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Worn-down nail syndrome is a nail disordercharacterized by thinning of the distal nail plateinduced by repetitive mechanical trauma. A Frenchvariant, entitled “bidet nail syndrome” was firstdescribed by Baran.

Background: Nail unit melanoma (NUM) is a rare melanoma variant, usually associated with a poor prognosis because of a delayed diagnosis. Few data are available concerning the management and long‐term outcome of in situ NUM. Objective: To use a large cohort to provide comprehensive patient data and long‐term follow‐up information. This will serve to investigate distinctive epidemiological, clinical and histological features of in situ NUM. To report treatment modalities, assess conservative surgery and evaluate its long‐term safety. Methods: Patients with confirmed diagnosis of in situ NUM were retrospectively reviewed. Demographics, clinical presentation, therapeutic data and follow‐up were analysed. Results: Sixty‐three cases of in situ NUM were identified as follows: 44 were women (70%), with a mean age of 51 years. The mean duration of symptoms prior to consultation was 4.3 years [range 3 months–28 years]. Clinically, with 58 cases, i.e. (92%) longitudinal melanonychia was the most common clinical presentation. The thumb was the most affected digit, being afflicted in 28 cases: 44%. Medical history found a widening and/or recent darkening of the melanonychia in 46 cases (82%). The treatment consisted of, respectively, 56 En bloc excisions of the nail apparatus 89% of the patients we studied, and seven amputations of the distal phalanx. During the follow‐up period (mean: 10 years), two patients presented in situ recurrences. Conclusion: The recognition of a NUM at an in situ stage allows early treatment and curing of this tumour. At this early stage, a 'functional surgery' is a rational approach with an excellent oncologic safety. [ABSTRACT FROM AUTHOR]

Tumours of the nail apparatus are often the subject of diagnostic dilemma. Until now, no reliable imaging methods have been available to assess these lesions correctly. We report the results of high and very high-resolution magnetic resonance imaging (MRI), which have been correlated with the anatomical findings in 14 cases of nail apparatus pathology, and discuss the possible contribution of MRI to diagnosis. With very high-resolution MRI. accurate analysis of the anatomy of the nail apparatus is possible, and lesions as small as 1 mm can be detected. An expansive process can be excluded when results are negative. Glomus tumour, mucoid pseudocyst, fibrokeratoma, and exostosis can be differentiated because of their different MRT characteristics. This is of importance when the exact nature of a subungual tumour cannot be determined by clinical findings alone. Measurement, determination of the exact localization of the tumour, and the study of its relationship to the other structures, can provide guidance for subsequent surgical procedures. MRI is reliable and accurate in the delineation of lesions, and provides a new tool for the investigation of pathology of the nail apparatus. [ABSTRACT FROM AUTHOR]

Lichen planus is a benign inflammatory disorder of unknown etiology that may affect the skin, mucosae, scalp, and nails. When the nails are affected, it may lead to permanent destruction with severe functional and psychosocial consequences. Therefore, prompt diagnosis and early treatment are essential, even in mild cases. There are currently no guidelines for the management of nail lichen planus and the published literature on treatment is limited. The aim of this review is to provide practical management recommendations for the classical form of nail lichen planus, especially when restricted to the nails. Topical treatment has poor short-term efficacy and may cause long-term side effects. Instead, intralesional and intramuscular triamcinolone acetonide should be considered first-line therapies. Oral retinoids are second-line choices, and immunosuppressive agents may also be considered., (Copyright © 2020 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Blue nevus of the nail apparatus is a rare entity and only isolated cases are reported in the literature., Objective: The aim of this study was to better characterize blue nevus at the nail unit., Methods: Retrospective analysis of all nail unit blue nevi from the Nail Group of the French Society of Dermatology was compared to the literature., Results: Eleven cases were retrieved from 2002 to 2019 with an average age of 45 years. The majority were women (9/11) and acquired (10/11). Hands were more frequently involved (9/11) with a predilection for the thumb and 2 cases were located on the hallux. Nail unit blue nevus mostly presented as a well-delimited blue spot of the lunula (9/11) and histologically was of the common type (10/11). There was no malignancy., Conclusion: Nail unit blue nevus is a rare asymptomatic benign entity, mostly acquired on the thumb or the hallux of women. The most frequent presentation is a painless blue spot on the lunula. Congenital blue nevi seem to only affect the paronychium. Main differential diagnosis is melanoma and histopathological examination is mandatory., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2020 by S. Karger AG, Basel.)

