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Background: Psoriasis is a common chronic inflammatory disorder affecting all aspects of a patient’s life. Nail involvement is frequent, but little is known about its associated inflammatory biomarker profile, including similarities or differences from cutaneous disease. Aim: We conducted this cross-sectional study to evaluate serum levels of inflammatory cytokines [tumour necrosis factor- alpha (TNF-α) and interleukin -17 (IL-17)] in patients with nail psoriasis and compared these to psoriasis patients without nail involvement, as well as in non-psoriatic healthy controls. Methods: Adult psoriasis patients with (Group I, n = 30) and without nail involvement (Group-II, n = 30) were sequentially recruited. In addition, non-psoriatic healthy controls (Group-III, n = 20) were recruited. The nail disease severity by NAPSI score was determined for patients in Group I. Cutaneous disease severity (by PASI score) and presence of psoriatic arthritis (through CASPAR criteria) were evaluated for patients in Groups I and II. Serum levels of TNF-α, IL-17, erythrocyte sedimentation rate (ESR), rheumatoid factor (RA factor), and anti-cyclic citrullinated peptide antibody (Anti-CCP) were evaluated for all three groups. Results: The median age was significantly higher for Group I as compared to Group II patients (41 ± 12.6 years vs 30 ± 12.4 years, p = 0.017). Group I patients also had higher median PASI score than Group II patients, although the difference was not statistically significant (10 ± 11.41 vs 6.50 ± 5.46, p = 0.275). The mean serum IL-17 levels were significantly higher for Group-I (113.39 ± 251.30 pg/mL) than Group II (27.91 ± 18.22 pg/mL, p = 0.002) and Group III (25.67 ± 12.08 pg/mL, p = 0.005). A weak positive correlation was found between NAPSI and serum IL-17 levels (Spearman’s Rho = 0.355) though not statistically significant (p = 0.054). Correlation between serum IL-17 and PASI was poor for Group-I patients (Spearman’s Rho = 0.13, p = 0.944) and strongly negative for Group-II patients (Spearman’s Rho = −0.368, statistically significant with p = 0.045). The mean serum levels of TNF-α were below the detection threshold of the assay kit, hence no meaningful comparison could be made. Limitations: A small sample size and low sensitivity of TNF-α assay kit. Conclusion: Our study showed that nail psoriasis could be independently associated with an elevation of IL-17. This can help choose appropriate drugs and estimate drug response in patients with nail psoriasis. [ABSTRACT FROM AUTHOR]

This document provides a historical overview of the management of ingrown toenails, tracing its history from ancient times to the 19th century. It explores the evolution of bipedal locomotion and the significance of the great toe in walking. The article also examines the etymology of ingrown toenails and describes different types of the condition. It highlights the presence of ingrown toenails in ancient medical texts and the contributions of scholars from diverse cultures. The document concludes by mentioning the pioneering work of Durlacher in the 19th century, who identified improper nail cutting as the primary cause of ingrown toenails. The history of ingrown toenail treatment dates back to ancient times, with various remedies and techniques being attempted throughout history. Ancient Egyptian and Indian texts mention treatments such as hot water washing, knife drainage, medicated oil application, and thermocautery. In civilizations where shoes were worn, remedies included rubbing mixtures of alum and honey, fomentation, and surgical procedures involving knives, cautery, and scissors. The use of anesthesia in the mid-19th century revolutionized the treatment of ingrown toenails. Despite advancements, there is still ongoing debate about the best approach to treating this condition. The article provides a historical overview of ingrown toenail management, highlighting important events and advancements in the field, such as the use of lunar caustics, the introduction of anesthesia for ingrown toenail operations, and the development of various surgical techniques. It emphasizes the [Extracted from the article]

