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.

Evaluation of the Recurrence Rate of Ingrown Toenail After a 45-Second Matrix Cauterization With Phenol.

INTRODUCTION: Ingrown toenail is a very common nail disorder, and partial matricectomy by phenolization is considered the most effective treatment technique. However, the contact time of the phenol with the nail matrix remains debatable. OBJECTIVE: To evaluate the recurrence rate of ingrown toenail after partial matricectomy by phenol for 45 seconds. METHODS: A total of 1,460 surgeries were performed, with a photographic record of 802 pictures for a period of 6 months. The presence of any nail spicule or sign of ingrowth during follow-up was considered a recurrence. RESULTS: A total of 802 surgeries were evaluated, with the most affected nails being the right (49.3%) and left (48%) big toes and most frequently the lateral fold (54.5%). The recurrence rate was 0.75% at 3 months and 1.87% at 6 months, and the medial nail fold had a higher recurrence rate than the lateral nail fold. CONCLUSION: Forty-five seconds of contact time of 88% phenol with the nail matrix was enough and effective, resulting in low recurrence rates. Prospective studies are needed to better assess postoperative morbidity.

Nail Squamous Cell Papilloma: A Rare Case Report.

Introduction: Squamous cell papilloma is a benign tumor whose pathogenesis is generally related to the human papillomavirus. Despite affecting several organs, we did not find cases reported in the nails. Case Presentation: A 67-year-old female presented with a painful lesion in the nail of the right hallux that started in 2021, with an erythematous appearance evolving to black and expansive growth. Due to the evolution and symptoms, she opted for excision, with a histopathological report of squamous cell papilloma. Complementary treatment with imiquimod was performed, with good healing and pain control. Discussion: Due to the lack of previous reports, treatment was based on therapeutic options for papillomas located in other regions. Excision was performed, followed by application of imiquimod with good response. The prognosis is favorable; however, further studies are needed to elucidate the diagnosis and management of nail squamous cell papilloma.

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.

Matricectomia química total com fenol a 88% como alternativa terapêutica das onicodistrofias / Total chemical matricectomy with 88% phenol as therapeutic alternative of onychodystrophy

RESUMO As distrofias ungueais são frequentes e acometem principalmente pacientes idosos. Os tratamentos clínicos são geralmente insuficientes e apresentam recidivas, sendo por vezes necessário abordagens cirúrgicas. Objetivos: Utilizar a técnica de matricectomia total com fenol a 88% para destruição permanente das unhas e avaliar sua eficácia. Métodos: Foi realizado a matricectomia total com aplicação da solução de fenol 88% em 20 pacientes, e avaliado o grau de melhora relatado pelo paciente, 12 meses após o procedimento cirúrgico. Além disso, foi avaliado a dor, a satisfação dos pacientes com a aparência estética final e a interferência para o uso de sapatos fechados e atividades diárias, bem como as complicações e recidivas do procedimento. Resultados: Antes da cirurgia, 60% dos pacientes relataram dor e 12 meses após a cirurgia, apenas uma paciente apresentou dor e em menor intensidade. A grande maioria dos pacientes ficou satisfeita com os resultados estéticos, sendo que apenas um paciente apresentou muita interferência na aparência estética após o procedimento. A interferência no uso de sapatos fechados reduziu de 89% para 21%. Igualmente, 79% dos participantes experimentavam algum grau de interferência da onicodistrofia para realizar as atividades diárias antes da cirurgia, e após a mesma, só 5%. Três pacientes apresentaram recidivas e nenhum paciente relatou complicações. Conclusão: A matricectomia química total com fenol a 88% é uma técnica segura, barata e possui alto índice de satisfação do paciente. Palavras-chaves: distrofia ungueal, matricectomia total, fenol 88%.