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Purpose of Review: Cutaneous manifestations are quite common in liver diseases and are often considered non-specific as some of these manifestations are seen even in healthy individuals.It is the constellation of these changes which points towards underlying liver diseases. This review is meant to detail the cutaneous changes that underline the concerned liver disease & help us reach the diagnosis better. Recent Findings: No relevant recent findings in this topic. Summary: Cutaneous manifestations seen in the setting of liver cirrhosis includes icterus, pruritus, spider angiomas, palmar erythema, xanthomas, pigmentary changes, nutritional deficiencies and hair & nail changes. There are certain cutaneous manifestations which are specific for certain liver diseases like HBV infection, HCV infection, PBC etc. Early identification of these cutaneous manifestations is critical for early diagnosis and management and underscores the importance of a good general physical examination [ABSTRACT FROM AUTHOR]

A wide spectrum of tumors may affect the periungual spaces of the digits. Superficial acral fibromyxoma (SAF) is a rare, benign soft tissue tumor with diverse clinical presentations. We present a case of a 55‐year‐old woman with a 2‐year history of a solitary periungual tumor on the left thumb, subjected to multiple episodes of trauma. Initially suspected to be a periungual squamous cell carcinoma (SCC) based on clinical and dermoscopic features, the tumor was confirmed to be a CD34− SAF through histopathology and immunohistochemistry. Although CD34 immunoreactivity is common in SAF, one‐third of these tumors, including this case, do not stain for this marker. Periungual SCC considered a "great mimicker of nail tumors," may resemble other benign nail tumors such as SAF. The patient underwent complete surgical excision with primary closure, resulting in no recurrence after 1 year. This case highlights SAF as an underrecognized benign entity that may manifest with features suspicious of malignancy, potentially leading to unnecessarily aggressive interventions. Recognizing SAF through accurate biopsy techniques and thorough histopathologic evaluation, even in the absence of CD34 reactivity, is crucial for appropriate treatment and preservation of hand function and appearance. [ABSTRACT FROM AUTHOR]

Introduction: Nail psoriasis is common in psoriasis vulgaris and even more prevalent in psoriatic arthritis. Dermatoscopy of the nail proves helpful in enhancing the visualization of psoriatic nail lesions. Objective: This systematic review aimed to summarize the existing studies published in the literature that reported the various dermoscopic features of nail psoriasis. Materials and methods: A systematic search of two medical databases, PubMed and Scopus, was conducted in April 2023. In total, 11 records were included. The number of reported cases in the included studies was 723. Results: The average age was 42.39 years. Sixty percent of patients were males, and 40% were females. Pitting constituted the most common onychoscopic feature indicating nail matrix involvement, followed by various other features such as leukonychia, nail plate thickening, transverse and longitudinal ridges, and different lunula abnormalities. The predominant onychoscopic feature indicating nail bed involvement was onycholysis, followed by splinter hemorrhages, oil drop sign, subungual hyperkeratosis, dilated capillaries, agminated capillary dots, erythematous border, and pustules. Vascular abnormalities observed in all locations were present in 52% of patients. Conclusions: The clinical signs of nail psoriasis are diverse, and for the majority, they are nonspecific. Nail dermoscopy is a noninvasive tool that enhances the visualization of the nail manifestations of psoriasis. It may facilitate the establishment of diagnostic criteria for this pathology without resorting to more invasive procedures, such as nail biopsy. [ABSTRACT FROM AUTHOR]

Here, we present the case of an otherwise healthy patient, without risk factors, who developed a refractory case of onychomycosis caused by Kloeckera apiculata, an uncommon human pathogen. The diagnosis was ultimately confirmed by fungal nail plate culture, histopathology, and PCR. Whereas prior treatments with topical 5 % tavaborole solution, oral terbinafine, and oral fluconazole were ineffective, complete clinical and mycological cure was achieved with a 3-month course of oral itraconazole.

The article in the International Journal of Dermatology discusses the dermoscopic findings of periungual Bowen's disease (PBD) in a retrospective case series. The study reviewed cases of PBD seen at a regional nail clinic from 2010 to 2020 and identified common dermoscopic features such as scaling, pink-white amorphous areas, and a prominent edge. The research found that PBD can be challenging to diagnose, especially in cases with prominent keratinization, and highlighted the importance of dermoscopy in distinguishing PBD from other conditions. [Extracted from the article]

Onychomycosis is an under-recognized healthcare burden. Despite the risk of misdiagnosis, confirmatory laboratory testing is under-utilized. Histopathologic examination with polymerase chain reaction (PCR) is currently the most effective diagnostic method; it offers direct detection and identification of a fungal invasion. In this retrospective cohort study, we assessed confirmatory testing results, with matching clinical diagnoses, in 96,293 nail specimens submitted during a 9-month period from 2022 to 2023. Toenail specimens were examined using fungal culture, histopathology and/or PCR. Clinical diagnoses were identified using the International Classification of Diseases 10th Revision codes. For clinically diagnosed onychomycosis patients, the overall positivity rate was 59.4%; a similar positivity rate (59.5%) was found in patients with clinically diagnosed non-fungal nail dystrophy. Performing a histopathologic examination with PCR was more likely to provide pathogen identification results than using fungal culture. Male patients had a higher rate of onychomycosis overall; however, female patients had more non-dermatophyte mold onychomycosis caused by Aspergillus. Clinically diagnosed onychomycosis patients with a co-diagnosis of tinea pedis were more likely to test positive for onychomycosis by PCR (odds ratio [OR]: 4.2; 95% confidence interval [CI]: 2.7–6.4), histopathology (OR: 2.5; 95% CI: 2.0–3.1) and fungal culture (OR: 3.2; 95% CI: 1.5–6.6). Our results support the use of confirmatory laboratory testing when there is a clinical diagnosis of onychomycosis. [ABSTRACT FROM AUTHOR]