Background: Isolated nail lichen planus (NLP) without mucocutaneous involvement is rare. Literature about the clinical profile and management is scarce. Aims/Objective: We attempted to characterize the clinico-demographic profile and analyze the management outcome of patients with isolated nail lichen planus. Methods: Records of 15 patients were evaluated, and their demographic profile, clinical features of the nail matrix and nail bed disease, onychoscopy findings, histopathological features, treatment given, and follow-up progress were analysed. Results: Data from 15 patients were collected. The mean age of the patients was 28.6 ± 19.0 years (range 3.5 years to 56 years). The gender ratio was 0.8 with 7 males and 8 females. The average disease duration at presentation was 2.8 ± 2.6 years (6 months–9 years). The average number of nails involved was 16.4 ± 4.6 (8-20 nails). All 20 nails were involved in 9 (60%) patients. Nail matrix involvement was seen in all, with onychorrhexis being the most common manifestation, which was seen in 11 (73.3%) patients. Nail bed involvement was seen in 11 (73.3%) patients, with onycholysis being the most common presentation. Severe nail disease was seen in 7 (46.7%) patients, and 5 (33.3%) had pterygium involving an average of 3.4 nails. Moderate to good improvement was observed in 9 (60%) patients after an average of 6.1 ± 2.4 (3-9) treatment sessions with intramuscular and intramatricial triamcinolone acetonide injection. Of these, 2/9 (22.2%) developed disease recurrence in a few nails after an interval of 1 and 1.5 years, respectively. Two patients achieved complete clinical cures that persisted beyond 2 years of follow-up. Limitations: Retrospective nature of the series and the small sample size are the major limitations. Conclusion: The risk of permanent disfigurement is high in NLP and calls for an early diagnosis and prompt treatment. Intralesional and intramuscular steroids are first-line therapeutic options depending upon the number of nails involved. [ABSTRACT FROM AUTHOR]

This article discusses two cases of Darier disease, a chronic skin condition characterized by keratotic papules and other symptoms. The patients had previously tried various treatments with limited success. However, they showed significant improvement after being treated with apremilast, a medication approved for other skin conditions. The authors suggest that apremilast may help control inflammation and regulate calcium levels in Darier disease. Further studies are needed to confirm the efficacy of apremilast for this condition. [Extracted from the article]

This article discusses a case of doxycycline-induced photo-onycholysis in a child with lymphatic filariasis. The child experienced detachment of the fingernail plates after prolonged exposure to sunlight while taking doxycycline. The article provides details of the case, including clinical findings and dermoscopic examination results. It also includes a brief review of similar cases and discusses the mechanism of doxycycline-induced photo-onycholysis. The article emphasizes the importance of photoprotective measures and highlights the need for awareness of this condition to avoid unnecessary worry and investigations. [Extracted from the article]

Background: Nail involvement in psoriasis is common and may be an indicator not only of disease severity, but also of the presence of psoriatic arthritis. However, the relationship of nail psoriasis with enthesitis remains under-explored. Aims: This study was conducted to evaluate the clinical, onychoscopic (nail dermatoscopic) and ultrasonographic features in patients with nail psoriasis. Materials and Methods: All nails of twenty adult patients with nail psoriasis were examined clinically and onychoscopically. Patients were evaluated for psoriatic arthritis (Classification Criteria for Psoriatic Arthritis), the severity of cutaneous disease (Psoriasis Area Severity Index) and nail disease (Nail Psoriasis Severity Index). Ultrasonography of the clinically involved digits was performed for evidence of distal interphalangeal joint enthesitis. Results: Out of 20 patients, 18 patients had cutaneous psoriasis and 2 had isolated nail involvement. Among the 18 patients with skin psoriasis, 4 had associated psoriatic arthritis. The most commonly observed clinical and onychoscopic features were pitting (31.2% and 42.2%), onycholysis (36% and 36.5%) and subungual hyperkeratosis (30.2% and 30.5%), respectively. Ultrasonographic evidence of distal interphalangeal joint enthesitis was seen in 57% (175/307) of the digits with clinical nail involvement. Enthesitis was more common in patients with psoriatic arthritis (77% vs 50.6%). Nail thickening, crumbling and onychorrhexis (all features of nail matrix involvement) were significantly associated with enthesitis (P < 0.005). Limitations: The major limitation was the small sample size and lack of controls. Only the clinically involved digits were evaluated for enthesitis. Conclusions: Enthesitis was frequently detected on ultrasonography in patients with nail psoriasis, even in clinically asymptomatic individuals. Nail features of thickening, crumbling and onychorrhexis may predict underlying enthesitis and the potential development of arthritis. A comprehensive evaluation could help identify patients with psoriasis at risk for arthritis, helping improve long-term outcomes. [ABSTRACT FROM AUTHOR]

