symptomatic patients. OBJECTIVE: To evaluate the effectiveness of total matricectomy with 88% phenol solution to treat some nail dystrophies, not otherwise satisfactorily managed. METHODS: A series of 48 surgeries were performed on 37 patients. Pain evaluation, interference with shoes and gait, recurrences, and patients' satisfaction with procedure were evaluated. RESULTS: All patients mentioned some pain or impairment in wearing shoes before surgery. Cosmetic results were remarkable, and most of the patients (95.11%) had a dramatic improvement of their discomfort after the procedure. No severe complications occurred during the 12-month follow-up. LIMITATIONS: Single-center study and the limited number of patients. CONCLUSION: Total matricectomy with 88% phenol solution is an effective surgical method with low rates of postoperative morbidity and high success rates for treating symptomatic nail dystrophies. The satisfaction with the cosmetic results is high, and this is a safe procedure for patients with associated comorbidities.

Fungal Viability of Nail Dust from Onychomycosis Abrasion: A Pilot Study.

INTRODUCTION: Onychomycosis is a frequent complaint in dermatological practice and corresponds to the most common nail disease. The treatment of onychomycosis remains a challenge, as several factors end up compromising and making treatment difficult. Nail abrasion is considered a useful method in many cases. However, there is controversy about this approach, as there is an aerosol formation that could contaminate the environment and cause fungal changes or hypersensitivity reactions by the disseminated dust. We conducted a pilot study to investigate the fungal viability of nail particles from nails with onychomycosis after abrasion procedure. METHODS: In this study, nail dust from the gloves and mask, used in the procedure, was collected from 9 patients with clinical and dermoscopic diagnoses of onychomycosis. RESULTS: Hyaline septate hyphae were found in 12 materials (gloves and/or masks) from 7 patients. However, these hyphae were morphologically deformed or mutilated in all exams. In Mycosel® agar, there was no growth of any fungus. DISCUSSION/CONCLUSION: The absence of dermatophyte isolation in all fungal cultures may demonstrate that the deformed fungal structures shown are not viable and would not present risks of contamination after nail abrasion.

Tratamento de verrugas virais com bleomicina intralesional / Treatment of viral warts with intralesional bleomycin

A verruga viral representa uma das dermatoses mais prevalentes. O quadro clínico varia de lesão única com cura espontânea até múltiplas lesões recalcitrantes. O sulfato de bleomicina é uma droga de ação citotóxica, aprovada para o tratamento quimioterápico de algumas malignidades. Há mais de 45 anos existem trabalhos demonstrando sua utilidade na dermatologia, em especial na terapia intralesional para verrugas virais, que constitui excelente opção para as lesões em topografias de difícil manejo e para os casos não responsivos a outras abordagens.

Viral warts are one of the most prevalent dermatoses. The clinical picture varies from a single lesion with spontaneous cure to multiple recalcitrant lesions. Bleomycin sulfate is a cytotoxic action drug approved for the chemotherapeutic treatment of some malignancies. There are a number of studies that have been carried out during the last 45 years demonstrating its usefulness in dermatology, especially in intralesional therapy for viral warts, meaning it is an excellent option for lesions in difficult-to-handle topographies and for cases that do not respond to other approaches.

Congenital Curved Nail of the Fourth Toe Associated with Oral Disorders.

Congenital curved nail of the fourth toe represents an unusual deformity in which the nail of the fourth toe curves in a plantar direction. It is unknown why only this toe is affected; however, the initial descriptions suggest that this is a mesodermal defect. We describe a case of congenital curved nail of the fourth toe associated with bifid uvula. There are only 2 reports mentioning the association of this nail abnormality with cleft palate and/or lip. In our patient, there was an association with bifid uvula that is considered a minor form of palatine fissure. There seems to be an association of congenital curved nail of the fourth toe with cleft palate to different degrees; however, the pathogenesis of the deformity remains unknown.

Syndrome in Question.

The Iso-Kikuchi Syndrome is a rare condition characterized by nail dysplasia involving the index fingers, including micronychia, polyonychia, anonychia, irregular lunula, malalignment and hemionychogryphosis. On the antero-posterior image, radiologic examination reveals a narrowing of the distal phalanx. The lateral image shows a Y-shaped bifurcation of the distal phalanx. We report a case of a patient with typical clinical and radiologic signs of Iso-Kikuchi Syndrome.

