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Nail cosmetics are an integral practice in many patients' lives. However, the manicuring process can result in nail damage via instrumentation, allergens in nail polish, and infections. Many of these nail disorders are preventable through proper education. Therefore, it is critical for physicians to understand the steps involved in regular, gel, and acrylic manicures and educate patients on how to protect their natural nails. Simple preventative measures can be discussed with patients and make a substantial difference in their long-term nail health.

Nail changes with thyroid disease have not been well studied. Nail findings are helpful in early diagnosis of thyroid disorders and therefore are important for dermatologist education. We reviewed the literature on nail changes in thyroid patients and found that onycholysis and slow-growing, thin nails are associated with hypothyroidism and that onycholysis, koilonychia, and brittle nails changes are associated with hyperthyroidism.

Exostosis is a type of benign bone tumor in which trabecular (spongy) bone overgrows its normal border in a nodular pattern. When the growth occurs under the nail bed, it is termed subungual exostosis or Dupuytren exostosis. This condition may mimic other bony abnormalities such as an osteochondroma and may present with nail deformities with or without pain. For this reason, a biopsy of the lesion is necessary to rule out a precancerous growth. In rare cases, pediatric patients may have subungual exostosis, as demonstrated in our case.

Nail psoriasis is a condition that can affect children and adolescents. It often is refractory to treatment. Data on its management in the pediatric population are limited. This article aims to summarize existing information-small case series and case reports-on the successful therapeutic approaches for nail psoriasis in children. As more agents are approved for on-label use in plaque psoriasis in pediatric patients, gradually more real-life data on their efficacy for nail psoriasis in children are expected to come to light.

Nail unit squamous cell carcinoma (NSCC) is a malignant neoplasm that can arise from any part of the nail unit including the nail bed, nail matrix, nail groove, and nail fold. Nail unit SCC is the most common malignant nail neoplasm, and yet its diagnosis often is delayed, partly due to the clinical presentation of NSCC mimicking benign conditions such as onychomycosis, warts, and paronychia. Nail unit SCC has a low rate of metastasis; however, a delayed diagnosis often can result in local destruction and bone invasion. It is imperative for dermatologists who are early in their training to recognize this entity and refer for treatment. Many approaches have been used to treat NSCC, including wide local excision, digital amputation, cryotherapy, topical modalities, and recently Mohs micrographic surgery (MMS).

Beau lines, onychomadesis, and retronychia are nail conditions with their own characteristic clinical findings. It has been hypothesized that these 3 disorders may share a common pathophysiologic mechanism of slowing and/or halting nail plate production at the nail matrix. We report the case of a 41-year-old woman who presented with concurrent Beau lines, onychomadesis, and retronychia 6 months following a diagnosis of scurvy. Simultaneous presentation of these 3 nail conditions is not commonly reported, and our case supports a shared pathophysiologic basis.

Sézary syndrome (SS) is the leukemic form of cutaneous T-cell lymphoma (CTCL) and can be associated with various nail irregularities, though they are infrequently reported. In this retrospective study, we reviewed medical records from a CTCL clinic database at the University of Texas MD Anderson Cancer Center (Houston, Texas) for reported nail abnormalities in patients with a diagnosis of SS. Findings for 2 select cases are described in more detail and are compared to prior case reports to establish a comprehensive list of nail irregularities that have been associated with SS.

Nail conditions are routinely encountered in dermatology clinical practice. Nails have important aesthetic functions, and onychodystrophies may cause pain and difficulties with ambulation and performing activities of daily living. Ideally, accurate diagnosis and optimal treatment of nail disorders are taught as early as medical school and extend into dermatology residency. We sought to determine the integration and content of nail education in the American Academy of Dermatology (AAD) Basic Dermatology Curriculum. Our results showed a paucity of nail content in this medical curriculum with only 101 total mentions of nails in 12 modules. Nail examinations were not mentioned as part of the full-body skin examination, nail unit melanoma was inadequately covered, and nail biopsy techniques were completely omitted. There is a notable need to enrich this curriculum with relevant nail content to educate students about the importance of nail disease.