Background: Though diabetes mellitus (DM) is a well-recognised risk factor for onychomycosis (OM), the epidemiology of OM in diabetic patients remains largely unexplored, especially from the Indian subcontinent. Aims and objectives: To estimate the prevalence of OM in diabetic patients, to identify and analyse risk factors, and correlate the severity of nail changes with glycemic control (HBA1c). Methods: This cross-sectional, analytical study involved 300 diabetic patients. Patients with the clinical diagnosis of OM, supplanted by at least two of the four tests (KOH, culture, onychoscopy and nail histopathology) were considered cases of OM. Demographic and haematological profile was analysed using chi-square test/Fischer's exact test. Logistic regression was applied to assess the independent risk factors. Results: The prevalence of OM in DM patients was 34% (102/300) and significant risk factors included; age >60 years, male gender, closed shoes, disease duration >5 years, high BMI (>25) and lack of awareness about nail changes. Distal and lateral subungual OM (78%) was the commonest presentation followed by proximal subungual OM, superficial OM and total dystrophic OM. Correlation between HbA1c and the number of nails involved was found to be significant. Limitations: As cases were recruited from a hospital setting, there could be chances of Berksonian bias. Conclusion: The prevalence of OM in diabetic patients is high and the severity of nail changes correlates with HbA1C levels. It is important to diagnose OM early in order to treat and prevent complications. [ABSTRACT FROM AUTHOR]

Onychomatricoma is a rare benign tumor of the nail matrix, characterized by finger-like projections that invade the nail plate. The fingernails of Caucasian women are most commonly affected. Because this tumor can easily mimic other more prevalent ungual diseases, it is crucial to be acquainted with its characteristic clinical and histopathologic features. The authors present a case of a 40-year-old man with an onychomatrichoma in the fourth left toenail, which was initially misdiagnosed and treated as onychomycosis. [ABSTRACT FROM AUTHOR]

Background Nail braces are reportedly effective for treating both acute inflamed and chronic dystrophic type ingrown toenails. Aims In this study, risk factors for poorly controlled and recurrence-prone ingrown toenails treated with nail braces were identified. Methods We performed a retrospective study on patients with ingrown toenails between June 1, 2015, and May 31, 2018. The last follow-up date was January 31, 2019. Multivariate logistic regression was performed to evaluate the possible factors associated with poorly controlled status (ongoing paronychia during treatment) and recurrence. Results There were 120 (244 sides) and 118 patients (167 sides) with chronic dystrophic and acute inflamed type ingrown toenails, respectively. The mean treatment duration and follow-up period were 161.2 ± 98.3 days and 432.7 ± 320.9 days, respectively. Poor control and recurrence were seen in 7.3% (17/232) and 12.2% (27/221) of the patients, respectively. In the multivariate analysis, acute inflamed ingrown toenails, previous nail avulsion, proximal nail fold hypertrophy and more than one affected side remained significantly associated with poorly controlled ingrown toenails. Foot bone deformity was significantly associated with recurrence. Limitations This study was a retrospective study so that confounding factors such as comorbidities, body mass index, accompanying nail changes and lifestyle could not be evaluated. Conclusion Several risk factors related to poor control and recurrence were identified. Patients could therefore benefit from more suitable treatment plans with reasonable expectation. [ABSTRACT FROM AUTHOR]

Background: Face was often thought to be spared in psoriasis possibly due to the protective effect of sebum and low-dose ambient ultraviolet radiation exposure. Some have suggested that facial involvement is common and indicates disease severity. There is a paucity of data on this, particularly from India. Psoriatics have a higher prevalence of metabolic syndrome, and patients with severe disease are at greater risk.Objective: A study of the frequency and type of facial involvement in Indian psoriatic patients and its association with disease severity and metabolic syndrome.Methods: A total of 250 consecutive psoriatic patients were screened and these yielded 188 patients with facial involvement. Facial psoriatics were divided into peripherofacial, centrofacial and mixed facial types. Disease severity was assessed using whole body, scalp, facial psoriasis area severity index scores and nail area psoriasis severity index scores. Patients were evaluated for the presence of metabolic syndrome using NCEP-III criteria. All parameters were compared both between facial and nonfacial psoriatics and between cases with different types of face involvement.Results: The mean age (P = 0.04) and age of onset of disease (P = 0.02) was lower and median whole-body psoriasis area severity index score was higher in psoriatics with facial involvement (P < 0.001) than those without. No significant association was found between facial involvement and metabolic syndrome. Mixed facial was the commonest type of facial involvement and there was a significant association of mixed facial involvement with increased total body psoriasis area severity index scores (P < 0.001).Limitations: Dietary habits, physical activity level, family history of diabetes and obesity were not enquired for in our patients. Centrofacial cases were too few in number, hence statistical comparisons are not relevant.Conclusion: Facial involvement in psoriatics is associated with severe disease but not metabolic syndrome. Mixed facial type might be considered a marker of overall psoriasis disease severity in the Indian population. [ABSTRACT FROM AUTHOR]

