Krankheiten der Nägel

Zusammenfassung: Nagelveränderungen sind häufig, aber oft nicht einfach einzuordnen. Grundlegende Kenntnisse der Anatomie und Biologie des Nagels erleichtern ihre Zuordnung. Vielfach lassen sich daraus die Entstehung und Morphologie zwanglos ableiten. Die folgende kurze Übersicht gibt Hinweise zu den wichtigsten Infektionen, entzündlichen Nagelkrankheiten und Tumore

Post-Traumatic Single-Digit Onychomycosis

Onychomycoses are a group of fungal nail infections commonly classified either according to the pathogenic fungus, to the duration of the disease or to the mode of fungal invasion. Most cases are diagnosed clinically, although there is a general consensus that the pathogen should be identified prior to initiating a treatment. However, this is often difficult as the classical mycologic methods of direct microscopy and culture frequently remain negative. We came across a particular subset of onychomycoses, which posed extreme diagnostic and therapeutic challenges. Over a period of 15 years, 44 patients were seen in specialized nail clinics with a single nail dystrophy that was examined and treated in vain by many practitioners and dermatologists prior to their consultation. Of the forty-four cases, thirty-nine patients had a fingernail affected and five had a toenail affected. The nail was almost completely onycholytic, the nail bed visibly keratotic, the proximal nail fold smooth and shiny and slightly swollen. All patients except five brought the results of negative mycologic cultures. Thirty-four patients had received antifungal therapy, mostly topical, as a single nail would not qualify for systemic treatment according to most national and international guidelines. The diagnosis was finally confirmed by histopathology of the nail plate showing an invasive onychomycosis in all cases. After nail avulsion and combined topical and systemic antifungal therapy, thirty-six patients were cured, three were lost from follow-up, and five showed improved nails but not a complete clinical and mycologic cure. A single-digit nail disease raises the suspicion of a tumor or a trauma; although, in rare cases, diseases normally affecting several nails may only affect a single nail. Such a case should prompt the clinician to ask for a previous trauma to this digit and to intensify the search for a specific pathogen. This study also underlines the importance of histopathology for the diagnosis of onychomycoses.info:eu-repo/semantics/publishedVersio

Multiple minute digitate hyperkeratosis affecting the face and folds: clinical, dermoscopic, and histological report of a familial case.

A case of a generalized non-follicular digitate keratosis classified as multiple minute digitate hyperkeratosis is described with suggestive clinical, dermoscopic, and histopathogical data. The patient was a 52-year-old Caucasian woman presenting a 6-year history of multiple asymptomatic skin-colored digitate lesions, 3 to 5 mm long and 1 to 2 mm wide, distributed on the forehead, neck, and extensor surface of the arms as well as in the inframammary folds, axillae, and lower limbs, especially on the popliteal fold. She reported having a 67-year-old sister and a 39-year-old niece with an identical eruption. Treatment with 15% glycolic acid (AHA) lotion and heliotherapy improved this disturbing eruption

Anatomie, Biologie, Physiologie und Grundzüge der Pathologie des Nagelorgans

Zusammenfassung: Der Nagel ist das größte Hautanhangsgebilde. Er wächst lebenslang ohne Abhängigkeit von Hormonen. Der Mittelfingernagel der dominanten Hand eines jungen Erwachsenen wächst im Durchschnitt 0,1mm/Tag, der Großzehennagel 0,03-0,05mm/Tag. Die Form und Größe der Nägel sind von Finger zu Finger und von Zehe zu Zehe in sehr charakteristischer Weise unterschiedlich, wofür in erster Linie der Knochen der Endphalangen verantwortlich ist. Das Nagelorgan besteht aus verschiedenen epithelialen und bindegewebigen Anteilen: Das Matrixepithel bildet die Nagelplatte, das Nagelbettepithel sorgt für eine feste Haftung des Nagels, das Hyponychium ist eine hoch spezialisierte Struktur, die es erlaubt, dass sich der Nagel problemlos vom Nagelbett ablösen kann und doch kein Spalt zwischen Nagel und Nagelbett entsteht, und schließlich ist der dorsale Nagelwall für den Schutz der Nagelwurzel und die Bildung der Kutikula an seinem freien Rand für die Versiegelung der Nageltasche verantwortlich. Nagelbett und Matrix haben ein spezialisiertes Bindegewebe mit morphogenetischer Potenz. Der proximale und die lateralen Nagelwälle bilden einen nach distal offenen Rahmen für den Nagel. Der Nagel bietet Schutz für die Endphalanx und die Fingerspitze, ist ein äußerst nützliches Werkzeug zur Verteidigung und Geschicklichkeit und erhöht die Sensibilität der Fingerspitze. Nagelapparat, Fingerspitze, Sehnen und Ligamente des Endgelenkes bilden eine funktionelle Einheit und können in vieler Hinsicht nicht isoliert gesehen werden. Das Nagelorgan hat nur eine gewisse Anzahl an Erkrankungsmustern, die sich in mancher Hinsicht von denen der behaarten und der palmoplantaren Haut unterscheiden

