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Two cases of chilblain lupus erythematosus (CLE) potentially triggered by exposure to ultraviolet (UV) nail lamps are presented. These cases, along with a review of the literature, suggest a possible link between UV nail lamp use and CLE development or reactivation. Further research is needed to confirm this association, but healthcare professionals should be aware of the potential risks of this practice, especially for patients with photosensitive conditions. [ABSTRACT FROM AUTHOR]

Dermoscopy of the nail unit (onychoscopy) is a method which allows for non‐invasive observation of the nail structures, increasing the accuracy of clinical diagnosis. Currently, it is used in evaluation of both inflammatory and neoplastic conditions of the nail unit. However, in contrast to the skin, the anatomy of the nail unit prevents direct observation of nail bed or nail matrix structure during classic onychoscopy. Intra‐operative onychoscopy is a variant of the technique which uses direct visualization of the nail unit structures after nail plate avulsion. The aim of this systematic review was to summarize the current state of knowledge on intra‐operative onychoscopy. The MEDLINE, EMBASE and Cochrane databases were systematically searched in January 2024. All types of study designs assessing intra‐operative dermoscopy of the nail unit were included in this study. The risk of bias in included studies was assessed using the Joanna Briggs Institute critical appraisal tools. The qualitative synthesis of 19 studies totalling a number of 218 cases in 217 patients included the following entities: melanoma, nevus, hypermelanosis (melanocytic activation), melanocytic hyperplasia, melanophages accumulation, squamous cell carcinoma, glomus tumour, lichen planus, onychomatricoma, onychomycosis and subungual exostosis. The main limitation of the study was a relatively low number of identified studies, most with low levels of evidence. Intra‐operative onychoscopy does not replace histologic examination, though it may be useful in determining the modality of surgical diagnostic procedures. [ABSTRACT FROM AUTHOR]

Clinical manifestations of dermatological and musculoskeletal conditions can sometimes overlap, leading to confusion in diagnosis. Patients with nail and skin infections may undergo imaging examinations with suspicions of muscle, tendon, or joint injuries. Dermatological infections often involve soft tissues and musculoskeletal structures, and their etiology can range from fungi, bacteria, viruses, to protozoa. Relying solely on physical examination may not be sufficient for accurate diagnosis and treatment planning, necessitating the use of complementary imaging exams. The objective of this paper is to present and discuss imaging findings of the main infectious conditions affecting the nail apparatus and skin. The paper also highlights the importance of imaging in clarifying diagnostic uncertainties and guiding appropriate treatment for dermatological conditions. [ABSTRACT FROM AUTHOR]

Onychomycosis, a nail infection caused by dermatophytes, yeast, and molds makes up roughly half of all onychopathies and is the most prevalent nail condition in the world. Clinically, nail psoriasis and onychomycosis can frequently be difficult to distinguish from one another. To assess the prevalence of onychomycosis in patients with psoriasis. Fifty patients with psoriasis associated with nail disease were included in this study. After taking clinical history, nail samples were gathered for dermoscopic inspection, culture, direct microscopy with 20% KOH solution, and nail clipping with PAS stain. Of the 50 patients recruited, 43 were males and 7 were females, with mean age 6–71 years (mean ± SD 44.06 ± 16.2). Eleven patients (22%) tested positive for onychomycosis. Dermatophytes were isolated from 2% of patients, yeast from 14% of patients, and non-dermatophytic mold from 38% of patients. Histopathological results revealed fungal hyphae and spores in 18% of patients. The most prevalent dermoscopic sign in psoriatic patients with onychomycosis was spikes (81.8%) with statistical significance (P-value < 0.001), while nail pitting was the most prevalent dermoscopic feature in nail psoriasis. This study lays the way for an accurate diagnosis of nail lesions by highlighting the significance of cooperation between mycology, histology, and dermoscopy in the diagnosis of onychomycosis in patients with nail psoriasis. [ABSTRACT FROM AUTHOR]

Chronic mucocutaneous candidiasis (CMC) is characterized by recurrent infections with Candida spp., often linked to primary immunodeficiencies. We report a case of two 8‐year‐old monozygotic twin brothers presenting with extensive dermatophytosis, later diagnosed with autoimmune polyendocrinopathy, candidiasis, and ectodermal dystrophy (APECED) syndrome due to a homozygous p.M1V mutation in the AIRE gene. The twins exhibited widespread skin and nail infection, along with malabsorption, dental caries, and other autoimmune manifestations. This case highlights the novel presentation of extensive dermatophytosis in APECED, underscoring the variability in clinical expression even within a single family. [ABSTRACT FROM AUTHOR]

Background: The potential link between alopecia areata (AA) and eosinophilia is unclear, as well as its clinical manifestations in these patients' subsets. Methods: This is a monocentric retrospective observational study in which clinical and laboratory data were summarized and evaluated the AA subset with concurrent eosinophilia. Results: In a sample of 205 AA patients, 38 (18.5%) were classified as AA with eosinophilia. Interestingly, this subset of patients had a statistically higher prevalence of atopia and nail abnormalities (p < 0.05) than AA without eosinophilia. AA patients with eosinophilia had a 3.70 higher odds of more severe hair loss versus age‐ and gender‐matched AA without eosinophilia. Conclusions: AA patients with eosinophilia had distinctive clinical and laboratory characteristics, so future studies may potentially explore the use of IL‐5 inhibitors. [ABSTRACT FROM AUTHOR]

This paper provides a comprehensive overview of image‐based techniques, particularly focusing on their applications and advancements in the context of nail disorders. Nowadays, high‐resolution digital cameras and dermoscopes enable dermatologists to capture detailed images of nail abnormalities, facilitating early diagnosis and meticulous tracking of disease progression. Onychoscopy is now a routine technique with well‐known criteria for the diagnosis, but recent developments allow us to visualize certain diseases better. Imaging modalities like high‐frequency ultrasound, magnetic resonance imaging, optical coherence tomography and confocal microscopy are being increasingly adopted for their superior diagnostic capabilities. These techniques are described in their technology, scanning protocols, normal findings, advantages and limitations. Moreover, the integration of technology in patient education has fostered a more informed patient population, capable of actively participating in their disease monitoring and treatment regimens. Proper training, validation, regulation and ethical considerations are, however, essential when integrating technology into healthcare practices. Imaging technologies that present the potential to add critical anatomical information to clinical diagnoses within reasonable costs and are available worldwide are the ones that will probably be used the most. [ABSTRACT FROM AUTHOR]

Telomere biology disorders (TBD) are a complex set of inherited illnesses characterized by short telomeres. Dyskeratosis congenita (DC), which is now considered a severe TBD phenotype, is characterized by reticulated pigmentary changes, nail dystrophy, premalignant oral leukoplakia, and systemic involvement. This case describes a 2‐year‐old female with reticulated pigmentary changes and Terry's nails who was found to have a TERT variant and short telomeres; she lacked other mucocutaneous and systemic features of TBD. This report describes a unique clinical presentation of TBD and highlights the importance of upholding suspicion for TBD in individuals with limited or subtle features of classic DC. [ABSTRACT FROM AUTHOR]