A 43-year-old male patient experienced pain and discomfort in his right index finger for 10 months after sustaining trauma. Upon examination, it was found that he had a split finger with a smaller, rudimentary nail growing in a different direction. The accessory nail was removed, providing relief to the patient. While accessory nails can be congenital, most cases are post-traumatic and occur when the nail matrix is implanted in the adjacent skin. The patient's identity was not disclosed, and there were no conflicts of interest or financial support for this report. [Extracted from the article]

This preliminary pilot therapy showed that low-dose secukinumab intramatricial injection seems to be a quick, effective and safe treatment method for nail psoriasis. The severity of each nail was evaluated using the target nail psoriasis severity index scores, which allows a probable target nail score of 0 to 32. 3 The baseline scores were 12, 10 and 8 for case 1 [Figure 1a], and 14, 12 and 12 for case 2 [Figure 2a]. © 2021 Indian Journal of Dermatology, Venereology and Leprology- Published by Scientific Scholar 116 Intramatricial low-dose secukinumab injection for nail psoriasis Sir, Nail psoriasis affects not only the nail structure and function; it can also adversely impact the psychological state in psoriasis patients. [Extracted from the article]

Background: Diagnosis of onychomycosis involves direct microscopic examination with potassium hydroxide, culture or histopathology with periodic acid-Schiff staining. Nail dermoscopy (onychoscopy) is a noninvasive, rapid and easily available diagnostic tool though its utility in onychomycosis remains unexplored.Objective: To describe the various onychoscopic patterns and compare its percentage positivity with that of standard potassium hydroxide examination, culture and histopathology in patients with a clinical diagnosis of onychomycosis.Methods: The study recruited 100 patients with a presumptive clinical diagnosis of onychomycosis. A detailed history, physical examination including that of nails and clinical photography was followed by onychoscopy with DermLite DL3. The nail clippings were sent for direct microscopic examination with potassium hydroxide, mycological culture and histopathology with periodic acid-Schiff stain. The patient was said to have onychomycosis if at least one of the three tests was positive.Results: Onychomycosis was confirmed by potassium hydroxide and/or culture and/or histopathology in 88 patients. Onychoscopic features were identified and their association with different clinical variants of onychomycosis was attempted. Percentage positivity for diagnosing onychomycosis in decreasing order was: direct microscopic examination with potassium hydroxide followed by spiked pattern, subungual hyperkeratosis, distal irregular termination on onychoscopy, histopathology, mycological culture and ruins aspect again observed on onychoscopy.Limitations: Small sample size.Conclusions: Many onychoscopic features are highly specific for different variants of onychomycosis so onychoscopy may serve as an important and quick adjunct to diagnose onychomycosis until other time-consuming investigations, such as culture and periodic acid-Schiff become available. Studies on a larger population will help arrive at a logistic conclusion. [ABSTRACT FROM AUTHOR]

The patient responded to the therapy with only the nail changes and lesions on the legs persisting. This preliminary pilot therapy showed that low-dose secukinumab intramatricial injection seems to be a quick, effective and safe treatment method for nail psoriasis. Therapy Letter 119 Indian Journal of Dermatology, Venereology and Leprology | Volume 87 | Issue 1 | January-February 2021 right three nails was 62.5%, 75% and 50% for case 1, and showed no significant improvement for case 2. Because the psoriatic nails of case 1 took a turn for the worse, steadily, before treatment, we thought the observed improvement in the untreated nails of case 1 could be attributed to systemic absorption and effects of the drug after low-dose secukinumab injection, especially considering her low body weight. [Extracted from the article]

