The nail and ageing

Para la ciencia podológica/podiátrica es muy importante conocer los cambios de la lámina ungueal en el anciano debido a su de alta frecuencia. Los cambios de la uña asociados al envejecimiento incluyen un crecimiento ungueal más lento, modificaciones en el espesor de la uña, alteraciones en la superficie, alteraciones en su configuración y cambios en el color. Estas alteraciones son muy comunes debido al insuficiente aporte sanguíneo a zonas distales, pero también a los microtraumas de repetición y a la dificultad de estos individuos gerontes en el cuidados de las uñas de sus pies. El envejecimiento predispone al desarrollo o al empeoramiento de diversas enfermedades, como las onicomicosis, las uñas quebradizas, la onicogrifosis, la paquioniquia, las uñas encarnadas, etc. Todas estas patologías pueden acontecer a cualquier edad, pero en la vejez hay una frecuencia más alta de su incidencia.For podiatric science is very important to know nail changes in old people because of their high frequency. Nail changes associated with ageing include slower growth rate, thickness modifications, surface alterations, configuration abnormalities and color changes. They are most commonly due to impaired blood supply, but also to chronic microtrauma and difficulty for elderly people to take care of their nails. Ageing predisposes to the development or to the worsening of different diseases, such as onychomycosis, brittle nails, onychogryphosis, pachionychia, pincer nails. These may occur at any age, but in old age there is a higher frequency of incidence

Alopecia: evaluation and treatment

Hair loss is a very common complaint. Patients may describe increased shedding and diffuse or localized alopecia. The differential diagnosis of hair loss includes a number of disorders causing cicatricial or noncicatricial alopecias. This paper describes the clinical approaches and diagnostic tests that are useful in the evaluation of patients presenting with alopecia. It also reviews treatments for noncicatricial alopecias, including androgenetic alopecia, alopecia areata, and telogen effluvium, as well as cicatricial alopecias, including lichen planopilaris, its clinical variant frontal fibrosing alopecia, and discoid lupus erythematosus

Trichoscopy of Dark Scalp

Abstract Trichoscopy (dermoscopy of the hair and scalp) is a technique that improves diagnostic accuracy and follow-up with hair and scalp disorders. Although several studies of trichoscopy have been made in Caucasian and Asian populations, little has been published regarding trichoscopy findings in skin of color, despite the great prevalence of hair diseases in populations with this kind of skin. The aim of this review was to describe the trichoscopic features of normal scalp and of hair disorders in patients with dark skin phototypes. This will help dermatologists to distinguish between unique trichoscopic features of dark skin, and allow them to provide more accurate diagnoses and treatments for these patients

Management of contact dermatitis due to nickel allergy: an update

Nickel is the major cause of allergic contact dermatitis in the general population, both among children and adults, as well as in large occupational groups. This metal is used in numerous industrial and consumer products, including stainless steel, magnets, metal plating, coinage, and special alloys, and is therefore almost impossible to completely avoid in daily life. Nickel contact dermatitis can represent an important morbidity, particularly in patients with chronic hand eczema, which can lead to inability to work, a decrease in quality of life and significant healthcare expenses. Therefore, its management is of great importance. This article reviews diagnostic, preventive and therapeutic strategies in this field

Dermoscopy in nail psoriasis

The authors report on their experience with the use of dermoscopy in nail psoriasis and describe their findings with this diagnostic tool.Os autores relatam sua experiência no uso da dermatoscopia na psoríase ungueal e descrevem os achados dessa ferramenta diagnóstica.Santa Casa de São Paulo Clínica de dermatologiaUniversidade de BolonhaHospital do Servidor Público do Estado de São Paulo Clínica de dermatologiaUniversidade Federal de São Paulo (UNIFESP) departamento de dermatologiaUNIFESP, Depto. de dermatologiaSciEL

Periungual keratoacanthoma preceded by a wart and followed by a verrucous carcinoma at the same site.

Sir, Periungual keratoacanthoma can be difficult to diagnose clinically. Its presentation may differ markedly from that of keratoacanthoma found elsewhere on the skin. The same observation concerning presentation is made for squamous cell carcinoma (SCC) of the perionychium and skin. A further distinction from SCC at these sites is the presence of human papilloma virus (HPV) in periungual squamous cell carcinoma and its routine absence at most other sites. We report the presence of oncogenic HPV 31 and 35 in a periungual keratoacanthoma, marked by the manifestation of a wart prior to and a verrucous carcinoma after the presentation of the keratoacanthoma at the same site