Onychomycosis is a recalcitrant fungal infection of the nail unit that can lead to secondary infections and foot complications. Accurate pathogen identification by confirmatory testing is recommended to improve treatment outcomes. In this study, we reviewed the records of 710,541 patients whose nail specimens were sent to a single molecular diagnostic laboratory between 2015 and 2024. PCR testing revealed a more comprehensive spectrum of pathogens than previously reported, which was corroborated by the demonstration of fungal invasion on histopathology. Consistent with our current understanding, the T. rubrum complex (54.3%) are among the most common pathogens; however, a significant portion of mycology-confirmed diagnoses were caused by the T. mentagrophytes complex (6.5%), Aspergillus (7.0%) and Fusarium (4.5%). Females were significantly more likely to be infected with non-dermatophytes molds (NDMs; OR: 2.0), including Aspergillus (OR: 3.3) and Fusarium (OR: 2.0), and yeasts (OR: 1.5), including Candida albicans (OR: 2.0) and C. parapsilosis (OR 1.6), than males. The T. mentagrophytes complex became more prevalent with age, and conversely the T. rubrum complex became less prevalent with age. Patients aged ≥65 years also demonstrated a higher likelihood of contracting onychomycosis caused by NDMs (OR: 1.6), including Aspergillus (OR: 2.2), Acremonium (OR: 3.5), Scopulariopsis (OR: 2.9), Neoscytalidium (OR: 3.8), and yeasts (OR: 1.8), including C. albicans (OR: 1.9) and C. parapsilosis (OR: 1.7), than young adults. NDMs (e.g., Aspergillus and Fusarium) and yeasts were, overall, more likely to cause superficial onychomycosis and less likely to cause dystrophic onychomycosis than dermatophytes. With regards to subungual onychomycosis, Aspergillus, Scopulariopsis and Neoscytalidium had a similar likelihood as dermatophytes. The advent of molecular diagnostics enabling a timely and accurate pathogen identification can better inform healthcare providers of appropriate treatment selections and develop evidence-based recommendations. [ABSTRACT FROM AUTHOR]

Background: Onychomycosis (OM) is a common nail infection treated with amorolfine hydrochloride nail lacquer in China. Monitoring drug concentrations and using dermoscopy to evaluate treatment efficacy may provide new insights. Objective: The study aims to analyse amorolfine concentrations in nails with mild to moderate OM, assess treatment outcomes using dermoscopy and explore factors influencing drug concentrations and efficacy. Methods: Patients with mild to moderate OM confirmed by fungal microscopy were enrolled. Amorolfine nail lacquer was applied twice weekly for 36 weeks. Monthly nail samples measured amorolfine concentrations using liquid chromatography. Dermoscopy was performed before and after treatment to evaluate responses. Mixed‐effects models and logistic regression analysed factors affecting drug concentrations and outcomes. Results: Ninety‐seven nails were included. Amorolfine concentrations increased over time, with higher levels in females, fingernails, 2nd–5th digits and superficial white OM (p < 0.05). Age was a risk factor, while drug concentration and OM type were protective for clinical efficacy (p < 0.05). Peak concentration correlated with clinical (r = 0.487, p = 0.000) and mycological (r = 0.433, p = 0.000) responses. Dermoscopic features improved significantly in successful cases (p < 0.05). Limitations: In the assessment of fungal efficacy, only fungal microscopy was used, and fungal cultures were not performed. The study was limited by a small sample size and the lack of a longer follow‐up to assess relapse. Conclusion: Amorolfine concentrations vary with patient and nail characteristics, influencing efficacy. Dermoscopy is valuable for monitoring OM treatment. [ABSTRACT FROM AUTHOR]

Nail capillaroscopic examination is an inexpensive and easily applicable method to identify capillary morphological changes in patients with conditions such as systemic sclerosis and Raynaud's. The detection of changes in capillaries makes an important contribution to diagnosing these diseases. Capillary morphology is important in the symptoms of these diseases, and capillary diameter, visibility, distribution, length, microbleeds, blood flow, and density are important indicators in capillaroscopic evaluation. Manual examination to determine these parameters is subjective, causes inconsistent results, and is labor-intensive and time-consuming. To overcome these problems, a YOLOv8s-based system was proposed in this paper to detect the number, thickness, and density of capillaries in the nail bed. The system's components include database systems that store the analysis results, artificial intelligence-based software that runs on the SBC (Single-Board Computer), and recorded microscope images. mAP and F1_score parameters were used to evaluate the system's performance, and values of 0.882 and 0.83 were obtained. The proposed system is promising in improving the diagnosis process of diseases such as systemic sclerosis and Raynaud's by providing objective measurements and the early diagnosis and monitoring of diseases. [ABSTRACT FROM AUTHOR]

Background Early identification, diagnosis and symptom control of psoriatic arthritis (PsA) in patients with psoriasis remain unmet medical needs. Objectives To compare the impact of disease and other characteristics between patients with psoriasis who screened positive for PsA using the Psoriasis Epidemiology Screening Tool (PEST) (screen-positive group) and patients who (i) have PsA (PsA group) or (ii) screened negative for PsA (screen-negative group). Also, to determine the proportion of patients at a patient-acceptable symptom state (PASS) in the screen-positive and PsA groups. Methods This was a cross-sectional analysis of the CorEvitas Psoriasis Registry. We included a convenience sample of patients with psoriasis from the screen-positive and PsA groups who completed the Psoriatic Arthritis Impact of Disease-12 (PsAID12), and a comparator screen-negative group who did not complete the PsAID12. We report descriptive summaries of demographics, comorbidities, psoriasis characteristics, patient-reported outcome measures and the proportion of patients at PASS (i.e. PsAID12 ≤ 4). Results The screen-positive, PsA and screen-negative groups included 369, 70 and 4724 patients, respectively. The screen-positive and PsA groups had a similar impact of disease, demographics, comorbidities and psoriasis characteristics (d < 0.337). Mean PsAID12 scores were 3.1 (SD 2.3) and 3.7 (SD 2.6) in the screen-positive and PsA groups, respectively. Compared with patients who screened negative for PsA, patients who screened positive exhibited higher rates of selected known predictors of PsA such as older age, longer psoriasis duration, nail disease and inverse psoriasis. The proportion of patients at PASS was 56% and 67% for the PsA and screen-positive groups, respectively. Conclusions The similar profiles between screen-positive and PsA groups, in comparison with the screen-negative group, support observations of possible underdiagnosis of PsA and the increased impact of disease, especially musculoskeletal disease, among patients who screen positive for PsA. The high percentage of patients not at an acceptable symptom state in the PsA and screen-positive groups highlights the need to optimize care in PsA. [ABSTRACT FROM AUTHOR]

Onychomycosis is a common fungal infection of the nails, predominantly caused by dermatophytes and is a notoriously difficult condition to treat. Thus, the objective of the present study was to evaluate and compare, in vitro, the efficacy of different applied ozone dosages against the main fungi that cause onychomycosis. Dermatophyte fungi Trichophyton rubrum (ATCC 28,188) and Microsporum gypseum (ATCC 24,102) were incubated at 28 °C for 14 days. Treatments were divided into nine experimental groups according to applied ozone dosages: Control Group 0 mg/m2: fungi were cultured but received no treatment; cultured fungi that received ozone therapy for 157, 314, 471, 628, 785 943, 1100 and 1257 mg/m2. The main results indicate that topical ozone therapy effectively reduced the germination percentage of T. rubrum and M. gypseum in all experimental periods, achieving a complete eradication with a treatment time of 628 and 1257 mg/m2, respectively. In conclusion, ozone therapy used topically with an applied ozone dosage of 628 mg/m2 for T. rubrum and 1257 mg/m2 for M. gypseum promoted antifungal action on the main dermatophytes responsible for critical complications of onychomycosis. Therefore, ozone therapy can be proposed as an adjuvant for dermatological treatments [ABSTRACT FROM AUTHOR]