Background: One of the most effective options available for treating psoriatic fingernails is intramatricial injection of triamcinolone acetonide. Efficacies of intramatricial methotrexate and cyclosporine have not been comparatively evaluated to date.Methods: Ninety fingernails in 17 patients were assigned to three groups of thirty nails each, and treated with intramatricial injections of triamcinolone acetonide (10 mg/ml), methotrexate (25 mg/ml) and cyclosporine (50 mg/ml) respectively. Each nail was given two injections with a 6-week interval, and graded at 24 weeks using the Nail Psoriasis Severity Index.Results: In both triamcinolone acetonide and methotrexate groups, 15 (50%) nails out of 30 showed >75% improvement. In the cyclosporine group, only ten (33%) nails showed >75% improvement. Side effects were most in the nails treated with cyclosporine.Limitations: The limited follow-up period of 24 weeks may have been insufficient for detecting delayed remissions. The number of patients was small and there was no randomization or blinding. The lack of a placebo/ no- treatment arm can be considered a limitation.Conclusions: Amongst the three drugs studied, intramatricial methotrexate injection yielded the most improvement with minimum side effects, results being comparable to intramatricial triamcinolone acetonide injection. Cyclosporine was the least effective drug, with the most side effects. Intramatricial injection therapy is a safe, economical, simple and effective therapeutic modality in the management of nail psoriasis. [ABSTRACT FROM AUTHOR]

The nail is an important skin appendage, but not many dermatologists are aware of the importance it receives outside our specialty. This article focuses on the nail in non-dermatological contexts. The nail is a keratinized matrix capable of continuous growth with the ability to incorporate various compounds within its structure. Therefore it can be used to monitor long-term consumption of drugs. It is also an excellent source of germ-line DNA for genetic analyses. With an increased undrstanding of nail physiology, there is now a better understanding of its connection to various pathologies as well. Nails, being peripherally placed, are easy to sample without significant discomfort to the patient, making them a valuable diagnostic tool. For this narrative review, we carried out a PubMed search using the key words "nail clipping," "nail DNA," "nail diabetes mellitus;" "nail clipping oncology," and "nail forensics". Retrieved articles were searched for information pertaining to non-dermatologic uses of nail for evaluation, which is presented in a narrative fashion. It is clear from recent literature that the nail is not just an inert skin appendage, but a dynamic window into the ever-changing metabolic and genetic milieu. We highlight the numerous roles of nail specimens, as well as point towards future research needed therein. [ABSTRACT FROM AUTHOR]

Background: Nail involvement in psoriasis is common with a lifetime incidence of 80-90%. It may reflect severity of cutaneous involvement and predict joint disease. Yet it remains, poorly studied and evaluated especially in Indian psoriatic patients.Aim: The present study was undertaken to evaluate clinical and serological profile of nail involvement in psoriasis and to assess quality of life impairment associated with nail involvement in Indian patients.Methods: Consecutive patients with nail psoriasis were assessed for severity of cutaneous disease (psoriasis area severity index score) and nail disease (nail psoriasis severity index score). The impairment in quality of life attributable to nail disease was scored with nail psoriasis quality of life 10 score. All patients were also assessed for joint disease and tested for inflammatory and serological markers as erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor and anti-cyclic citrullinated peptide antibodies.Results: In our cohort of 38 patients with nail psoriasis, 9 had concomitant psoriatic arthritis. The mean psoriasis area severity index was 14.4 ± 9.6 (range = 0.4-34). The most commonly recorded psoriatic nail changes were pitting (97.4%), onycholysis (94.7%) and subungual hyperkeratosis (89.5%). The mean nail psoriasis severity index score was 83.2 ± 40.1 (range = 5-156) and mean nail psoriasis quality of life 10 was 1.1 ± 0.4. Erythrocyte sedimentation rate and C-reactive protein were raised in 22/38 (57.9%) and 15/38 (39.5%) patients, respectively; rheumatoid factor was positive in 5/38 (13.2%) and anti-cyclic citrullinated peptide antibody was raised in 4/38 (10.5%) patients.Limitations: Small sample size and lack of a control group.Conclusions: In Indian patients with nail psoriasis, severity of nail involvement was found to be poorly correlated with the extent of cutaneous disease. In addition the impact of nail disease on patient's quality of life was found to be minimal. This suggests the need for a quality of life questionnaire suited to the Indian population. Serological markers were raised overall in the study patients and more so in the patients with concomitant arthritis. [ABSTRACT FROM AUTHOR]