Nail diseases are varied, and their diagnosis is often difficult. Misdiagnosis can result in failure to recognize a severe disease in urgent need of treatment and in the prescription of treatments that are inappropriate, long, ineffective, and expensive. Acute paronychia must be managed rapidly, treated with antiseptics several times a day, and closely monitored. Nail lichen must be recognized early and treated rapidly and appropriately to prevent permanent scarring. All chronic pain (to shocks or cold) of the tip of a finger or toe should suggest a glomus tumor. Any unexplained persistent single-finger onychopathy should in principle cause the physician to suspect a tumor, carcinoma, or melanoma and to order a histologic examination. An onychopathy must not be treated as an onychomycosis without diagnostic certainty. Repeated microtraumas of the toenails cause injuries that absolutely must be differentiated from onychomycosis. In growth of the big toenail can often be avoided by appropriate cutting of the nails, leaving in place the lateral parts of the nail plate.

Purpose: To determine the magnetic resonance (MR) imaging findings in recurrent glomus tumors of the fingertips., Materials and Methods: Twenty-four consecutive patients with recurrent pain after previous excision of a glomus tumor of the fingertip underwent MR imaging studies and surgery. T1-weighted spin-echo MR images were obtained in each patient before and after intravenous injection of contrast material; T2-weighted spin-echo and three-dimensional gradient-recalled echo images were also obtained. MR angiography was performed in four patients. Postsurgical histopathologic analysis revealed recurrent glomus tumors in 22 patients. Signal intensity, enhancement, and margins of the scar tissue and the recurrent tumors at MR were assessed., Results: The postsurgical scars were depicted in 21 (88%) of 24 patients with all sequences but were best demonstrated on gradient-recalled echo MR images. Seven patients had undergone multiple surgical procedures and had extensive scar tissue and, in one case, a neuroma. In all patients, MR imaging revealed a nodule compatible with the diagnosis of a recurrent glomus tumor. In 13 (54%) of 24 patients, the nodule had typical features of a glomus tumor. In eight (33%) of 24 patients, the tumors had low signal intensity or isointensity compared with the nail bed on T2-weighted images. In six (25%) of 24 patients, the tumors had faint enhancement after intravenous gadolinium chelate administration. The margins of the tumors were blurred by scar tissue in nine of 24 cases., Conclusion: MR imaging can aid in the evaluation of recurrent glomus tumors.

Purpose: To report the magnetic resonance (MR) imaging features of finger hemangiomas., Materials and Methods: Sixteen patients clinically suspected of having hemangioma of the finger underwent 1.5-T MR imaging with a customized local gradient coil. The location, size, margins, signal intensity, and enhancement patterns of the lesions were noted. In accordance with the literature on MR imaging of deep hemangiomas, the authors' findings could be divided into those with typical features-that is, high signal intensity at T1- and T2-weighted imaging, lobulated appearance, strong enhancement, and heterogeneous pattern with flow void artifacts-and those with atypical features. The reference standard was surgery (n = 12) or clinical outcome (n = 4)., Results: One posttraumatic hematoma was excluded. Most lesions were in the fingertip (n = 10), with involvement of the nail bed and/or the pulp (n = 5). Hemangiomas were classified as typical in ten cases and atypical in five. The mean size of typical lesions was larger than that of atypical lesions. The unique imaging features of atypical hemangiomas included a masslike appearance, which was either homogeneous with diffuse enhancement-suggestive of hypervascularity (n = 2)-or heterogeneous with poor enhancement (n = 3)., Conclusion: MR imaging characteristics of finger hemangiomas can be classified as typical or atypical. Knowledge of both patterns can be helpful in the distinction of soft-tissue abnormalities at this location.

Linear pigmentation of the nail apparatus most reflects longitudinal melanonychia. It results either from simple activation of matrical melanocytes induced by various factors or from benign (lentigo or naevus) or malignant (melanoma) melanocyte hyperplasia. Hematomas and some fungal infections can falsely resemble linear pigmentation. Non-linear pigmented lesions of the nail bed are most often subungual hematoma or infections (fungal, or pyocyanic superfection of a loosened or separated nail). Opening the nail bed directs the diagnosis. A possible tumoral cause should be kept in mind, especially melanoma, or carcinoma.