This article highlights pearls shared during a unique and enlightening lecture by Antonella Tosti, MD, a professor at the University of Miami Health System, Florida, on the presentation and management of common pediatric nail diseases. These clinical pearls are shared to help deliver utmost care to our pediatric patients presenting with nail pathology and may help shed light on the management of pediatric nail diseases.

Onychomadesis is the proximal separation of the nail plate from the nail matrix due to a temporary cessation of nail growth. It can occur in children of all ages including neonates. Diagnosis is made clinically through palpation and inspection of the nail plate. Physicians should consider underlying associations. A review of the patient's history for any viral illnesses 1 to 2 months prior to nail changes often will help identify the causative disease. Onychomadesis typically is mild and self-limited. There is no specific treatment, but a conservative approach to management is recommended with treatment of any underlying causes and supportive care. Spontaneous nail regrowth usually occurs within 12 weeks and may occur faster in children. In this article, causes of onychomadesis are described, including the connection between hand-foot-and-mouth disease (HFMD) and onychomadesis. We also explore several theories of possible mechanisms for onychomadesis; however, the precise mechanism remains unclear and further investigation is needed.

This report highlights a rare case of a woman with horizontal ridging and tenderness of the right great toenail associated with dyspigmentation of 5 years' duration. Histopathology revealed a cystic structure with an epithelial lining mostly reminiscent of an isthmus-catagen cyst admixed with the presence of both an intermittent, focal granular layer and an eosinophilic cuticle surrounding pink, laminated keratin, most consistent with a diagnosis of subungual onycholemmal cyst (SOC). It is a rare and distinctive nail abnormality occurring in the dermis of the nail bed. We present a case of an SOC in the toenail mimicking subungual malignant melanoma, which may be an underrecognized and common entity that must be considered when discussing tumors of the nail unit, especially subungual melanoma.

Subungual exostosis is an uncommon bony tumor of the distal phalanx most often seen on the hallux. Although this lesion is completely benign, it must be distinguished from a number of other subungual tumors, both benign and malignant. Radiography of the digit is a noninvasive test that should be part of the initial workup whenever subungual exostosis is in the differential diagnosis. Once identified, surgical removal of the exostosis generally is both effective and well tolerated. We present a case of subungual exostosis that was discovered incidentally during a full-body skin examination. We also review the pertinent clinical and histopathologic findings, diagnosis, and treatment of this entity.

Imatinib mesylate (IM) represents the first-line treatment of patients with chronic myeloid leukemia (CLM) or gastrointestinal stromal tumor (GIST). It presents several side effects. However, less than 10% are nonhematologic including nausea, vomiting, diarrhea, muscle cramps, and cutaneous reactions. The aim of our study was to identify data regarding IM cutaneous adverse effects (AEs) to improve the clinical diagnosis and management of the more frequent side effects. Skin examination should be done before and during IM treatment so that AEs can be diagnosed and treated early with less impact on chemotherapy treatments and on the quality of life of the patient.

Onychomatricoma is a subungual tumor that is clinically characterized by banded or diffuse thickening, yellowish discoloration, splinter hemorrhages, and transverse overcurvature of the nail plate. It is often and easily misdiagnosed because the condition is not well known and rarely has been described. We report the case of a 45-year-old man with a subungual tumor on the right index finger that fulfills the criteria of onychomatricoma.

Superficial acral fibromyxoma (SAFM) is a rare fibromyxoid mesenchymal tumor with a predilection for the distal extremities and frequent nail bed involvement. Superficial acral fibromyxoma typically arises as a solitary, slow-growing nodule on a toe or finger, with the great toe being the most commonly affected site. Histopathologically, SAFM characteristically presents as a well-circumscribed but unencapsulated dermal tumor composed of spindle and stellate cells in a loose storiform or fascicular arrangement embedded in a myxoid, myxocollagenous, or collagenous stroma. The tumor often occupies the entire dermis and may extend into the subcutis and occasionally the underlying fascia and bone. The characteristic immunohistochemical profile of SAFM includes expression of CD34, epithelial membrane antigen (EMA), and CD99; it is notably negative for S-100 protein. We report 3 cases of SAFM and also provide a review of the literature on the clinical and histopathologic presentations of this unique entity as well as the differential diagnosis.