Nail psoriasis is a chronic, inflammatory condition which is difficult to treat, linked with greater psoriasis severity, and may be associated with anxiety and significant functional impairment of the quality of life. The 1064 nm Nd: YAG laser was reported to yield satisfactory results in the treatment of nail psoriasis. The aim of the study was to assess the clinical and ultrasonographic efficacy of long-pulsed 1064 nm Nd: YAG laser in the treatment of fingernail psoriasis and compare its effect to control fingernails. This intra-patient randomized controlled trial analyzed 86 fingernails collected from 13 patients suffering from cutaneous and nail psoriasis. The nails were randomized into two groups. Group A was treated with Nd: YAG laser once monthly for three sessions while group B served as control. Assessment took place at baseline, 1 and 3 months after the last treatment session. For scoring, the 32-points target NAPSI scoring systems was used. Additionally, two blinded dermatologists' score of improvement, patients' pain assessment by visual analogue score and ultrasonographic assessment were all performed. At the end of follow up, the medians of tNAPSI score, plate definition, matrix thickness, bed thickness and bed vascularity decreased significantly in the Nd: YAG laser treated group in comparison to baseline (p = 0.001, 0.006, 0.039, < 0.001 and 0.010, respectively). While, there was a non-significant reduction in median tNAPSI score in the control group at last follow up, however, ultrasonography recorded a significant reduction in the medians of plate definition, bed thickness and vascularity (p = 0.002, 0.011 and 0.033, respectively) from the baseline. Comparison of the Nd: YAG laser and the control groups showed no significant difference from baseline regarding the medians of tNAPSI, tNAPSI percentile improvement, pits count, blinded evaluation of photographs and ultrasonographic assessments. In conclusion, Nd: YAG laser showed clinical and ultrasonographic improvement in fingernail psoriasis. Ultrasonography is a useful noninvasive tool in diagnosing and monitoring the clinical and even the subclinical changes in nail psoriasis. Nail psoriasis although difficult to treat, may show spontaneous improvement. [ABSTRACT FROM AUTHOR]

Tavaborole, a topical antifungal agent containing Boron is used for the treatment of onychomycosis, an infection of the nail and nail bed caused by Trichophyton rubrum or Trichophyton mentagrophytes infection. Tavaborole is chemically known as 5 - Fluoro -1,3 - dihydro -2,1-benzoxaborol -1-ol. It acts by inhibiting Leucyl-tRNA synthetase an essential fungal enzyme required for protein synthesis. AB SCIEX Instruments LC-ESI-MS/MS (Model no. 5068379-Y) QTRAP Enabled Triple Quad 5500+ with Agilent Zorbox C18 (150 mm x 4.6 mm x 3 µm) column and PDA detector was employed for the present study. The total run time was 10 mins and the detection wavelength was 254 nm. A mixture of 5 mM Ammonium formate: Methanol (30: 70) was used as mobile phase on isocratic mode with 1 ml/min as flow rate. Tavaborole has shown linearity over the concentration range 0.5-100 μg/ml and the proposed method was validated as per ICH guidelines. The proposed method is found to be simple, precise, accurate and suitable for the quantification of the marketed formulations of Tavaborole. Stress degradation studies were performed and the method is found to be selective and specific. [ABSTRACT FROM AUTHOR]

Onychomycosis is a common fungal nail infection for which new antifungals are needed to overcome antimicrobial resistance and the limitations of conventional treatments. This study reports the development of antifungal nail lacquers containing oregano essential oil (OEO), rosemary essential oil (REO), and biogenic silver nanoparticles (bioAgNPs). The formulations (F) were tested against dermatophytes using agar diffusion, ex vivo nail infection, and scanning electron microscopy techniques. They were evaluated for their pharmacotechnical characteristics and by FTIR-PAS to assess permeation across the nail. F-OEO and F-OEO/bioAgNPs were promising candidates for the final nail lacquer formulation, as they permeated through the nail and showed antifungal efficacy against dermatophytes-contaminated nails after 5 days of treatment. Treated nails exhibited decreased hyphae and spores compared to the untreated control; the hyphae were atypically flattened, indicating loss of cytoplasmic content due to damage to the cytoplasmic membrane. The formulations were stable after centrifugation and thermal stress, maintaining organoleptic and physicochemical characteristics. Both F-OEO and F-OEO/bioAgNPs had pH compatible with the nail and drying times (59–90 s) within the reference for nail lacquer. For the first time, OEO and bioAgNPs were incorporated into nail lacquer, resulting in a natural and nanotechnological product for onychomycosis that could combat microbial resistance. [ABSTRACT FROM AUTHOR]

Background: Nearly 10% of all dermatological disorders and conditions are attributed to the disorders of the nails. Onychoscopy is beneficial in the diagnosis of nail conditions as well as for assessment of the progression, severity, and monitoring of the response to the therapy. Aim: The present study aimed to assess the dermoscopic and sociodemographic features in subjects with nail disorders and Onychoscopy of nail lesions in subjects with dermatological disorders. Methods: The present study assessed 88 subjects with nail disorders from both genders. There were 56.81% (n=50) males and 43.18% (n=38) females in the study. In all included subjects, dermoscopic and sociodemographic features were assessed. The data gathered were analyzed for results formulation. Results: The study results showed that fingernails were more commonly affected in 37.5% (n=33) subjects compared to toenails in 84.09% (n=74) subjects. The most common nail condition was Onychomycosis seen in 32.9% (n=29) subjects that showed findings of onycholysis with spikes and jagged edges in 68.9% (n=20), subungual hyperkeratosis in 72.41% (n=21) subjects, and 75.86% (n=22) subjects respectively. The next common condition was nail psoriasis seen in 18.1% (n=16) of study subjects depicting dilated globose nail fold vessels on capillaroscopy, and onycholysis. Conclusions: The present study concludes that onychoscopy can decrease the need for biopsy which is an invasive procedure by focusing on subtle changes and helps in excluding the differential diagnosis. Also, onychoscopy is a diagnostic choice in young children. The present study helped to assess connective tissue disorder severity and can help in diagnosing the benign nature of melanonychia. [ABSTRACT FROM AUTHOR]