Onychoscopy refers to the examination of the nail unit using a dermoscope. Since the advent of dermoscopy, attempts have been made to use it for the diagnosis of nail disorders, most commonly pigmented lesions. As of now, onychoscopy has carved out a distinct niche for itself in the diagnostic work up of nail disorders. The nail is capable of mounting only a limited number of reaction patterns to the large number of disorders affecting it. Therefore, simple visual inspection may not be helpful in diagnosing many conditions reliably. Even a nail biopsy may not give a definitive answer every time. Onychoscopy is thus a valuable aid not only in enhancing visible nail features but also in revealing cryptic features of diagnostic value. This review aims to summarize the current level of knowledge about onychoscopic features of various diseases of the nail unit. It also aims to offer practical tips on how to conduct onychoscopy. For the purpose of review, a PubMed search about the indications and results of onychoscopy was done using the keywords "onychoscopy," "nail fold capillaroscopy," "dermoscopy nail" and "dermatoscopy nail." All the articles were retrieved and classified into case reports, reviews and clinical studies. The final data was then analyzed and presented in a narrative fashion. [ABSTRACT FROM AUTHOR]

Background: Acquired ungual fibrokeratomas are uncommon fibrous tissue tumors located in the ungual area. Though there are many reports of this entity, only some reports have reviewed the clinical features of the tumor.Aims: The aim of this study was to clarify the clinical characteristics of acquired ungual fibrokeratomas.Methods: We reviewed twenty patients who were treated surgically at our clinic from 2003 to 2014 for acquired ungual fibrokeratomas confirmed on histopathological examination. Our study was conducted by retrospective analysis of charts, clinical pictures and patient records. Cases of tuberous sclerosis were not included.Results: Acquired ungual fibrokeratomas occurred on toenails in 16 (80%) patients and on fingernails in 4 (20%) patients. Periungual lesions were noted in 15 (75%) patients followed by intraungual lesions in 4 (20%) patients and subungual lesions in 1 (5%) patient. A longitudinal groove was observed in 80% of patients. Surgical resection was performed in all cases for both medical and cosmetic reasons. After excision, recurrence occurred in three cases.Limitations: This was a retrospective study of a limited number of patients.Conclusions: Acquired ungual fibrokeratomas occurred more commonly on toenails than on fingernails and were located in the periungual area in most patients. A longitudinal groove in the nail plate was a frequent finding. Surgical resection led to medical and cosmetic improvement with a recurrence in 3 (15%) patients. [ABSTRACT FROM AUTHOR]

Nail tic disorders are classic examples of overlap between the domains of dermatology and psychiatry. They are examples of body-focused repetitive behaviors in which there is an irresistible urge or impulse to perform a certain behavior. The behavior is reinforced as it results in some degree of relief and pleasure. Nail tic disorders are common, yet poorly studied and understood. The literature on nail tic disorders is relatively scarce. Common nail tics include nail biting or onychophagia, onychotillomania and the habit tic deformity. Some uncommon and rare nail tic disorders are onychoteiromania, onychotemnomania, onychodaknomania and bidet nails. Onychophagia is chronic nail biting behavior which usually starts during childhood. It is often regarded as a tension reducing measure. Onychotillomania is recurrent picking and manicuring of the fingernails and/or toenails. In severe cases, it may lead to onychoatrophy due to irreversible scarring of the nail matrix. Very often, they occur in psychologically normal children but may sometimes be associated with anxiety. In severe cases, onychotillomania may be an expression of obsessive-compulsive disorders. Management of nail tic disorders is challenging. Frequent applications of distasteful topical preparations on the nail and periungual skin can discourage patients from biting and chewing their fingernails. Habit-tic deformity can be helped by bandaging the digit daily with permeable adhesive tape. Fluoxetine in high doses can be helpful in interrupting these compulsive disorders in adults. For a complete diagnosis and accurate management, it is imperative to assess the patient's mental health and simultaneously treat the underlying psychiatric comorbidity, if any. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the case study of a 35-year-old man with four-month history of dystrophy of all nails and one-month history of hair loss and fragility of hair all over his body, in which the patient was diagnosed with selenium toxicity.

A quiz related to dermatology is presented.

A letter to the editor is presented regarding the case of a 45-year-old woman who received acitretin and topical clobetasol for trachyonychia, an inflammatory disease of the nail matrix.

The article presents the study on the effectiveness of subungal hyperkeratosis nail biopsy in the diagnosis of onychomycosis in HIV-infected and immunocompetent adults. The study reportedly involved several HIV-infected persons with onychomycosis and who were not screened. The results revealed that periodic acid-Schiff stain of subungal hyperkeratosis nail biopsy is effective for diagnosing onychomycosis in HIV patients and non-HIV patients.