Background: Dermoscopy has emerged as a useful diagnostic tool to evaluate skin lesions, including psoriasis. We aimed to compare the clinical examination and digital dermoscopy findings of nail involvement in patients with psoriatic nails. Methods: This study included 60 patients with clinically diagnosed psoriasis. The nail findings and NAPSI were evaluated clinically and via dermoscopy, and then the severity of the disease was calculated using PASI criteria. Results: About 32 patients were males, with a median PASI score of 4.4, and pitting and subungual hyperkeratosis were the most common findings. The clinical and dermoscopic examination had a moderate diagnostic resemblance regarding onycholysis, subungual hyperkeratosis, and leukonychia. The resemblance between the two methods for the diagnosis of leukonychia in patients with a duration of disease

Lichen planus is a chronic inflammatory disorder that may affect the skin, nails, and/or oral mucosa. Bullous lichen planus is a rare variant of lichen planus, which is even less common in the nails. We present a case of nail bullous lichen planus, in a 48-year-old male presenting with a 10-month history of onychodystrophy of all ten fingernails. A longitudinal excision of the left thumbnail was performed, with histopathology consistent with lichen planus with focal transition to bullous lichen planus. He was treated with intralesional triamcinolone injections to the fingernails monthly, with improvements noted after three treatments. Our patient’s nail bullous lichen planus manifested with longitudinal ridging, white-yellow discoloration, onycholysis, subungual hyperkeratosis, and v-shaped nicking. Histopathological findings included classical lichen planus changes, as well as formation of subepidermal bullae, colloid bodies, and extensive inflammatory infiltrate. Increased awareness and high index of suspicion for this condition are necessary, given the often late diagnosis reported in previously published cases.

Lichen planus is a chronic inflammatory disorder that may affect the skin, nails, and/or oral mucosa. Bullous lichen planus is a rare variant of lichen planus, which is even less common in the nails. We present a case of nail bullous lichen planus, in a 48-year-old male presenting with a 10-month history of onychodystrophy of all ten fingernails. A longitudinal excision of the left thumbnail was performed, with histopathology consistent with lichen planus with focal transition to bullous lichen planus. He was treated with intralesional triamcinolone injections to the fingernails monthly, with improvements noted after three treatments. Our patient’s nail bullous lichen planus manifested with longitudinal ridging, white-yellow discoloration, onycholysis, subungual hyperkeratosis, and v-shaped nicking. Histopathological findings included classical lichen planus changes, as well as formation of subepidermal bullae, colloid bodies, and extensive inflammatory infiltrate. Increased awareness and high index of suspicion for this condition are necessary, given the often late diagnosis reported in previously published cases. [ABSTRACT FROM AUTHOR]

Introda significant: Onychomycosis is the most common nail disorder seen in clinical practice, and it may have significant impact on patient quality of life. Understanding risk factors for onychomycosis may help to devise screening and treatment guidelines for populations that are more susceptible to this infection. Using a national database, we aimed to explore associations between onychomycosis and age, sex, and underlying medical conditions, as well as to examine current onychomycosis treatment trends. Materials and Methods: We performed a nested, matched, case–control study of patients in the All of Us database aged ≥ 18 years (6 May 2018–1 January 2022). Onychomycosis cases were identified using International Classification of Diseases (ICD) and Systematized Nomenclature of Medicine (SNOMED) diagnostic codes (ICD-9 110.1, ICD-10 B35.1, SNOMED 414941008). Demographic information (i.e., age, sex, and race), treatments, and co-diagnoses for onychomycosis patients and case–controls were recorded. Wald's test applied to multivariate logistic regression was used to calculate odds ratios and p-values between onychomycosis and co-diagnoses. Additionally, 95% confidence intervals were calculated with a proportion test. Results: We included 15,760 onychomycosis patients and 47,280 matched controls. The mean age of onychomycosis patients was 64.9 years, with 54.2% female, 52.8% Non-Hispanic White, 23.0% Black, 17.8% Hispanic, and 6.3% other, which was similar to controls. Patients with onychomycosis vs. controls were more likely to have a co-diagnosis of obesity (46.4%, OR 2.59 [2.49–2.69]), tinea pedis (21.5%, OR 10.9 [10.1–11.6]), peripheral vascular disease (PVD) (14.4%, OR 3.04 [2.86–3.24]), venous insufficiency (13.4%, OR 3.38 [3.15–3.59]), venous varices (5.6%, OR 2.71 [2.47–2.97]), diabetes mellitus (5.6%, OR 3.28 [2.98–3.61]), and human immunodeficiency virus (HIV) (3.5%, OR 1.8 [1.61–2.00]) (p < 0.05, all). The most frequently prescribed oral and topical medications were terbinafine (20.9%) and ciclopirox (12.4%), respectively. The most common therapeutic procedure performed was debridement (19.3%). Over the study period, ciclopirox prescriptions (Spearman correlation 0.182, p = 0.0361) and fluconazole prescriptions increased (Spearman correlation 0.665, p = 2.44 × 10−4), and griseofulvin (Spearman correlation −0.557, p = 0.0131) and itraconazole prescriptions decreased (Spearman correlation −0.681, p = 3.32 × 10−6). Conclusions: Our study demonstrated that age, obesity, tinea pedis, PVD, venous insufficiency, diabetes mellitus, and HIV were significant risk factors for onychomycosis. In addition, the most frequent oral and topical onychomycosis medications prescribed were terbinafine and ciclopirox, likely reflective of efficacy and cost considerations. Identifying and managing these risk factors is essential to preventing onychomycosis' primary infections and recurrences and improving treatment efficacy. [ABSTRACT FROM AUTHOR]