Involucrin in the differential diagnosis between linear psoriasis and inflammatory linear verrucous epidermal nevus: a report of one case.

Inflammatory linear verrucous epidermal nevus is a variant of verrucous epidermal nevus, characterized by recurrent inflammatory phenomena. Despite well-established clinical manifestations, the differential diagnosis between inflammatory linear verrucous epidermal nevus and linear psoriasis remains difficult. Clinical history, physical examination and histopathology analysis may not be sufficient to confirm the diagnosis. We report the case of a 4-year-old girl in which the involucrin immunostaining was helpful in the diagnosis of inflammatory linear verrucous epidermal nevus. Our findings confirm that involucrin immunohistochemistry is a useful tool in such cases.

Cirurgia das unhas. Seguimento de casos operados em curso prático realizado em Congresso Dermatológico / Nail surgery: followup on cases conductedduring a practical course of a Dermatological Meeting

Introdução: Durante os Congressos de Dermatologia são ministrados cursos práticos com o intuito de ensinar, ao vivo e de forma detalhada, os procedimentos cirúrgicos. Porém, a evolução pós-operatória, bem como os resultados obtidos, ficam restritos aos médicos dos serviços responsáveis pela organização desses eventos. Objetivos: avaliar a evolução e resultados dos casos operados tornando-os conhecidos. Métodos: Oito casos operados durante Congresso Dermatológico ­ RADESP 2011 - no curso de cirurgia da unha, com diferentes diagnósticos pré-operatórios seguidos por nove meses. Os resultados foram avaliados pelos cirurgiões responsáveis pelas cirurgias, por meio de fotos a cada três meses. Resultados: Dos oito casos operados, dois foram considerados com resultados satisfatórios, sendo um com leve distrofia da placa e outro com tempo considerado insuficiente para melhor avaliação e cinco curados. Um caso não compareceu aos retornos. Conclusão: A apresentação do seguimento destes pacientes bem como a avaliação dos cirurgiões responsáveis complementa o conhecimento adquirido pelos participantes destes cursos como também aos demais congressistas.

Introduction: Workshops are offered during Dermatological Meetings in order to teach surgical procedures, both live and in detail. Nevertheless, access to post-operative developments, as well as to the results obtained, are restricted to the physicians from the medical services responsible for organizing these events. Objective: To assess, and make known, the progress and results of previously operated cases. Methods: Eight patients with different pre-operative diagnoses were operated on the nail surgery workshop that occurred during the Brazilian dermatological meeting RADESP 2011, with a nine-month follow up. The results were evaluated using photographs, taken every three months, by the surgeons responsible for the surgeries. Results: Of the eight operated cases, two were considered as yielding satisfactory results (one with mild dystrophy of the nail plate and the other with time considered insufficient for better assessment), and five were deemed as cured. One case did not return for the follow-up visits. Conclusion: Following up and presenting the post-operative development of these patients as well as publishing the responsible surgeons' evaluations, complements the knowledge acquired by the workshops' attendees, and that of other participants at the meetings.

Synchronous subungual glomus tumors in the same finger.

The glomus tumor is an uncommon benign neoplasm of glomus cells. In the majority of the cases it is presented as a solitary painful papule in the subungual region. We report a rare case of a patient with two individual synchronous glomus tumors under the nail bed of the same finger.

Synchronous subungual glomus tumors in the same finger / Tumores glômicos subungueais sincrônicos no mesmo dedo

The glomus tumor is an uncommon benign neoplasm of glomus cells. In the majority of the cases it is presented as a solitary painful papule in the subungual region. We report a rare case of a patient with two individual synchronous glomus tumors under the nail bed of the same finger.

O tumor glômico é uma neoplasia benigna de células glômicas. Na maioria dos casos se apresenta como uma pápula solitária dolorosa na região subungueal. Relatamos o caso raro de um paciente com dois tumores glômicos sincrônicos sob o leito ungueal do mesmo dedo.