Nails are cutaneous appendages mostly involved in mechanical functions. However, nails may reflect presence of various systemic disorders evidenced by alteration of their shape, size, color or texture. Genodermatoses are multisystem disorders with cutaneous involvement. Many of the genodermatoses present with nail changes and some of these may be the clinical pointers to the diagnosis. Diagnostic clues to various genodermatoses derived from nail findings have been discussed. [ABSTRACT FROM AUTHOR]

Nail biopsy (NB) is an investigation that is not routinely resorted to by most of the dermatologists. The commonly cited reasons are the complexity of the procedure, risk of scarring and the reluctance of the patient. However, in cases with isolated nail psoriasis, isolated nail lichen planus, onychomycosis not confirmed on direct microscopy and culture, or longitudinal melanonychia, the treating dermatologist is left with no choice but to resort to this procedure. Nail as a unit, is capable of projecting only a limited number of clinical manifestations. This is responsible for the more or less similar clinical presentation of many different nail disorders. Hence, a practical knowledge of the indications, appropriate patient selection, procedural details and histopathological interpretation of a NB is a must-have for any practicing dermatologist. The risk of scarring is none to minimal if appropriate type of biopsy is performed, not to mention the wealth of histopathological data that can be retrieved from the nail unit. This article aims to explore the various practical do's and don'ts for the NB and tells us what to expect from of the procedure. [ABSTRACT FROM AUTHOR]

Onychomycosis (OM) is the commonest disorder affecting the nail unit. The fact that it affects 3-26% people worldwide goes to show that it is a significant health problem. The prevalence of OM has been reported to be increasing over the years. Although, we know much about various predisposing factors, we are yet unclear about its exact pathogenesis. The peculiarities of the nail unit with respect to its structure and its immune mechanisms make OM an adversary, which once established is difficult to eradicate. There have been many recent advances in our understanding of the pathogenesis of OM and our methods of diagnosing it. The increasingly valuable role of histopathology; refinements in its technique; PCR techniques; Optical coherence tomography and advances in spectrometric techniques have been reported. The present review is aimed at discussing the newer advances in our understanding of the pathogenesis of various clinical types of OM apart from the newer and exciting techniques of diagnosing it. [ABSTRACT FROM AUTHOR]

Nail dyschromias have a wide variety of presentation. There are numerous causes of discoloration of the nail affecting the nail plate, nail attachments, or the substance of the nail. The chromonychia may also be caused due to the exogenous deposition of pigments over the nail plate. Careful examination of the nail and few bed side tests may help in identifying the root cause of the nail dyschromia and many a times unravels some underlying systemic disorder too. [ABSTRACT FROM AUTHOR]

Nail abnormalities secondary to systemic disease could be classified as nail abnormalties associated with systemic disease, disease of specific organ system or associated with syndromes and genodermatoses. Because nail findings are easily observable and yield valuable information, careful examination of nails could be an important diagnostic tool for a dermatologist. A brief review of the common and not so common nail changes in systemic illness is presented. [ABSTRACT FROM AUTHOR]

Trachyonychia or rough nails, may present as an idiopathic disorder of the nails or it can be associated with other dermatological conditions. The dystrophic nail findings seen in trachyonychia are characterized by brittle, thin nails, with excessive longitudinal ridging. The most common histopathologic features associated with trachyonychia are spongiosis and exocytosis of inflammatory cells into the nail epithelia; typical features of lichen planus or psoriasis can also be detected. Determining the cause of trachyonychia is challenging. Treatment is often unsatisfactory, although in general it should be aimed at the underlying cause, if found. In most cases, the nail abnormalities improve spontaneously. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including the advancements in nail disorders and the various diagnostic procedures available for these conditions.