Nail conditions are not only aesthetic concerns, and nail changes may be a clue to an underlying systemic diseases or infection. Without timely treatment, nail diseases can continue to worsen and significantly impair performance of daily activities and reduce quality of life. Examination of the nails is essential at every medical visit, and may uncover important findings. Brittle nail syndrome, onychomycosis, paronychia, nail psoriasis, longitudinal melanonychia, Beau’s lines, onychomadesis and retronychia are common nail disorders seen in clinical practice. These conditions stem from infectious, inflammatory, neoplastic and traumatic aetiologies. Though each nail condition presents with its own distinct characteristics, the clinical findings may overlap between different conditions, resulting in misdiagnosis and treatment delays. Patients can present with nail plate changes (e.g. hyperkeratosis, onycholysis, pitting), discolouration, pain and inflammation. The diagnostic work-up of nail disease should include a detailed history and clinical examination of all 20 nail units. Dermoscopy, diagnostic imaging and histopathologic and mycological analyses may be necessary for diagnosis. Nail findings concerning for malignancy should be promptly referred to a dermatologist for evaluation and biopsy. Nail disease management requires a targeted treatment approach. Treatments include topical and/or systemic medications, discontinuation of offending drugs or surgical intervention, depending on the condition. Patient education on proper nail care and techniques to minimize further damage to the affected nails is also important. This article serves to enhance familiarity of the most common nail disorders seen in clinical practice. It will highlight the key clinical manifestations, systematic approaches to diagnosis and treatment options for each nail condition to improve diagnosis and management of nail diseases, as well as patient outcomes.Key messagesNail disease is not only a cosmetic issue, as nail changes can indicate the presence of a serious underlying systemic disease, infection or malignancy.Nail pain and changes associated with NP are physically and emotionally distressing and may contribute to functional impairment and diminished quality of life.LM is a hallmark sign of subungual melanoma and this finding warrants further investigation to rule out malignancy.

Onychomycosis is a commonly encountered fungal infection of the nail that is increasing in prevalence worldwide. Diagnosis and treatment of onychomycosis is essential for any dermatologic practice, and the options available for both are numerous. The subtypes of this infection can help guide diagnostic techniques and determine the route and type of treatment that should be pursued. This article reviews the pathogenic organisms, epidemiology, clinical presentation and subtypes, and diagnostic and current treatment options available to treat this condition. [ABSTRACT FROM AUTHOR]

In this work, we report a method of identifying anisotropic structural features beneath the nail with differential polarization parameters. First the form of the differential Mueller matrix of medium in terms of the average and the fluctuation parameters of the differential polarization parameters in backscattering configuration is derived. The results are then employed to identify anisotropic structures beneath the human nail. For the first time, to our knowledge, it was found that collagen fibrils of the layers of epidermal cells of nail bed, the layers of actively dividing cells of the stratum germinativum of nail matrix, and the longitudinal striations in nail root can be related to the covariance of the linear birefringence along the x-y laboratory axes and the 45°axes. Although some tissue constituents can be observed in images of both macroscopic and differential parameters, the tissue components revealed by differential polarization parameters cannot be discerned in any image of the macroscopic parameters.

Onychomycosis is an under-recognized healthcare burden. Despite the risk of misdiagnosis, confirmatory laboratory testing is under-utilized. Histopathologic examination with polymerase chain reaction (PCR) is currently the most effective diagnostic method; it offers direct detection and identification of a fungal invasion. In this retrospective cohort study, we assessed confirmatory testing results, with matching clinical diagnoses, in 96,293 nail specimens submitted during a 9-month period from 2022 to 2023. Toenail specimens were examined using fungal culture, histopathology and/or PCR. Clinical diagnoses were identified using the International Classification of Diseases 10th Revision codes. For clinically diagnosed onychomycosis patients, the overall positivity rate was 59.4%; a similar positivity rate (59.5%) was found in patients with clinically diagnosed non-fungal nail dystrophy. Performing a histopathologic examination with PCR was more likely to provide pathogen identification results than using fungal culture. Male patients had a higher rate of onychomycosis overall; however, female patients had more non-dermatophyte mold onychomycosis caused by Aspergillus. Clinically diagnosed onychomycosis patients with a co-diagnosis of tinea pedis were more likely to test positive for onychomycosis by PCR (odds ratio [OR]: 4.2; 95% confidence interval [CI]: 2.7–6.4), histopathology (OR: 2.5; 95% CI: 2.0–3.1) and fungal culture (OR: 3.2; 95% CI: 1.5–6.6). Our results support the use of confirmatory laboratory testing when there is a clinical diagnosis of onychomycosis.