Purpose: Acute compartment syndrome (ACS) remains a devastating complication of orthopaedic trauma. The tibial diaphysis is especially implicated in the development of ACS, both at the time of injury and after operative management. Identification of risk factors for ACS for these distinct scenarios has been investigated in a large cohort of patients. Methods: This is a retrospective cohort study of all adults (age 18 years and older) presenting to a level 1 trauma centre with a diaphyseal tibia fracture. ACS was determined by a combination of clinical signs and symptoms and compartmental pressure monitoring. Potential risk factors were subject to univariate analysis with significant variables undergoing binary logistic regression analysis. Results: 1147 tibial diaphyseal fractures over a twelve year period were studied. Age, multifragmented fracture pattern, male gender, high energy mechanism and intra- articular extension all showed a statistically significant association for ACS. Increasing body mass index (BMI) and treatment with an intramedullary nail favoured development of ACS post-operatively. Conclusion: Risk factors for the development of ACS specifically in tibial diaphyseal fractures have been highlighted. Patients managed with IMN or high BMI may warrant particular observation following operative intervention. [ABSTRACT FROM AUTHOR]

This article, published in the Australasian Journal of Dermatology, explores the clinical and dermoscopic features of onychomatricoma in Korean patients. Onychomatricoma is a rare benign tumor that originates from the nail matrix. The study analyzed ten patients with pathologically confirmed onychomatricoma and found that the most common clinical findings were increased nail thickness and xanthonychia. Dermoscopic examination revealed patterns such as localized nail thickening and multiple cavities at the free edge. The study also identified four distinct types of onychomatricoma based on clinical and dermoscopic findings. The article concludes by acknowledging the limitations of the study and the need for further research on the morphologic characteristics of onychomatricoma in different ethnicities. [Extracted from the article]

Onychomycosis is a common fungal nail infection that is difficult to diagnose due to its similarity to other nail conditions. Accurate identification is essential for effective treatment. The current gold standard methods include microscopic examination with potassium hydroxide, fungal cultures, and Periodic acid-Schiff biopsy staining. These conventional techniques, however, suffer from high turnover times, variable sensitivity, reliance on human interpretation, and costs. This study examines the potential of integrating AI (artificial intelligence) with visualization tools like dermoscopy and microscopy to improve the accuracy and efficiency of onychomycosis diagnosis. AI algorithms can further improve the interpretation of these images. The review includes 14 studies from PubMed and IEEE databases published between 2010 and 2024, involving clinical and dermoscopic pictures, histopathology slides, and KOH microscopic images. Data extracted include study type, sample size, image assessment model, AI algorithms, test performance, and comparison with clinical diagnostics. Most studies show that AI models achieve an accuracy comparable to or better than clinicians, suggesting a promising role for AI in diagnosing onychomycosis. Nevertheless, the niche nature of the topic indicates a need for further research. [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]

Background: Raman spectroscopy is a well-known tool used in criminology, molecular biology, and histology. It is also applied to diagnose bone mineral disorders by taking advantage of the similarity of the structure of keratin and bone collagen. Raman spectroscopy can also be used in dermatology and diabetology. The purpose of the present review is to critically evaluate the available research about the use of Raman spectroscopy in the mentioned areas of medicine. Methodology: PubMed was searched for peer-reviewed articles on the subject of use of Raman spectroscopy in bone mineral disorders, dermatology, and diabetes mellitus. Results: Nail keratin and bone collagen are related structural proteins that require disulfide bond for structural stability. Therefore, Raman spectroscopy of keratin may have potential as a diagnostic tool for screening bone quality and distinguishing patients at risk of fracture for reasons different from low bone mineral density (BMD) in the adult women population. Raman spectroscopy can also investigate the changes in keratin's structure in nails affected by onychomycosis and distinguish between healthy and onychomycosis nail samples. It could also reduce the need for nail biopsy by distinguishing between dermatophytic and non-dermatophytic agents of onychomycosis. Additionally, Raman spectroscopy could expedite the diagnostic process in psoriasis (by assessing the secondary structure of keratin) and in diabetes mellitus (by examining the protein glycation level). Conclusions: In adult populations, Raman spectroscopy is a promising and safe method for assessing the structure of fingernails. However, data are scarce in the pediatric population; therefore, more studies are required in children. [ABSTRACT FROM AUTHOR]

Acrylates and methacrylates, though common in a wide variety of products, especially in the dental industry, can cause adverse skin reactions. These compounds, including 2-hydroxyethyl methacrylate, triethylene glycol dimethacrylate, and bisphenol A-glycidyl methacrylate, are strong contact irritants or allergens. Found in dental prostheses, composite resins, dentin bonding materials, and glass ionomers, they pose a higher risk of exposure for dental personnel. Clinically, acrylate allergies manifest as facial rashes, eczema with cracked skin on fingers (pulpitis), nail dystrophy, and periungual dermatitis. Recently, however, the highest frequency of allergic reactions to acrylates has been observed in the beauty industry due to increased use in artificial nails, eyelashes, and hair extensions. This has led to greater sensitization. Acrylates are also used in medical applications such as bone cement for orthopedic endoprostheses, soft contact lenses, hearing aids, histological preparations, and wound dressings, which can also cause allergic reactions. For example, acrylates in surgical glue can cause severe dermatitis, and diabetic medical devices are also potential sources of allergic contact dermatitis. Given the extensive use and prolonged skin contact of products containing acrylates and methacrylates, this review aims to present current knowledge from the literature on reactions to these compounds across different industries. [ABSTRACT FROM AUTHOR]

Abstract Background Histopathology can be crucial for diagnosis of inflammatory nail diseases. Longitudinal excision and punch biopsies are the most used techniques to obtain the tissue sample. However, there is a low clinical-histopathological correlation, besides the risk of nail dystrophy. Tangential excision biopsy (TB) is a well-established technique for the investigation of longitudinal melanonychia. TB could also be used to evaluate diseases in which histopathological changes are superficial, as in psoriasis. Objective To study the value of TB in the histopathological diagnosis of nail psoriasis. Methods This is a prospective and descriptive study of the clinical-histopathological findings of samples from the nail bed or matrix and nail plate of 13 patients with clinical suspicion of nail psoriasis. Biopsies were obtained through partial nail avulsion and TB. Results In nine patients, the hypothesis of psoriasis was confirmed by histopathology; in one, the criteria for diagnosing nail lichen planus were fulfilled. The tissue sample of only one patient did not reach the dermal papillae, and, in four of 13 patients, the adventitial dermis was not sampled. No patient developed onychodystrophy after the procedure. Study limitations In three patients, the clinical and, consequently, histopathological nail changes were subtle. Also, in one patient’s TB didn’t sample the dermal papillae. Conclusions TB is a good option to assist in the histopathological diagnosis of nail psoriasis, especially when appropriate clinical elements are combined. Using this technique, larger and thinner samples, short postoperative recovery time, and low risk of onychodystrophy are obtained.