In children the nail has physiologic characteristics that imply specific abnormalities. The most common dermatological localisation in psoriasis in the child; it is seen as trachyonychia, pitting, and occasionally pachyonychia. Ingrowth of the large toenail is a common problem, whether due to congenital hypertrophy of the lateral nail folds of the hallux in the newborn, to congenital malalignment of the nail of the big toe, or to a juvenile ingrown nail. Many other nail disorders are observed in the child: parakeratosis pustulosa, nail lichen, lichen striatus, melanonychia, dermatophyte onychomycosis, candida infection, herpes.... Aside from warts, tumours are rare.

Background: High-resolution magnetic resonance imaging (MRI) of subungual glomus tumors has been recently reported., Objective: Our purpose was to compare high-resolution MRI and standard MRI for the diagnosis of 44 glomus tumors of the toes and fingertips., Methods: Glomus tumors (11 cases) were first examined by MRI with a commercial surface coil (set 1). Thirty-three other glomus tumors and one tumor from set 1 were then examined with a high-resolution module designed for skin imaging (set 2)., Results: All 44 glomus tumors were identified with MRI. The limits of the tumors were detected in 54% of set 1 and 100% of set 2. A capsule was present in most cases, but was incomplete or absent in eight cases. Subtypes of glomus tumors were more easily differentiated in set 2., Conclusion: Standard MRI was adequate to detect glomus tumors, but high-resolution MRI assessed tumor characteristics more accurately.

Purpose: To assess the usefulness of magnetic resonance (MR) imaging in the diagnosis and clarification of the physiopathology of digital mucoid cysts., Materials and Methods: Twenty-three patients (14 women, nine men; aged 52-75 years) with mucoid cysts underwent MR imaging at 1.5 T with a local surface gradient coil. The pixel size was 117 microns in one direction. T2 relaxation times were measured. Contrast material was intravenously administered in 15 patients., Results: All mucoid cysts had high signal intensity and sharp borders on T2-weighted images. Intracystic septa were present in nine patients (39%). Most cysts were solitary (n = 13) and/or in the proximal nail fold (n = 16). Satellite cysts were present in five patients. Nineteen patients (83%) had cysts with pedicles that extended to the joint. Osteoarthritis of the distal interphalangeal joint was present in 16 patients (70%). Five patients (22%) had multiple flattened cysts that were usually independent of the joint. In seven patients (30%), MR images showed cysts beneath the nail plate., Conclusion: Digital mucoid cysts may be polymorphic. MR imaging is helpful when cysts are in the nail bed.

High-resolution sagittal magnetic resonance images depict an oval area in the dermis beneath the nail matrix that gives a particular signal. This study defines the magnetic resonance imaging characteristics of this area and examines its correlation with the lunula. A high-resolution surface gradient coil specially designed for skin imagining was used on a 1.5 T magnetic resonance unit. The subnail matrix (SNM) areas of 12 subjects had a significantly longer T2 relaxation time and a higher enhancement ratio after injection of gadolinium than did the nail bed dermis. The length of the SNM area distal to the free edge of the proximal nail fold was highly correlated with the length of the lunula (R = 0.98) in 30 fingers and 10 toes. The total length of the SNM area was somewhat correlated with the nail thickness (R = 0.86) in 30 fingers. The histology and microvascularization of the subungual tissue in 21 fingers showed that this SNM area had specific features: The area was composed of loose connective tissue without bundles, and the reticular and subdermal vascular networks had large regular meshes in this oval area. The lunula is shown to be linked to a well-defined area in the underlying dermis with a specific histology and microvascularization.

Purpose: To determine the magnetic resonance (MR) imaging features of subungual glomus tumors., Materials and Methods: Thirty-one patients with a clinical suspicion of glomus tumor and 10 control subjects underwent MR imaging at 1.5 T. MR images of normal glomus bodies of a cadaver finger were correlated with histologic slices. With a local surface gradient coil, the pixel size reached 117 microns in one direction. Relaxation times were measured. Gadoterate meglumine was injected in 19 patients., Results: Normal glomus bodies were visualized in the reticular dermis of the nail bed. Twenty-seven of 28 pathologically confirmed glomus tumors were detected with MR imaging. A peripheral capsule was present in most tumors. The nail matrix was compressed in 13 cases. The authors were able to differentiate three subtypes of glomus tumors (vascular, solid, and myxoid) on the basis of relaxation times and enhancement characteristics. Four patients had mucoid cysts or angioma in the nail bed., Conclusion: MR imaging can help accurately define the location and limits of glomus tumors before excision.