Julianne M Falotico,1 Shari R Lipner2 1Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA; 2Weill Cornell Medicine, Department of Dermatology, New York, NY, USACorrespondence: Shari R Lipner, Weill Cornell Medicine, Department of Dermatology, 1305 York Avenue, NY, NY, 10021, USA, Tel +1 646-962-3376, Fax +1 646-962-0033, Email shl9032@med.cornell.eduAbstract: Onychomycosis is the most common nail disease encountered in clinical practice and can cause pain, difficulty with ambulation, and psycho-social problems. A thorough history and physical examination, including dermoscopy, should be performed for each patient presenting with nail findings suggestive of onychomycosis. Several approaches are available for definitive diagnostic testing, including potassium hydroxide and microscopy, fungal culture, histopathology, polymerase chain reaction, or a combination of techniques. Confirmatory testing should be performed for each patient prior to initiating any antifungal therapies. There are several different therapeutic options available, including oral and topical medications as well as device-based treatments. Oral antifungals are generally recommended for moderate to severe onychomycosis and have higher cure rates, while topical antifungals are recommended for mild to moderate disease and have more favorable safety profiles. Oral terbinafine, itraconazole, and griseofulvin and topical ciclopirox 8% nail lacquer, efinaconazole 10% solution, and tavaborole 5% solution are approved by the Food and Drug Administration for treatment of onychomycosis in the United States and amorolfine 5% nail lacquer is approved in Europe. Laser treatment is approved in the United States for temporary increases in clear nail, but clinical results are suboptimal. Oral fluconazole is not approved in the United States for onychomycosis treatment, but is frequently used off-label with good efficacy. Several novel oral, topical, and over-the-counter therapies are currently under investigation. Physicians should consider the disease severity, infecting pathogen, medication safety, efficacy and cost, and patient age, comorbidities, medication history, and likelihood of compliance when determining management plans. Onychomycosis is a chronic disease with high recurrence rates and patients should be counseled on an appropriate plan to minimize recurrence risk following effective antifungal therapy.Keywords: onychomycosis, nail disease, fungal nail infection, diagnosis, management, treatment, recurrence

There is a lack of efficacious topical treatments for patients suffering from psoriatic nail disease (PND). We investigated the efficacy of Calcipotriol‐Betamethasone Dipropionate (Cal/BD) foam with and without ablative fractional laser (AFL) in patients with PND. A total of 144 nails from 11 patients were treated in a 24‐week long, open‐label, randomized, intra‐patient controlled proof‐of‐concept hybrid trial. In addition to daily Cal/BD foam application, half of each patient's psoriatic nails were randomized to receive optical coherence tomography (OCT)‐guided AFL treatment at baseline, 6‐, and 12‐week follow‐ups. In‐clinic assessment (N‐NAIL), patient‐reported outcomes (PROMs), and drug consumption were supplemented by remote evaluation of 15 subclinical OCT features, smartphone app‐based safety monitoring, and photo‐based assessment (NAPSI). After 24 weeks of Cal/BD foam treatment, patients achieved a significant improvement (p < 0.001) in both clinical (N‐NAIL −76%, NAPSI −68%) and subclinical (OCT −43%) PND severity as well as a 71% reduction in PROMs. AFL‐assisted Cal/BD treatment led to higher clinical (N‐NAIL −85%, NAPSI −78%) and OCT‐assessed (−46%) reduction of PND signs than Cal/BD alone (N‐NAIL −66%, NAPSI −58%, OCT −37%), but did not reach statistical significance. Smartphone app images documented adverse events and mild local skin reactions, particularly erythema (75%), laser‐induced swelling (28%), and crusting (27%). This hybrid trial demonstrated a reduction in clinical NAPSI and N‐NAIL scores, subclinical OCT features, and PROMs, suggesting that Cal/BD foam is a safe and efficacious treatment for PND. Larger trials are warranted to prove the clinical benefit of AFL pretreatment as a Cal/BD delivery enhancer. [ABSTRACT FROM AUTHOR]

Nail conditions are not only aesthetic concerns, and nail changes may be a clue to an underlying systemic diseases or infection. Without timely treatment, nail diseases can continue to worsen and significantly impair performance of daily activities and reduce quality of life. Examination of the nails is essential at every medical visit, and may uncover important findings. Brittle nail syndrome, onychomycosis, paronychia, nail psoriasis, longitudinal melanonychia, Beau's lines, onychomadesis and retronychia are common nail disorders seen in clinical practice. These conditions stem from infectious, inflammatory, neoplastic and traumatic aetiologies. Though each nail condition presents with its own distinct characteristics, the clinical findings may overlap between different conditions, resulting in misdiagnosis and treatment delays. Patients can present with nail plate changes (e.g. hyperkeratosis, onycholysis, pitting), discolouration, pain and inflammation. The diagnostic work-up of nail disease should include a detailed history and clinical examination of all 20 nail units. Dermoscopy, diagnostic imaging and histopathologic and mycological analyses may be necessary for diagnosis. Nail findings concerning for malignancy should be promptly referred to a dermatologist for evaluation and biopsy. Nail disease management requires a targeted treatment approach. Treatments include topical and/or systemic medications, discontinuation of offending drugs or surgical intervention, depending on the condition. Patient education on proper nail care and techniques to minimize further damage to the affected nails is also important. This article serves to enhance familiarity of the most common nail disorders seen in clinical practice. It will highlight the key clinical manifestations, systematic approaches to diagnosis and treatment options for each nail condition to improve diagnosis and management of nail diseases, as well as patient outcomes. Nail disease is not only a cosmetic issue, as nail changes can indicate the presence of a serious underlying systemic disease, infection or malignancy. Nail pain and changes associated with NP are physically and emotionally distressing and may contribute to functional impairment and diminished quality of life. LM is a hallmark sign of subungual melanoma and this finding warrants further investigation to rule out malignancy. [ABSTRACT FROM AUTHOR]