Background: Onychopapilloma is an uncommon benign tumor of the nail bed and the distal matrix. Objectives: We aimed to investigate the clinical and pathological features of onychopapilloma in Taiwan. Materials and methods: We conducted a retrospective analysis of 12 patients with histopathologically proven onychopapilloma in a medical center in southern Taiwan from 2017 to 2023. Results: This case series consisted of 5 men and 7 women aged 29 to 38, with a mean age of 41.25 years. The clinical features were as follows: distal subungual hyperkeratosis (100%), longitudinal erythronychia (50%), longitudinal leukonychia (50 %), distal onycholysis (41%), and distal nail plate fissuring (41%). The duration of the disease varied greatly, ranging from 1 month to several years. Most patients were asymptomatic (58%), while some presented tenderness (41%). Fingernail involvement was more prevalent than toe involvement, with the thumb being the most commonly affected site. Most of the patients presented with a solitary onychopapilloma. None of the seven patients who underwent surgery and were available for follow-up experienced recurrence. Conclusions: This study highlights that longitudinal erythronychia and leukonychia emerged as the predominant clinical presentations of onychopapilloma. Furthermore, our findings suggest that surgical excision appears to be an effective method for onychopapilloma. [ABSTRACT FROM AUTHOR]

Introduction: Dyskeratosis congenita is a rare genetic disorder characterized by abnormalities of the skin, nails, and oral mucosa. Retinal involvement in this condition is uncommon. Here, we present a case of a young male patient diagnosed with presumptive cytomegalovirus retinitis, ultimately found to be concomitant with dyskeratosis congenita. Case Presentation: A non-HIV-infected young male with recurrent infections, including aspergillus pneumonia and pneumocystis pneumonia, presented with presumptive cytomegalovirus retinitis in both eyes. Systemic manifestations included cutaneous hyperpigmentation, nail dystrophy, and oral mucosal leukoplakia. Genetic testing revealed a mutation in the DKC1 gene. The final diagnosis was dyskeratosis congenita complicated by presumptive cytomegalovirus retinitis. Conclusion: Cytomegalovirus retinitis can serve as an ocular complication of dyskeratosis congenita. When a patient presents with cytomegalovirus retinitis, a comprehensive systematic examination should be conducted as it indicates severe immunodeficiency. [ABSTRACT FROM AUTHOR]

Simple Summary: Many cancer treatments, including chemotherapy, targeted therapy, immunotherapy, and radiotherapy, can cause skin side effects. These are called 'dermatologic toxicities' or 'skin toxicities'. There are many different types of skin toxicities, some of which can not only affect the quality of life but also lead to cancer treatment being stopped or slowed down. This paper gives an overview of 12 of the most common skin toxicities experienced by people receiving cancer treatment. These include rashes, dry skin, skin irritation, hair loss, changes in skin colouring, and itching. We have provided Australia/New Zealand-specific recommendations on how skin toxicities can be prevented and managed, including the role of dermocosmetic solutions. Cancer systemic therapeutics and radiotherapy are often associated with dermatological toxicities that may reduce patients' quality of life and impact their course of cancer treatment. These toxicities cover a wide range of conditions that can be complex to manage with increasing severity. This review provides details on twelve common dermatological toxicities encountered during cancer treatment and offers measures for their prevention and management, particularly in the Australian/New Zealand context where skincare requirements may differ to other regions due to higher cumulative sun damage caused by high ambient ultraviolet (UV) light exposure. Given the frequency of these dermatological toxicities, a proactive phase is envisaged where patients can actively try to prevent skin toxicities. [ABSTRACT FROM AUTHOR]

Summary Routine ABO blood group typing of apparently healthy individuals sporadically uncovers unexplained mixed‐field reactions. Such blood group discrepancies can either result from a haematopoiesis‐confined or body‐wide dispersed chimerism or mosaicism. Taking the distinct clinical consequences of these four different possibilities into account, we explored the responsible cause in nine affected individuals. Genotype analyses revealed that more than three‐quarters were chimaeras (two same‐sex females, four same‐sex males, one sex‐mismatched male), while two were mosaics. Short tandem repeat analyses of buccal swab, hair root and nail DNA suggested a body‐wide involvement in all instances. Moreover, genome‐wide array analyses unveiled that in both mosaic cases the causative genetic defect was a unique copy‐neutral loss of heterozygosity encompassing the entire long arm of chromosome 9. The practical transfusion‐ or transplantation‐associated consequences of such incidental discoveries are well known and therefore easily manageable. Far less appreciated is the fact that such findings also call attention to potential problems that directly ensue from their specific genetic make‐up. In case of chimerism, these are the appearance of seemingly implausible family relationships and pitfalls in forensic testing. In case of mosaicism, they concern with the necessity to delineate innocuous pre‐existent or age‐related from disease‐predisposing and disease‐indicating cell clones. [ABSTRACT FROM AUTHOR]

This article provides an overview of nail diseases and their management. It emphasizes the importance of recognizing and assessing changes in the nails, as they can indicate underlying systemic or localized diseases. The most common nail diseases seen in primary care include fungal infections, psoriasis, trauma, and melanonychia. Treatment can be challenging due to the anatomy of the nail and limited options available. The article also discusses various nail conditions, such as discoloration, thickening, thinning, pitting, pain, abnormal curvature, and grooves. It provides information on specific conditions like nail psoriasis, longitudinal melanonychia, Bowen's disease, myxoid pseudocysts, onychopapilloma, malalignment, and chronic paronychia. Treatment options include physical therapies, surgery, and environmental management. Recognizing the clinical features and seeking appropriate treatment is crucial for timely diagnosis and improved outcomes. [Extracted from the article]

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]

Onychocryptosis, popularly known as "ingrown toenail", is defined as an inflammatory condition of the lateral nail fold resulting from the ingrowth of the lateral edge of the nail plate into the lateral nail fold, which occurs most frequently in the hallux. It is a reason for great demand for primary health care and is sometimes associated with disabling pain and, therefore, a frequent reason for absenteeism from work. Nail fold hypertrophy is a common consequence of onychocryptosis. Therefore, the present study reports an exuberant case of lateral nail fold hypertrophy treated surgically in a patient with chronic onychocryptosis. [ABSTRACT FROM AUTHOR]

Self‐improving dystrophic epidermolysis bullosa (DEB) is a genodermatosis that is inherited autosomal dominantly or recessively, and its clinical symptoms may improve or subside spontaneously. Herein, we report a case of self‐improving DEB with COL7A1 p.Gly2025Asp variant. The diagnosis was made through histopathological, electron microscopic examination, and genetic testing. The same variant is also noted on his father, who presents with dystrophic toenails without any blisters. This study highlights that idiopathic nail dystrophy could be linked to congenital or hereditary disease. Furthermore, we conducted a review of the literature on the characteristics of reported cases of self‐improving DEB with a personal or family history of nail dystrophy. The results supported our findings that nail dystrophy may be the sole manifestation in some family members. We suggest that individuals suffering from idiopathic nail dystrophy may seek genetic counselling when planning pregnancy to early evaluate the potential risk of hereditary diseases. [ABSTRACT FROM AUTHOR]