''Endonyx'' Onychomycosis: A New Modality of Nail Invasion by Dermatophytes

Three patients with onychomycosis due toTrichophyton soudanense with an ''endonyx'' type of nail invasion are presented. Endonyx onychomycosis is clinically characterized by a diffuse milky-white discolouration of the aiected nail, in the absence of nail bed hyperkeratosis or onycholysis. Nail plate surface and nail thickness are normal. The pathology shows a contrast between the great number of fungal hyphae visible in the nail plate and the absence of fungal elements in the nail bed. The nail bed does not show in£ammatory changes or hyperkeratosis and adheres strictly to the lowermost layers of the nail plate. The hyponychium is normal and does not contain hyphae. The endonyx pattern of nail infection appears to be speci¢c to T. soudanense nail invasion and may possibly re£ect the high a⁄nity of T. soudanense to hard keratins. Key words: dermatophytes; endonyx; onychomycosis; Trichophyton soudanense

A multicentre, randomised, parallel‐group, double‐blind, vehicle‐controlled and open‐label, active‐controlled study (versus amorolfine 5%), to evaluate the efficacy and safety of terbinafine 10% nail lacquer in the treatment of onychomycosis

Background: Onychomycosis is a difficult-to-treat fungal nail infection whose treatment can involve systemic or topical antifungal approaches. Objectives: To assess the efficacy and safety of terbinafine 10% nail lacquer in distal-lateral subungual onychomycosis (DLSO). Patients/methods: Patients with mild-to-moderate DLSO were randomised (3:3:1) to receive double-blind topical terbinafine 10% (n = 406) or its vehicle (n = 410) administered once daily for 4 weeks and then once weekly for 44 weeks, or open-label topical amorolfine 5% (n = 137) for 48 weeks, with a 12-week follow-up period. The primary efficacy endpoint, complete cure rate at Week 60, was a composite of negative potassium hydroxide (KOH) microscopy, negative culture for dermatophytes and no residual clinical involvement of the target big toenail. Results: Complete cure rates at Week 60 in the terbinafine, vehicle and amorolfine groups were 5.67%, 2.20% and 2.92%, respectively (odds ratio (OR) vs vehicle = 2.68; 95% confidence intervals (CI): 1.22-5.86; p = .0138). Statistically significant differences in responder (negative KOH and negative culture and ≤10% residual clinical involvement) and mycological cure rates (negative KOH and negative culture) at Week 60 were obtained between terbinafine and vehicle. Terbinafine was well-tolerated with no systemic adverse reactions identified; the most common topical adverse reactions were erythema and skin irritation. Conclusions: Terbinafine 10% nail lacquer was an effective treatment for mild-to-moderate onychomycosis improving both clinical and mycological criteria compared with vehicle. Furthermore, there may be some benefits compared to the currently available topical agent, amorolfine 5%. Treatment was well-tolerated and safe

Postgrafting administration of granulocyte colony-stimulating factor impairs functional immune recovery in recipients of human leukocyte antigen haplotype–mismatched hematopoietic transplants

AbstractIn human leukocyte antigen haplotype–mismatched transplantation, extensive T-cell depletion prevents graft-versus-host disease (GVHD) but delays immune recovery. Granulocyte colony-stimulating factor (G-CSF) is given to donors to mobilize stem cells and to recipients to ensure engraftment. Studies have shown that G-CSF promotes T-helper (Th)-2 immune deviation which, unlike Th1 responses, does not protect against intracellular pathogens and fungi. The effect of administration of G-CSF to recipients of mismatched hematopoietic transplants with respect to transplantation outcome and functional immune recovery was investigated. In 43 patients with acute leukemia who received G-CSF after transplantation, the engraftment rate was 95%. However, the patients had a long-lasting type 2 immune reactivity, ie, Th2-inducing dendritic cells not producing interleukin 12 (IL-12) and high frequencies of IL-4– and IL-10–producing CD4+ cells not expressing the IL-12 receptor β2 chain. Similar immune reactivity patterns were observed on exposure of donor cells to G-CSF. Elimination of postgrafting administration of G-CSF in a subsequent series of 36 patients with acute leukemia, while not adversely affecting engraftment rate (93%), resulted in the anticipated appearance of IL-12–producing dendritic cells (1-3 months after transplantation versus > 12 months in transplant recipients given G-CSF), of CD4+ cells of a mixed Th0/Th1 phenotype, and of antifungal T-cell reactivity in vitro. Moreover, CD4+ cell counts increased in significantly less time. Finally, elimination of G-CSF–mediated immune suppression did not significantly increase the incidence of GVHD (< 15%). Thus, this study found that administration of G-CSF to recipients of T-cell–depleted hematopoietic transplants was associated with abnormal antigen-presenting cell functions and T-cell reactivity. Elimination of postgrafting administration of G-CSF prevented immune dysregulation and accelerated functional immune recovery