Introduction: The primary objective of this study was to determine the prevalence of nail diseases and its population in nail consultation., Methods: A retrospective study of clinical records between 2012 and 2022 was conducted. The 1,372 established diagnoses were categorized into nosological groups, which included physical signs, infectious diseases, dermatological diseases, systemic diseases, drug reactions, occupational disorders, congenital diseases, traumatic disorders, and tumors., Results: Overall, 1,239 records were enrolled, with 64% ( n = 788) involving female patients. The median age was 50 years. In 71.5% of cases ( n = 886), it was possible to establish an etiological diagnosis or a causative relationship based on physical findings, while 28% of patients ( n = 347) presented nonspecific physical signs., Conclusion: Onychomycosis was the most prevalent diagnosis and revealed a descending trend over the 10-year period study., Competing Interests: The authors have no conflicts of interest to declare., (© 2024 S. Karger AG, Basel.)

Nail disease in psoriasis has been found to be associated with psoriatic arthritis (PsA); however, which subtype of nail disease holds greater relevance to PsA remains unclear. This study was performed to explore the associations between three subtypes of fingernail disease (pitting, onycholysis, and hyperkeratosis) and PsA among patients with psoriasis. Patients with psoriasis attending five dermatology clinics in Shanghai between January 2020 and May 2021 were examined for skin, joint, and fingernail changes. Multivariate logistic regression analyses were utilized to test the strength of associations between subtypes of fingernail disease and PsA. The receiver operator characteristic (ROC) curve with area under curve (AUC) was used to evaluate their accuracies in diagnosing PsA. Sensitivity and specificity were also calculated. Of 1985 patients with psoriasis included, 228 (11.5%) patients were diagnosed with PsA, and the remaining patients were cutaneous-only psoriasis (PsC). One-hundred and fifty-seven (68.9%) patients with PsA and 748 (42.6%) patients with PsC had fingernail disease. Adjusted models showed that onycholysis and hyperkeratosis were the only type of fingernail disease independently associated with PsA. This association was further confirmed by the forward conditional stepwise regression model (OR, 95% CI for onycholysis: 2.34, 1.79 to 4.27, p < 0.01; for hyperkeratosis: 1.62, 1.12 to 2.66, p = 0.037). ROC analysis showed that, compared to pitting and hyperkeratosis, onycholysis had higher AUC (0.630) and sensitivity (52.6%). The psoriatic fingernail onycholysis and hyperkeratosis hold greater relevance to PsA than pitting. Clinically, psoriatic patients with fingernail onycholysis and hyperkeratosis should be assessed for arthritis. Key Points • Psoriatic fingernail onycholysis and hyperkeratosis, rather than pitting, are significantly associated with PsA • Clinically, psoriatic patients with fingernail onycholysis and hyperkeratosis should be assessed for arthritis [ABSTRACT FROM AUTHOR]

Human nail disease is usually ignored since it does not reveal clinical signs that are harmful to one's health. Nail disease, on the other hand, can be an early sign of a health issue. Some types of nail disease can cause infection, injury, or even the loss of the nail itself. It can reduce a person's aesthetics and beauty. Nail disease is very varied, so it is often difficult for clinicians to diagnose because several types have high similarities. Therefore, an automatic nail disease classification method based on nail photos was proposed in this study. The proposed method was based on the VGG-16 neural network architecture with an Adam optimizer. Nail diseases including Koilonychia, Beaus Lines, Leukonychia have been classified in this study. The model in this study is simulated in Python programming. The simulation results show that the highest classification accuracy is 96%, achieved with epoch-10. The transfer learning method based on a neural network simulated in this study is expected to support the clinical diagnosis of nail disease.