Background: The assessment of nail changes in connective tissue diseases (CTD) has been rarely explored in previous studies. The use of dermoscopy to study vascular changes in nailfolds is an interesting diagnostic technique. The aim of the study was to describe the epidemiological, clinical, and dermoscopic features of nail lesions in CTD. Methods: A prospective study was performed at the Dermatology Department of Habib Thameur Hospital (Tunis, Tunisia) in collaboration with the Internal Medicine Department over a period of 15 months, from July 2020 to September 2021, including patients diagnosed with systemic sclerosis (SS), systemic lupus erythematosus (SLE) and dermatomyositis (DM). Results: Our study included 48 patients. Nail involvement was found in 44 cases. Dermoscopic nailfold abnormalities were identified in 37 cases. The most common clinical features were ragged cuticle, nailfold erythema, and onycholysis. Additionally, splinter hemorrhage, longitudinal ridging, lunula abnormalities, melanonychia, trachyonychia, leukonychia, increase in transverse curvature, parrot beak nail, half and half nails, and onychorrhexis were described. Nailfold dermoscopy showed a normal pattern in 10 cases, a nonspecific pattern in nine cases (SLE), and a scleroderma pattern in 29 cases (SS and DM). The scleroderma pattern was further categorized into an early pattern (6), an active pattern (14), and a late pattern (9). Normal pattern was observed solely in patients in remission. The late scleroderma pattern was associated with disease duration and systemic involvement. In SLE, disease activity correlated with onycholysis, nailfold erythema, and pathologic pattern in dermoscopy. However, patients with DM displayed a positive correlation between pulmonary involvement and scleroderma pattern. Conclusion: Nail involvement in CTD includes a diverse range of abnormalities. Despite being nonspecific, it can provide crucial clues for establishing a diagnosis. Nailfold dermoscopy serves as a mirror for microangiopathy, enabling the detection of changes at an initial stage, and thus, it becomes a diagnostic and prognostic tool. [ABSTRACT FROM AUTHOR]

Cryotherapy is widely used in health contexts, including first aid, treating acute musculoskeletal injuries and women undergoing chemotherapy. Studies have shown that frozen gloves can help reduce nail toxicity for women undergoing chemotherapy. Nail toxicity is a common issue among people undergoing chemotherapy, causing disfigurement and pain. Although cooling gloves have been shown to reduce nail toxicity, the range of temperatures used remains unclear, often resulting in discomfort. In this innovative study, we used a quasi-experimental, two group pretest-posttest design to evaluate the effectiveness of Chemo-Cooling Gloves developed by the researchers to help prevent nail toxicity. We assessed satisfaction with the gloves among 27 Thai women undergoing chemotherapy who were purposively recruited according to the inclusion criteria from a chemotherapy center of a university-affiliated hospital in a southern region of Thailand. Participants underwent a regimen of cyclophosphamide in combination with doxorubicin and 5-flu- orouracil every 21 days for six cycles. Each participant served as their own control, wearing the cooling glove on the one hand randomly selected, while the other hand remained unprotected and acted as the control. Data were collected using a demographic questionnaire, the Common Terminology Criteria for Adverse Events version 3.0, and the Chemo-Cooling Gloves Satisfaction Questionnaire. Data analysis utilized descriptive statistics and Cochran's Q test. The results revealed that nail toxicity was significantly lower in the protected hand than in the control hand during cycles 2 to 3 and 2 to 4, but no significant difference between the two hands during cycles 2 to 5 and 2 to 6. Overall satisfaction with the Chemo-Cooling Gloves was at the highest level. The use of frozen gloves aligns with evidence-based practice, as supported by our study. Nurses need to be trained in the proper use and application of the gloves and educate patients on the benefits and correct usage to maximize comfort and efficacy. By incorporating the Chemo-Cooling Gloves into routine practice, nurses can help improve patient adherence to chemotherapy regimens and potentially enhance treatment outcomes. [ABSTRACT FROM AUTHOR]

Nail disorders are common in the pediatric population and affect quality of life. We review inflammatory conditions (ie, nail psoriasis, nail lichen planus [NLP], trachyonychia, nail lichen striatus, nail atopic dermatitis [AD]) as well as infectious conditions (ie, nail disease due to hand, foot, and mouth disease [HFMD] or Kawasaki disease, onychomycosis, acute paronychia). Inflammatory and infectious nail conditions may involve the skin or occur in isolation. By highlighting the distinctive features and clinical presentations of these infectious and inflammatory nail disorders in children, we aim to raise awareness among dermatologists to improve diagnosis and management. [ABSTRACT FROM AUTHOR]

Background: Paediatric digital tip injuries are a common presentation. Controversy exists in the use of composite grafts as a method of repair regarding the time of inset and likelihood of graft survival. We sought to determine our experience of composite graft as a method of fingertip reconstruction, and compare the time of graft replacement to viability with the traditionally accepted five-hour mark from injury to graft inset. Methods: Demographics, cause and level of injury, time to replacement and graft survival were analysed from the clinical notes of 40 complete amputations. Statistical analysis was performed to determine the outcomes of graft viability from the time of injury to graft inset. Secondary measures included rates of infection, wound problems, nail deformities and the requirement for a secondary operation. Results: No significant differences in graft survival were found for those inset before or after five hours, or within in our range of data. There were no significant adverse events or secondary revisions. Conclusions: We conclude that composite grafting of injured paediatric digital tips can be delayed until normal working hours if the patient presents out with this time. We propose an algorithm that has been implemented in our department.. Level of evidence: Level III, Therapeutic [ABSTRACT FROM AUTHOR]

Lichen planus (LP) is a chronic skin, mucous membrane, and nail disease. Lichen planus is a rare skin condition occurring in less than 1% of the general population, affecting both children and adults. Oral lichen planus (OLP) involvement is much more common. It is an autoimmune disease caused by T lymphocytes, with epigenetic factors playing a significant role in the development of autoimmune skin diseases. MicroRNAs (miRNAs), a group of non-coding RNAs, play a substantial role in regulating the immune response.1 The etiology of lichen planus in not fully understood. It can be triggered by antihypertensive drugs, betablockers, infections, viral hepatitis, psychological stress, and others. Cases of lichen planus appearing after recovering from COVID-19 have been reported, as well as a significant increase in cases after COVID-19 vaccination.2-5 Diagnosis is based on clinical presenstation and characteristic histopathological findings. The disease is often self-limiting, accompanied by persistent itching and painful erosions of the mucous membrane, affecting the patient's quality of life and mental well-being. First-line treatments inculde topical corticosteroids and/or oral corticosteroids. There are reports of new potential treatments, such as biologic drugs (anti-IL12/13, anti-IL17) and Janus kinase inhibitors. Consequently, a dramatic change in lichen planus treatment can be expected in the near future. The majority of patients suffering from lichen planus develop metabolic syndrome which is the cause of other diseases. This article provides a comprehensive overview of current knowledge about lichen planus and its variants. [ABSTRACT FROM AUTHOR]

Purpose: This study explored the incidence of IRCs used in the procedures of the femur in children with osteogenesis imperfecta (OI) and investigated the independent risk factors of IRCs. Methods: Three hundred eight-eight cases of surgical data about children with OI were included, who were treated with plate, elastic nail, Kirschner wire and telescopic rod. The choice of different procedures depended on the age of children, the status of femur and the availability of devices. Patient demographics and major IRCs were recorded to compare the outcomes of the four procedures. Then, Cox proportional hazard regression was used to analyse the independent risk factors of IRC, and subgroup analysis was applied to further verify the above results. Results: The total incidence of IRC in the four groups was 90.1% (191/212) for plate, 96.8% (30/31) for Kirschner wire, 87.7% (57/65) for elastic nail and 30.0% (24/80) for telescopic rod. The incidence of IRC in the telescopic rod was lower than that in plate, elastic nail and Kirschner wire (P < 0.001). Cox proportional hazard regression analysis confirmed that procedure was the independent risk factor of IRC (HR, 0.191; 95% CI, 0.126–0.288; P < 0.001), fracture (HR, 0.193; 95% CI, 0.109–0.344; P < 0.001) and deformity (HR, 0.086; 95% CI, 0.027–0.272; P < 0.001). In addition, age of surgery was the independent risk factor of fracture (HR, 0.916; 95% CI, 0.882–0.952; P < 0.001) and deformity (HR, 1.052; 95% CI, 1.008–1.098; P = 0.019). Subgroup analysis confirmed that age of surgery, gender, classification, preoperative state and angle did not affect the effect of telescopic rod on reducing the risk of IRCs. Conclusions: In our cohort, lower incidence of IRCs was observed in telescopic rod group compared with plate, Kirschner wire and elastic nail. Procedure and age of surgery were independent risk factors of fracture. Likewise, procedure and age of surgery were independent risk factors of deformity, and procedure was independent risk factors of IRC. [ABSTRACT FROM AUTHOR]