Lichen striatus (LS) is a relatively rare and self-limited linear dermatosis of unknown etiology. It primarily affects children, with more than 50% of cases occurring in patients aged 5 to 15 years. The case of a 2-year-old boy who presented for evaluation of a nonpruritic linear rash on the left side of the lower abdomen of 3 weeks' duration is discussed. A diagnosis of lichen striatus (LS) was made and the lesions completely resolved within 6 months. At 5 years of age, the patient returned for evaluation of bluish discoloration and thinning of the nails on the left middle and ring fingers, which ultimately fell off and started to regrow 2 months prior to the second evaluation. The rare diagnosis of isolated onychodystrophy as a late manifestation of LS was made.

Although Staphylococcus lugdunensis is a constituent of the normal human skin flora, it does have pathogenic potential. Infections can range from severe (eg, endocarditis, osteomyelitis) to less invasive skin and soft-tissue infections. We report a case of a subungual abscess in a patient with S lugdunensis infection.

Psoriasis can involve the skin, joints, and nails, either alone or in combination. Psoriasis of the nails can involve both the nail bed and nail matrix. The treatment of nail psoriasis largely depends on the severity of symptoms. The pulsed dye laser (PDL) recently has demonstrated efficacy in treating resistant plaque-type psoriasis and has been suggested as an alternative to conventional therapies. We review 4 studies of PDL for nail psoriasis and discuss the findings in relation to treatment recommendations. Ultimately, a standardized regimen for the treatment of nail psoriasis remains elusive.

Segmental neurofibromatosis (SNF) is an uncommon presentation of neurofibromatosis type 1 (NF-1). Although patients with SNF are at a lower risk for developing NF-l-associated complications, the estimated occurrence of related malignancies may be approaching the frequency observed in patients with NF-1. Idiopathic polydactylous longitudinal erythronychia also may be associated with SNF, though the frequency of this association remains to be determined.

It is not easy to predict the clinical course of longitudinal melanonychia (LM) in children because few prospective studies have been conducted. In our prospective study 15 Japanese children with LM were followed for more than 2 years. Eight patients demonstrated gradual fading of LM. Clinical features such as the patient's sex and the site, age of onset, duration, color, and width of the melanonychia were not significantly associated with the outcome. Dots distributed along melanotic lines, a finding we referred to as dots and lines, can be a dermoscopic sign of regression of melanonychia in children with LM. In this study, the presence of dermoscopically observed dots was significantly related with regression of melanonychia (P = .019; odds ratio, 18.0).

Brittle nail syndrome refers to nails that exhibit surface roughness, raggedness, and peeling. It is a common problem, with a higher prevalence among elderly patients. The goal of this study was to determine if tazarotene cream 0.1% ameliorates the signs and symptoms of brittle nails. In this open-label, single-center trial, participants applied tazarotene cream to the nails twice daily for 24 weeks. Signs and symptoms were rated by the investigators and by the participants during treatment and 12 weeks after discontinuation. Twenty participants were enrolled in the study; 1 participant withdrew prior to the 4-week followup visit. Of the 18 participants available for analysis (1 participant was excluded because baseline photographs were not available) for the primary end point of improvement in the physician global improvement assessment (PGIA), all 18 participants achieved improvement of the target nails at week 12 as well as 16 participants (88.9%) at week 24. All 18 participants had improvement in the PGIA score 12 weeks posttreatment at week 36. The physician global assessment (PGA) improved for 14 of 19 participants (73.7%) at both weeks 12 and 24; at week 24, 4 of 19 participants had achieved a PGA score of none. At week 36, 17 of 19 participants (89.5%) agreed that their nails had improved overall. Only 1 participant (5.3%) reported mild local irritation. This study demonstrated that tazarotene improves some of the changes noted in conjunction with brittle nail syndrome with minimal to no irritation.