Introda significant: Onychomycosis is the most common nail disorder seen in clinical practice, and it may have significant impact on patient quality of life. Understanding risk factors for onychomycosis may help to devise screening and treatment guidelines for populations that are more susceptible to this infection. Using a national database, we aimed to explore associations between onychomycosis and age, sex, and underlying medical conditions, as well as to examine current onychomycosis treatment trends. Materials and Methods: We performed a nested, matched, case–control study of patients in the All of Us database aged ≥ 18 years (6 May 2018–1 January 2022). Onychomycosis cases were identified using International Classification of Diseases (ICD) and Systematized Nomenclature of Medicine (SNOMED) diagnostic codes (ICD-9 110.1, ICD-10 B35.1, SNOMED 414941008). Demographic information (i.e., age, sex, and race), treatments, and co-diagnoses for onychomycosis patients and case–controls were recorded. Wald’s test applied to multivariate logistic regression was used to calculate odds ratios and p-values between onychomycosis and co-diagnoses. Additionally, 95% confidence intervals were calculated with a proportion test. Results: We included 15,760 onychomycosis patients and 47,280 matched controls. The mean age of onychomycosis patients was 64.9 years, with 54.2% female, 52.8% Non-Hispanic White, 23.0% Black, 17.8% Hispanic, and 6.3% other, which was similar to controls. Patients with onychomycosis vs. controls were more likely to have a co-diagnosis of obesity (46.4%, OR 2.59 [2.49–2.69]), tinea pedis (21.5%, OR 10.9 [10.1–11.6]), peripheral vascular disease (PVD) (14.4%, OR 3.04 [2.86–3.24]), venous insufficiency (13.4%, OR 3.38 [3.15–3.59]), venous varices (5.6%, OR 2.71 [2.47–2.97]), diabetes mellitus (5.6%, OR 3.28 [2.98–3.61]), and human immunodeficiency virus (HIV) (3.5%, OR 1.8 [1.61–2.00]) (p < 0.05, all). The most frequently prescribed oral and topical medications were terbinafine (20.9%) and ciclopirox (12.4%), respectively. The most common therapeutic procedure performed was debridement (19.3%). Over the study period, ciclopirox prescriptions (Spearman correlation 0.182, p = 0.0361) and fluconazole prescriptions increased (Spearman correlation 0.665, p = 2.44 × 10−4), and griseofulvin (Spearman correlation −0.557, p = 0.0131) and itraconazole prescriptions decreased (Spearman correlation −0.681, p = 3.32 × 10−6). Conclusions: Our study demonstrated that age, obesity, tinea pedis, PVD, venous insufficiency, diabetes mellitus, and HIV were significant risk factors for onychomycosis. In addition, the most frequent oral and topical onychomycosis medications prescribed were terbinafine and ciclopirox, likely reflective of efficacy and cost considerations. Identifying and managing these risk factors is essential to preventing onychomycosis’ primary infections and recurrences and improving treatment efficacy.

Aim:The incidence and spectrum of nail abnormalities in children differ from adults. The aim of this study is to investigate the frequency and spectrum of nail abnormalities in children and adolescents admitted to a dermatology outpatient clinic.Materials and Methods:This cross-sectional study included 600 patients under the age of 18 who presented at a dermatology outpatient clinic with various dermatological complaints between March and May 2018.Results:In this study, among 600 patients; 325 (54.16%) were female and 275 (45.84%) were male. The mean age was 9.18±5.12 years (1 month to 17 years). Nail abnormalities were present in 226 patients of whom 131 (58%) were female and 95 (42%) were male. The rate of nail abnormalities was 37.66% (226/600) among the study group. The number of nail abnormalities detected was 288 and the number of abnormality types was 23. The most common group of nail abnormalities were surface (18.16%) and colour (16.50%) changes. The most common nail abnormalities were leukonychia (16.50%), onychoschizia (6.5%), and onychophagia/onychotillomania (6.5%). Fingernail abnormalities were significantly higher in males than females. Leukonychia and onychophagia/onychotillomania were significantly higher in males than females. The rate of patients observed with ungual complaints among the patients with nail abnormalities was 10.61% (24/226).Conclusion:Nail abnormalities are very common in childhood. Although patients do not have a primary complaint, evaluation of the nails during physical examination may prevent the occurrence of permanent damage to the nails and stop the spread of infectious diseases to other nails.

This is a case study of a 55-year-old woman presenting with dystrophic nails that arose during her teenage years and has worsened over the last few years. The patient reported frequent wet work, exposure to irritants, and cuticle manipulation. The physical examination showed proximal nail fold bolstering, loss of cuticle, and a wavy dorsal nail plate resembling a "washboard." She was diagnosed with chronic paronychia and onychotillomania. She was prescribed clobetasol ointment and sulfacetamide in ethanol and was counseled on hygiene and at-home care. One month after the regimen was started, there was noticeable reduction of inflammation to the cuticle. [ABSTRACT FROM AUTHOR]

Onychomycosis is the most common nail disease encountered in clinical practice. Its importance extends well beyond aesthetics, often causing pain, difficulty with ambulation and performing daily activities, and impairing quality of life. Many patients fail to achieve cure with antifungal monotherapy and recurrences are common. Combination therapy has therefore gained considerable interest, given the potential for drug synergy and prevention of antifungal resistance, but it has not been well studied. A systematic review of onychomycosis medication only, as well as medication and procedural (laser, debridement, photodynamic therapy), clinical or randomized controlled trials evaluating combination vs. monotherapies was performed. After exclusions, 30 studies were included in the final analysis. There were conflicting results for medication-only trials, with some showing significant benefit of combination therapy over monotherapy, however, trials were not robustly designed and lacked sufficient follow-up. Procedural studies also lacked long-term follow-up, and failed to demonstrate efficacy in some severe onychomycosis cases. Considering the high cure rates demonstrated in pivotal antifungal monotherapy trials, and conflicting results, costs, and safety concerns associated with combination therapy, we recommend that combination therapy be reserved as second-line treatment options in patients with poor prognostic factors or for those who failed monotherapy for onychomycosis. [ABSTRACT FROM AUTHOR]