Background: Tinea faciei is a relatively uncommon dermatophyte infection. The studies, which included clinical forms, and isolated species of dermatophytes, are limited. Materials and Methods: This retrospective study aims to determine the causative organism, clinical characteristics, treatments and outcomes of patients with tinea faciei attending the dermatologic clinic, Siriraj Hospital, from 1 January 2017 to 30 September 2021. Demographic data, clinical presentations, isolated dermatophyte species, treatments and outcomes were collected and analysed. Results: A total of 151 tinea faciei cases were observed. Trichophyton rubrum (48.6%), Trichophyton mentagrophytes complex (22.2%) and Microsporum canis (18.1%) were common causative agents. Tinea faciei was commonly detected in females (64.9%) with a history of pets (54.6%). Clinical presentations often involved plaques and scales on the cheeks. Among patients with lesions on the cheek, mycological cure was observed significantly less often compared to those without cheek lesions. Patients with other concurrent skin or nail infections, a history of topical steroids and a history of previous fungal infection had a slightly longer duration of mycological cure than those without factors. Recurrent infection was found in 33.3%. Male, history of previous fungal infection, and lesions on the cheeks were significantly associated with recurrent infection. Conclusions: Fungal infection of the face was commonly found in women and patients with pets. The most common pathogen that caused tinea faciei was T. rubrum. Topical antifungal treatments could be used with favourable outcomes. The history of past infection and lesion on the cheeks should be carefully assessed to be vigilant for recurrent infection. [ABSTRACT FROM AUTHOR]

Nail growth disturbance commonly takes place after trauma or relevant diseases, such as infections and tumors. However, abnormal growth of the nail plate sometimes occurs without an obvious causative factor. This report presents the case of a patient who underwent male genital reconstruction with a radial forearm free flap for gender affirmation. Although the entire process was smooth, with no accidental events, the second, third, and fourth phalangeal nail plates of the hand from which the flap was harvested showed no evident growth of the fingernail 2 months postoperatively. Nail production was preserved in the remaining fingernails. Typical symptoms, such as redness, swelling, and tenderness, were noted upon clinical observation. Eventually, nail production restarted 5 months after surgery. Steroid and antibiotic treatment was attempted to reduce periungual inflammation. Additionally, close observation with psychological support was conducted. [ABSTRACT FROM AUTHOR]

Introduction: It has long been accepted that trauma is one of the most important and frequent predisposing factors for onychomycoses. However, the role of direct trauma in the pathogenesis of fungal nail infections has only recently been elucidated in a series of 32 cases of post-traumatic single-digit onychomycosis. The importance of repeated trauma due to foot and toe abnormalities was rarely investigated. Aimof the study: This is a multicenter single-author observational study over a period of 6 years performed at specialized nail clinics in three countries. All patient photographs taken by the author during this period were screened for toenail alterations, and all toe onychomycosis cases were checked for whether they contained enough information to evaluate potential foot and toe abnormalities. Particular attention was paid to the presence of hallux valgus, hallux valgus interphalangeus, hallux erectus, inward rotation of the big toe, and outward rotation of the little toe, as well as splay foot. Only cases with unequivocal proof of fungal nail infection by either histopathology, mycologic culture, or polymerase chain reaction (PCR) were accepted. Results: Of 1653 cases, 185 were onychomycoses, proven by mycologic culture, PCR, or histopathology. Of these, 179 involved at least one big toenail, and 6 affected one or more lesser toenails. Three patients consulted us for another toenail disease, and onychomycosis was diagnosed as a second disease. Eight patients had a pronounced tinea pedum. Relatively few patients had a normal big toe position (n = 9). Most of the cases had a mild to marked hallux valgus (HV) (105) and a hallux valgus interphalangeus (HVI) (143), while hallux erectus was observed in 43 patients, and the combination of HV and HVI was observed 83 times. Discussion: The very high percentage of foot and toe deformations was surprising. It may be hypothesized that this is not only a pathogenetically important factor but may also play an important role in the localization of the fungal infection, as no marked hallux deviation was noted in onychomycoses that affected the lesser toes only. As the management of onychomycoses is a complex procedure involving the exact diagnosis with a determination of the pathogenic fungus, the nail growth rate, the type of onychomycosis, its duration, and predisposing factors, anomalies of the toe position may be important. Among the most commonly mentioned predisposing factors are peripheral circulatory insufficiency, venous stasis, peripheral neuropathy, immune deficiency, and iatrogenic immunosuppression, whereas foot problems are not given enough attention. Unfortunately, many of these predisposing and aggravating factors are difficult to treat or correct. Generally, when explaining the treatment of onychomycoses to patients, the importance of these orthopedic alterations is not or only insufficiently discussed. In view of the problems encountered with the treatment of toenail mycoses, this attitude should be changed in order to make the patient understand why there is such a low cure rate despite excellent minimal inhibitory drug concentrations in the laboratory. [ABSTRACT FROM AUTHOR]

Ectodermal dysplasia-syndactyly syndrome 1 (EDSS1) is an exceedingly rare condition associated with mutations in the PVL4 gene. It is characterised by sparse, brittle hair, eyebrows and eyelashes, abnormal dentition and nails, along with bilateral cutaneous syndactyly involving the fingers and toes. We report a 2-year-old girl who presented to us with bilateral complete simple syndactyly of the third and fourth web spaces of the hands, along with bilateral syndactyly of both feet involving the second to fourth toes. Upon examination, sparse hair and eyebrows, along with abnormal dentition, were noted. Thorough clinical examination and genetic analysis were conducted on the affected child and her father, who exhibited similar clinical features. Genetic analysis revealed a homozygous nonsense mutation in the PVL4 gene in both individuals. According to the literature, EDSS1 has been reported in only 10 families worldwide, and there are no reported cases from India. Level of Evidence: Level V (Therapeutic) [ABSTRACT FROM AUTHOR]

