Congenital malalignment of the great toenails in a pair of monozygotic twins.

Congenital malalignment of the great toenails is the lateral deviation of the long axis of nail growth relative to the distal phalanx. The nails grow slowly, with thickening, curving, and transverse ridging. We describe a pair of 3-year-old monozygotic female twins with congenital malalignment of the great toenails complicated by ingrowing and paronychia. Although there are a few cases without any family history, congenital malalignment is believed to be inherited through an autosomal-dominant gene of variable expression. This report provides further evidence of the heritability of the disease.

Clinical manifestations of cutaneous graft-versus-host disease after allogeneic haematopoietic cell transplantation: long-term follow-up results in a single Turkish centre.

The aim of this study was to evaluate the clinical manifestations of cutaneous graft-versus-host disease (GVHD) developed after allogeneic haematopoietic cell transplantation. In all, 67 patients were evaluated: 49 patients developed acute GVHD, 17 patients developed de novo chronic GVHD and 29 developed secondary chronic (15 limited, 14 progressive) GVHD following acute cutaneous GVHD. Of the 46 patients with chronic GVHD, lichenoid lesions were observed in 32 and sclerodermoid lesions were observed in 12. In four patients with sclerodermoid cutaneous GVHD, these lesions occurred after a lichenoid phase. Oral lesions were present in 61% of the patients and six of them had only oral mucosal involvement without any skin lesions. Nail lesions were observed in 31% of the patients. During the follow-up period 15 patients with GVHD died and in 7 of them the cause of death was related to chronic GVHD. In conclusion, GVHD has a wide spectrum of cutaneous manifestations, which can be used as an important tool for the early diagnosis of the disease.

Idiopathic localized crossed (left side of the upper part of the body, right side of the lower part of the body) hyperhidrosis: successful treatment of facial area with botulinum a toxin injection.

BACKGROUND: Localized hyperhidrosis either may be due to an organic cause or may be idiopathic. Most cases of localized hyperhidrosis are reported to be idiopathic and unilateral. OBJECTIVE AND RESULT: We report a case of idiopathic localized hyperhidrosis with extensive involvement on crossed sides of the body. The hyperhidrotic area on the forehead was treated with a single session of botulinum A toxin injection with a quite successful result, and the area remained free of symptoms during a follow-up period of 5 months. CONCLUSION: All documented cases of idiopathic localized hyperhidrosis are located on one side of the body. To the best of our knowledge, idiopathic localized crossed hyperhidrosis has not previously been reported. The botulinum A toxin injection produced a rapid and successful result on the facial area.

A 15-year-old boy with Rubinstein-Taybi syndrome associated with severe congenital malalignment of the toenails.

Rubinstein-Taybi syndrome (RTS) is a well-known disorder characterized by growth and mental retardation, typical facial features, short stature, and broad thumbs and toes. Although several cutaneous manifestations are observed in these patients, they are not diagnostic and are usually considered to be coincidental. Congenital malalignment of the great toenails is a very rare disorder that is characterized by lateral deviation of the nail plate along its longitudinal axis. The nail plate grows into the lateral nail fold resulting in pain and infection. It is usually present at birth or begins in early childhood. We report a patient with characteristic manifestations of RTS and congenital malalignment of the great toenails. The association of these two entities has not been reported previously.

Chemical matricectomy with 10% sodium hydroxide for the treatment of ingrowing toenails.

BACKGROUND: In the last decades, phenol cauterization has been widely used with high success rates for the treatment of ingrowing toenails. However, unpredictable tissue damage and prolonged healing time are the disadvantages of this technique. Sodium hydroxide is an alternative chemical agent that causes less tissue damage. OBJECTIVE: In this study, long-term results and postoperative morbidity of two sodium hydroxide chemical matricectomy procedures carried out by different application times have been investigated. METHODS: A total of 156 partial chemical matricectomy procedures were performed with 10% sodium hydroxide in 60 patients divided into two groups. The first group (80 nail sides) received a 2-minute application of sodium hydroxide, whereas the second group (76 nail sides) received a combination of curettage of the lateral matrix area and 1-minute application of sodium hydroxide. Postoperative pain, drainage, and tissue damage were evaluated 2 days after the operation and at three more visits with weekly intervals. Long-term success rates of the methods were evaluated on the 6th month and at a further visit with a mean time of 16.83+/-2.18 months (range, 13 to 20). RESULTS: Partial matricectomy with 10% sodium hydroxide was found to be 100% successful in both of the groups (P>0.05). Postoperative pain and tissue damage were either absent or minimal in the great majority of the patients with no statistical difference between the two groups (P>0.05). On the 2nd day, more patients in the first group experienced mild drainage than the patients in the second group (P=0.001), but in the following control visits, this difference disappeared. CONCLUSION: Matricectomy with 10% sodium hydroxide, either applied for 2 minutes or 1 minute combined with curettage, is equally effective in the treatment of ingrowing toenails with high success rates and minimal postoperative morbidity.

Multifocal papillomavirus epithelial hyperplasia: successful treatment with CO2 laser therapy combined with interferon alpha-2b.

Human papilloma virus (HPV) infections of the oral mucosa presents with various clinical and histopathologic features in relation with the causative HPV type and chronicity and the extent of the infection.1 The entity is known by several names based on histopathologic variations such as focal epithelial hyperplasia, oral florid papillomatosis, verrucous hyperplasia, oral florid verrucosis, and Ackerman's tumor. In recent years, the term multifocal papillomavirus epithelial hyperplasia (MPVEH) has been proposed to define the variant that usually occurs in childhood and is characterized by diffuse confluent papillomatous lesions in the oral mucosa.1 Despite the lesions' benign appearance, early diagnosis and therapy of MPVEH is essential because of its high capacity for progression and its tendency for malign degeneration.