The nails, in combination with skin, glands and hair, comprise the integumentary system. Abnormalities in the colour, shape and clinical appearance of nails can be indicative of pathophysiological disorders, habit-tics such as bitten nails, poor grooming, nutritional deficits and cosmetic practices. Discolouration and changes in nail appearance are common reasons for referral of individuals to dermatologists. This paper presents a melange of common nail disorders with a clinical focus on those that present with discolouration. [ABSTRACT FROM AUTHOR]

Here, we present the case of an otherwise healthy patient, without risk factors, who developed a refractory case of onychomycosis caused by Kloeckera apiculata , an uncommon human pathogen. The diagnosis was ultimately confirmed by fungal nail plate culture, histopathology, and PCR. Whereas prior treatments with topical 5 % tavaborole solution, oral terbinafine, and oral fluconazole were ineffective, complete clinical and mycological cure was achieved with a 3-month course of oral itraconazole., Competing Interests: There are none., (© 2024 The Authors.)

Knee disorders that compromise patients’ lower leg movements and self-care may put these patients at greater risk of onychomycosis. However, little is known about the prevalence of onychomycosis in patients with knee diseases. This study evaluated the prevalence and characteristics of onychomycosis in patients with knee osteoarthritis. A total of 520 consecutive patients with symptomatic knee osteoarthritis who visited the Department of Orthopedics for a potential knee surgery were evaluated for onychomycosis by PCR-based reverse blot hybridization assay. Of the 520 patients, 308 (59.2%) were diagnosed with onychomycosis. Age (p = 0.004), male sex (p = 0.015), and being barefooted (p = 0.031) were statistically significant risk factors for onychomycosis. Knee disease severity, based on Kellgren-Lawrence grade, was associated with severity of onychomycosis. The impairment of physical function and self-care caused by knee disorders may increase the prevalence of onychomycosis in these patients.

Millions of Americans seek medical care for their nail conditions each year, consulting physicians of many different specialties. To characterize the burden of ambulatory nail disease in the United States from 2007 to 2016. The National Ambulatory Medical Care Survey (NAMCS) provided data on physician visits relating to nail complaints and nail diagnoses from 2007 to 2016. Across the estimated 21.1 million outpatient visits for nail conditions from 2007 to 2016, the ratio of females to males diagnosed with each condition was between 45.1% and 52.2%. Whites comprised over 80% of each nail diagnosis. Age group differences varied by nail diagnosis, but overall, patients aged 25–64 presented most frequently with nail complaints. The specialty consulted also varied by nail diagnosis, primarily including dermatology, family medicine, and pediatrics. We were limited by the accuracy of diagnosis and the specialties included in NAMCS data collection. Patients of all ages, races, and sexes consulted physicians for the treatment of nail conditions. Onychomycosis was the most frequently diagnosed nail condition, and consultations were split between dermatologists, pediatricians, and general practitioners. [ABSTRACT FROM AUTHOR]

Background/Objectives: Neonatal abstinence syndrome (NAS) incidence continues to rise in the United States due to increasing opioid use disorder in pregnancy. While cutaneous excoriations have been noted in NAS, there is a paucity of literature regarding abnormal nail findings in NAS. Methods: A retrospective, observational case series was conducted of twelve patients with NAS and abnormal nail findings who were admitted to the neonatal intensive care unit between January 1, 2018, and May 1, 2020. Results: Twelve neonates (10 male, 2 female, mean gestational age at birth 38.1 weeks) with NAS diagnosis and abnormal nail findings were identified between January 1, 2018, and May 1, 2020. NAS was diagnosed by elevated Modified Finnegan Neonatal Abstinence Syndrome Tool (M‐FNAST) scores. All patients required pharmacologic treatment for NAS with seven (58.3%) requiring phenobarbital in addition to first‐line morphine. Common nail findings included periungual erythema, yellow crusting, desquamation of the proximal and/or distal lateral nail folds and sheared distal nail edges. Two patients (16.7%) required antibiotic treatment for paronychia. Peak M‐FNAST scores were positively correlated with number of abnormal nail findings (r =.58, P =.047). Conclusions: Twelve neonates with severe NAS demonstrated similar nail abnormalities, likely secondary to NAS agitation and motor hyperactivity. Nail exams, therefore, are important in the setting of suspected or confirmed NAS to limit continued nail trauma and infection. Our findings also introduce an association between NAS severity and abnormal nail findings, which will require larger studies for further confirmation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Bowen nail disease is considered a squamous cell carcinoma in situ, it is a rare and difficult disease to diagnose due to its various clinical presentations. CLINICAL CASE: A 37-year-old male who came to our unit due to a spot located on the nail apparatus, affecting the first finger of the right hand and the third finger of the left hand of four months of evolution and asymptomatic. The biopsy reported Bowen nail disease. Surgical resection of both lesions was performed, with closure by second intention and repair with placement of a hydrocolloid dressing. CONCLUSIONS: Bowen nail disease is infrequent and due to its multiple clinical varieties; it is common to confuse with benign lesions. It is important to have in mind the diagnostic suspicion despite the rare nature of this location, and when in doubt, always carry out histological confirmation. All this, with the aim of making an early diagnosis to achieve a better aesthetic and functional result. [ABSTRACT FROM AUTHOR]