An 8-week-old infant presented with 7 weeks history of nail involvement and discoloration. Lesions started over the middle fingernail of right hand at 1 week of age, spreading over to other nails within 2 weeks. Only two nails of the feet were spared. On KOH examination, fungal hyphae were seen and culture showed growth of Trichophyton rubrum. The purpose is to report the earliest case of onychomycosis having multiple nail involvement of fingers and toes (18 nails). [ABSTRACT FROM AUTHOR]

Background: Psoriatic nail changes predispose to onychomycosis because it becomes easier for fungi to penetrate an already compromised nail plate. Moreover, some of the psoriatic nail changes closely resemble onychomycosis. Aim: To investigate cases of nail psoriasis for any evidence of onychomycosis. Methods: Seventy-two patients with psoriasis were included in the study. The patients were selected from the psoriasis clinic and dermatology in-patient ward. Direct microscopic examination with 20% KOH and culture were carried out in all patients showing psoriatic nail changes. Histopathological examination with Periodic Acid-Schiff (PAS) stain was done in cases negative by KOH examination and culture. Results: Nail changes were seen in 66.66% (48/72) of psoriasis patients. The most common fingernail changes observed were pitting, onycholysis and subungual hyperkeratosis, and the most common toenail changes were onycholysis and subungual hyperkeratosis. Nail changes were significantly more common in males. The duration of skin lesions of psoriasis and Psoriasis Area Severity Index scores were significantly higher in patients with nail changes. Out of 48 patients with psoriatic nail change, 23 (47.91%) had investigative evidence of onychomycosis. The fungal isolates on culture were non-dermatophytic molds in nine patients (18.75%) and yeast like fungi also in nine patients (18.75%). Conclusion: Coexistent onychomycosis in psoriatic nails does occur. [ABSTRACT FROM AUTHOR]

Psoriasis is a common, chronic, inflammatory disease with a wide range of clinical presentations. The disease severity ranges from mild to severe. Plaque type of psoriasis is the most common. A number of factors like previous treatment history and comorbid conditions influence the treatment of psoriasis in an individual patient. Location of the lesions is also an important consideration. Psoriasis localized to certain areas of the body like scalp, nails, palms and soles remains difficult to treat. These sites have been referred to as the difficult locations in literature. This article covers the management of psoriasis limited to these special areas. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented related to squamous cell carcinoma of the nail fold masquerading as pyogenic granuloma.

A letter to the editor is presented in response to the article "Effective treatment of severe nail psoriasis using topical calcipotriol with betamethasone dipropionate gel" that was published in the previous issue.

A letter to the editor is presented in response to the article "Nail changes in psoriatic children" that was published in the previous issue.

Nail disorders are frequent among the geriatric population. This is due in part to the impaired circulation and in particular, susceptibility of the senile nail to fungal infections, faulty biomechanics, neoplasms, concurrent dermatological or systemic diseases, and related treatments. With aging, the rate of growth, color, contour, surface, thickness, chemical composition and histology of the nail unit change. Age associated disorders include brittle nails, trachyonychia, onychauxis, pachyonychia, onychogryphosis, onychophosis, onychoclavus, onychocryptosis, onycholysis, infections, infestations, splinter hemorrhages, subungual hematoma, subungual exostosis and malignancies. Awareness of the symptoms, signs and treatment options for these changes and disorders will enable us to assess and manage the conditions involving the nails of this large and growing segment of the population in a better way. [ABSTRACT FROM AUTHOR]

Background: Onychomycosis is a recalcitrant disease of the nails caused by dermatophytes, yeasts, and molds.Aims: To compare the clinical efficacy of oral itraconazole pulse therapy and oral terbinafine pulse therapy in onychomycosis.Methods: A randomized single-blind clinical comparative study was undertaken on 120 patients of onychomycosis during the period March 1999-February 2002. Sixty patients were randomly assigned to receive oral itraconazole 100 mg, two capsules twice daily for seven days a month and the other group of sixty patients received oral terbinafine 250 mg, one tablet twice daily for seven days every month. Four such monthly pulses were administered for each drug. The patients were evaluated at 4-weekly intervals till sixteen weeks and then at 24, 36 and 48 weeks.Results: We observed a clinical cure rate of 82% and mycological cure rate of 90% in the group of patients treated with itraconazole while the group with terbinafine showed clinical and mycological cure rates of 79% and 87% respectively. This difference was not statistically significant.Conclusions: Both oral itraconazole and terbinafine are effective in the treatment of onychomycosis when administered in the pulse dosage form. Terbinafine is more cost effective while itraconazole has a broader spectrum of antimycotic activity. [ABSTRACT FROM AUTHOR]

The article offers information on bead retention test in koilonychia, a nail disease. Topics include the comparison of water-drop test and bead retention test for koilonychia, retention of spherical plastic beads on the concave surface of nail plates in patients with koilonychia, and false positive results of water-drop test.