Background: Glomus tumour is a painful small tumour of the glomus body commonly located under the nail bed. The aim of this study is to evaluate the correlation of clinical diagnosis with MRI findings, determine the prevalence of the tumour at different subungual locations and determine the differences in outcomes (if any) between a longitudinal and a transverse nail bed incision for excision of the tumour. Methods: This retrospective study of 56 subungual glomus tumour was conducted from May 2010 to December 2021. Data with regard to gender, age at presentation, digit involved, presenting symptoms, duration of symptoms, clinical signs, need for MRI, anatomical location, surgical approach (longitudinal versus transverse), histopathology result, period of follow-up and complications were recorded. Results: All 56 (100%) patients presented with classic triad of symptoms. The average duration of symptoms was 52.9 months (range: 3–204 months). Eleven (20%) tumours were in the sterile matrix, 38 (68%) at the junction of sterile and germinal matrix and 7 (12%) in the germinal matrix. The tumours were excised through the longitudinal incision in 31 (55.3%) patients and transverse incision in 25 (44.7%). One (1.8%) tumour was intraosseous that was diagnosed intraoperatively and excised successfully. Average follow-up was 35.4 months (range: 6–120 months). There was no difference in outcomes (pain or nail deformity) between the two incisions. One patient (1.8%) has persistent pain that was due to a missed satellite lesion in the same digit. This was excised later with resolution of symptoms. There were no recurrences and all patients were cured after excision of tumour. Conclusions: Diagnosis of glomus tumour is usually clinical, and most are located at junction of sterile and germinal matrix. Tumour can be excised either by longitudinal or transverse nail bed incisions without any change of treatment outcome. Level of Evidence: Level IV (Therapeutic) [ABSTRACT FROM AUTHOR]

Introduction: Psoriasis involvement in special areas (e.g., scalp or nails) is associated with a great disease burden yet it is often inadequately treated with topical treatments. The efficacy and tolerability of apremilast plus existing topical therapy in Japanese patients with mild to moderate plaque psoriasis were demonstrated in PROMINENT, a phase 3b, multicenter, open-label, single-arm study. We evaluated the efficacy of apremilast across disease severities and special areas involved in these patients. Methods: In PROMINENT, patients received apremilast 30 mg twice daily for 16 weeks in addition to their existing topical therapy, with the option of topical therapy reduction at the discretion of their physician while continuing apremilast treatment from Weeks 16 to 32. We performed a post hoc analysis, assessing apremilast efficacy and safety in Japanese patients stratified by baseline static Physician Global Assessment (sPGA) score (2 [mild] or 3 [moderate]) and special area involvement. Results: Of patients with baseline sPGA = 2 and sPGA = 3, 62.7% and 30.7%, respectively, achieved sPGA score 0 or 1 at Week 32. At Week 32, improvements in skin, nail, scalp, and quality of life assessments were observed regardless of baseline sPGA score. Improvements in these endpoints at Week 32 were also observed in patients with special area (scalp or nail) involvement (n = 134). Incidence of adverse events was similar between patients with baseline sPGA = 2 and sPGA = 3. Conclusions: Apremilast in combination with topical therapy may be a beneficial treatment for Japanese patients, who have limited systemic treatment options for mild to moderate psoriasis or psoriasis in special areas. Trial Registration: NCT03930186. [ABSTRACT FROM AUTHOR]

Introduction: Onychomycosis is a fungal infection of the nails that can be challenging to treat. Here, matrix-assisted laser desorption ionization–Fourier transform ion cyclotron resonance (MALDI-FTICR) imaging was applied to the quantitative analysis of the penetration profile of the antifungal compound, amorolfine, in human mycotic toenails. The amorolfine profile was compared with those of three other antifungals, ciclopirox, naftifine, and tioconazole. Methods: Antifungal compounds (amorolfine 5% lacquer, ciclopirox 8% lacquer, naftifine 1% solution, and tioconazole 28% solution) were applied to mycotic nails (n = 42). Nail sections were prepared, and MALDI-FTICR analysis was performed on the sections at a spatial resolution of 70 μm to compare the distribution profiles. Based on the minimum inhibitory concentrations of the four test compounds needed to kill 90% (MIC90) of the fungal organism, Trichophyton rubrum, the fold differences between the MIC90 and the antifungal concentrations in the nails (termed the multiplicity of the MIC90) were calculated for each. Results: The penetration profiles indicated higher concentrations of amorolfine and ciclopirox in the deeper layers of the nails 3 h after treatment, compared with naftifine and tioconazole. The mean concentrations across the entire nail sections at 3 h were significantly different among the four antifungals: amorolfine, 2.46 mM; ciclopirox, 0.95 mM; naftifine, 0.63 mM; and tioconazole, 1.36 mM (p = 0.016; n = 8 per compound). The median multiplicity of the MIC90 at 3 h was 191-fold for amorolfine, tenfold for ciclopirox, 52-fold for naftifine, and 208-fold for tioconazole. Conclusion: In this study, MALDI-FTICR was successfully applied to the quantitative analysis of antifungal distribution in human mycotic nails. The findings suggest that amorolfine penetrates deeper layers of the nail and accumulates at concentrations far exceeding the MIC needed to exert antimycotic activity. [ABSTRACT FROM AUTHOR]

Fungi occurred naturally like Candida yeast, in the human body. It may grow on skin, inside the digestive system and vagina. Antifungal drugs are used to kill or stop this fungal growth. According to their mode of action they are divided into azoles (inhibit ergosterol synthesis), echinocandins (damage cell walls), and polyenes (destroy fungal cells) etc. Depending on the seriousness of infection and type of infection, generally antifungal drugs are administered to a body. Oral antifungals are taken by mouth for systemic infections. Topical antifungals (creams, ointments) treat localized skin and nail infections. Intravenous (IV) administration is used for severe cases. Common side effects of antifungals are yeast infection, hepatotoxicity, ringworm, nail and skin infections etc. Serious fungal infections pose a growing threat to human health specially for vulnerable patients having significant morbidity and mortality such as AIDS patients, transplant recipients, and individuals using certain medications. Some of the existing antifungal drugs, particularly azoles, are facing increasing resistance. In order to ensure successful treatment of these drug-resistant infections, there is a critical need for the development of novel antifungal agents which is very challenging. Here about the antifungals, its classification, pros and cons of using antifungal drugs, prevention and control of antifungals are discussed in detail. [ABSTRACT FROM AUTHOR]

Background: Onychomycosis is a chronic nail infection, and dermatophytes, yeasts, and nondermatophytic molds may be the causative agents. This study aimed to determine the etiological agents of onychomycosis by using conventional and molecular methods. Methods: Between June 2020 and July 2021, 37 patients with a presumptive diagnosis of onychomycosis and mycological evidence (culture and/or EUROArray Dermatomycosis assay) were included in the study. Organisms detected in cultured nail specimens were identified by combined phenotypic characteristics and by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). An EUROarray Dermatomycosis assay was used for molecular detection of fungal pathogens. Results: The EUROArray Dermatomycosis assay was positive for a single fungal target in 23 samples, and 14 samples were positive by culture. The most common pathogen was Trichophyton rubrum in both methods. Coinfection was detected in 14 samples by using molecular methods, and Trichophyton rubrum and Fusarium solani (9 samples) were the most common pathogens detected together. Trichophyton spp., nondermatophyte molds, and Candida spp. were detected in 33 (89.2%), 16 (43.2%), and 6 (16.2%) samples, respectively, when the two methods were evaluated together. Conclusions: Our results revealed that fungal culture allows the diagnosis of onychomycosis, but it is not as sensitive as the EUROArray Dermatomycosis test, especially in patients receiving antifungal therapy. [ABSTRACT FROM AUTHOR]