Objective: To examine the association of nail psoriasis with disease activity, quality of life, and work productivity in patients with psoriatic arthritis (PsA).Methods: All patients with PsA who enrolled in the Corrona PsA/Spondyloarthritis Registry between March 2013 and October 2018 and had data on physician-reported nail psoriasis were included and stratified by presence vs absence of nail psoriasis at enrollment. Patient demographics, disease activity, quality of life (QOL), and work productivity at enrollment were compared between patients with vs without nail psoriasis using t-tests or Wilcoxon rank-sum tests for continuous variables and chi-square or Fisher exact tests for categorical variables.Results: Of the 2841 patients with PsA included, 1152 (40.5%) had nail psoriasis and 1689 (59.5%) did not. Higher proportions of patients with nail psoriasis were male (51.9% vs 44.1%) and disabled from working (12.3% vs 7.8%) compared with patients without nail psoriasis (all P < 0.05). Patients with nail psoriasis had higher disease activity than those without nail psoriasis, including higher tender and swollen joint counts, worse Disease Activity Index for Psoriatic Arthritis and Psoriatic Arthritis Disease Activity Score values, and increased likelihood of having enthesitis and dactylitis (all P < 0.05). Patients with nail psoriasis had worse pain, fatigue, and work and activity impairment than those without nail psoriasis (all P < 0.05).Conclusion: Patients with PsA who have nail psoriasis had worse disease activity, QOL, and work productivity than those without nail involvement, emphasizing the importance of identification and management of nail disease in patients with PsA. [ABSTRACT FROM AUTHOR]

Aim: The incidence and spectrum of nail abnormalities in children differ from adults. The aim of this study is to investigate the frequency and spectrum of nail abnormalities in children and adolescents admitted to a dermatology outpatient clinic. Materials and Methods: This cross-sectional study included 600 patients under the age of 18 who presented at a dermatology outpatient clinic with various dermatological complaints between March and May 2018. Results: In this study, among 600 patients; 325 (54.16%) were female and 275 (45.84%) were male. The mean age was 9.18±5.12 years (1 month to 17 years). Nail abnormalities were present in 226 patients of whom 131 (58%) were female and 95 (42%) were male. The rate of nail abnormalities was 37.66% (226/600) among the study group. The number of nail abnormalities detected was 288 and the number of abnormality types was 23. The most common group of nail abnormalities were surface (18.16%) and colour (16.50%) changes. The most common nail abnormalities were leukonychia (16.50%), onychoschizia (6.5%), and onychophagia/onychotillomania (6.5%). Fingernail abnormalities were significantly higher in males than females. Leukonychia and onychophagia/onychotillomania were significantly higher in males than females. The rate of patients observed with ungual complaints among the patients with nail abnormalities was 10.61% (24/226). Conclusion: Nail abnormalities are very common in childhood. Although patients do not have a primary complaint, evaluation of the nails during physical examination may prevent the occurrence of permanent damage to the nails and stop the spread of infectious diseases to other nails. [ABSTRACT FROM AUTHOR]

Introduction: Onychomycosis is the most common nail infection, predominantly caused by Trichophyton spp., and is divided into four main types. Confirmatory testing is crucial, but obtaining an adequate sample may be challenging. We suggest the use of carbon dioxide (CO 2 ) laser for painlessly detaching the nail plate during mycological examination and ensuring a sufficient specimen., Methods: We retrospectively enrolled 25 patients with distolateral onychomycosis, treated according to the following protocol: (1) multiple passes of CO 2 laser at 10 W in continuous mode along the proximal border of the affected nail plate; (2) the nail plate was gently cut; (3) the nail bed was curetted; (4) subungual debris and plate fragments were collected for KOH test and culture., Results: The mean visual analog score (VAS) for pain experienced during the procedure was 0.7 (SD: 2.1), indicating that the sampling was relatively painless for the majority of patients. There were no permanent changes observed in the nail unit of any patients during the follow-up visits as a result of using the CO 2 laser., Conclusion: We firmly believe that the use of lasers offers numerous advantages, including ease of use, reduced pain perception, and the ability to target the proximal margin of fungal infections where viable hyphae are significantly represented., Competing Interests: The authors have no conflicts of interest to declare., (© 2024 S. Karger AG, Basel.)

Background: Dermoscopy has emerged as a useful diagnostic tool to evaluate skin lesions, including psoriasis. We aimed to compare the clinical examination and digital dermoscopy findings of nail involvement in patients with psoriatic nails., Methods: This study included 60 patients with clinically diagnosed psoriasis. The nail findings and NAPSI were evaluated clinically and via dermoscopy, and then the severity of the disease was calculated using PASI criteria., Results: About 32 patients were males, with a median PASI score of 4.4, and pitting and subungual hyperkeratosis were the most common findings. The clinical and dermoscopic examination had a moderate diagnostic resemblance regarding onycholysis, subungual hyperkeratosis, and leukonychia. The resemblance between the two methods for the diagnosis of leukonychia in patients with a duration of disease <2 years (Kappa = 0.59) and 2-6 years was moderate (Kappa = 0.48), and for 6 years< was perfect (Kappa = 0.62). The resemblance for the diagnosis of subungual hyperkeratosis and onycholysis in subjects with a duration of disease <2 years was slight, and for 2-6 years and 6 years< were moderate. The resemblance between the NAPSI score by the two methods was also moderate (95%CI -0.89-0.81, P  < 0.001)., Conclusion: Dermoscopy is an efficient, supportive, and non-invasive method providing a better diagnosis of nail psoriasis., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)