Maligne Tumoren des Nagelorgans

Zusammenfassung: Entsprechend den unterschiedlichen Geweben, die das Endglied von Fingern und Zehen aufbauen, gibt es sehr viele verschiedene Tumoren. Am häufigsten ist der Morbus Bowen, der meist als verruköse Veränderung bei Personen ab dem Alter von 40Jahren auftritt. Hauptlokalisationen sind der laterale Nagelwall und das Nagelbett. Nach jahre- bis jahrzehntelangem Bestand ist der Übergang in ein invasives Plattenepithelkarzinom möglich. Dieses kann sich aber auch primär subungual entwickeln, meist als Onycholyse mit Nässen. Der zweithäufigste maligne Nageltumor ist das Melanom. Wenn es von der Matrix ausgeht, ist es meist pigmentiert, während Nagelbettmelanome überwiegend amelanotisch sind und oft als Unguis incarnatus bei älteren Personen imponieren. Therapie der Wahl ist bei in situ und früh invasiven Melanomen die großzügige Lokalexzision unter Erhalt der Endphalanx. Amputation ist nur bei fortgeschrittenen Melanomen indiziert. Neben den beiden häufigen ungualen Malignomen gibt es selten nagelspezifische Karzinome, maligne Gefäß- und Knochentumoren sowie andere Sarkome, Beteiligung im Rahmen von malignen Systemerkrankungen und Metastasen. Sie lassen sich in der Mehrzahl der Fälle nicht klinisch eindeutig diagnostizieren. Trotzdem muss an einen malignen Tumor gedacht werden bei allen umschriebenen, auf konservative Therapie nicht ansprechenden Nagelprozessen

Nail Lichen Planus: Successful Treatment with Etanercept

BACKGROUND: Etanercept is a fully human tumor necrosis factor a receptor fusion protein that binds tumor necrosis factor a with greater affinity than natural receptors. Biologics are widely used in the treatment of psoriasis and psoriasis arthritis and may represent a new therapeutic option for some patients with psoriatic nail disease. CASE REPORT: We report a case of lichen planus limited to the toe nails successfully treated with etanercept monotherapy. CONCLUSION: The significant improvement of our case suggests that etanercept is an effective treatment modality for lichen planus limited particularly to the nails. Further controlled studies are needed to establish the effectiveness and therapeutic regimes

The Fibroid Growth Study: Determinants of Therapeutic Intervention

The demographics, ethnicity, symptoms, lifestyle characteristics, and treatment outcomes are analyzed in participants of a study designed to evaluate uterine leiomyoma growth and correlate symptoms and outcomes in a clinically relevant population of women (Fibroid Growth Study)

Glial cell line‐derived neurotrophic factor increases matrix metallopeptidase 9 and 14 expression in microglia and promotes microglia‐mediated glioma progression

Glial cell line‐derived neurotrophic factor (GDNF) is released by glioma cells and promotes tumor growth. We have previously found that GDNF released from the tumor cells is a chemoattractant for microglial cells, the immune cells of the central nervous system. Here we show that GDNF increases matrix metalloproteinase (MMP) 9 and MMP14 expression in cultured microglial cells from mixed sexes of neonatal mice. The GDNF‐induced microglial MMP9 and MMP14 upregulation is mediated by GDNF family receptor alpha 1 receptors and dependent on p38 mitogen‐activated protein kinase signaling. In organotypic brain slices, GDNF promotes the growth of glioma and this effect depends on the presence of microglia. We also previously found that MMP9 and MMP14 upregulation can be mediated by Toll‐like receptor (TLR) 2 signaling and here we demonstrate that GDNF increases the expression of TLR1 and TLR2. In conclusion, GDNF promotes the pro‐tumorigenic phenotype of microglia

An outbreak of coxsackievirus A6 hand, foot, and mouth disease associated with onychomadesis in Taiwan, 2010

<p>Abstract</p> <p>Background</p> <p>In 2010, an outbreak of coxsackievirus A6 (CA6) hand, foot and mouth disease (HFMD) occurred in Taiwan and some patients presented with onychomadesis and desquamation following HFMD. Therefore, we performed an epidemiological and molecular investigation to elucidate the characteristics of this outbreak.</p> <p>Methods</p> <p>Patients who had HFMD with positive enterovirus isolation results were enrolled. We performed a telephone interview with enrolled patients or their caregivers to collect information concerning symptoms, treatments, the presence of desquamation, and the presence of nail abnormalities. The serotypes of the enterovirus isolates were determined using indirect immunofluorescence assays. The VP1 gene was sequenced and the phylogenetic tree for the current CA6 strains in 2010, 52 previous CA6 strains isolated in Taiwan from 1998 through 2009, along with 8 reference sequences from other countries was constructed using the neighbor-joining command in MEGA software.</p> <p>Results</p> <p>Of the 130 patients with laboratory-confirmed CA6 infection, some patients with CA6 infection also had eruptions around the perioral area (28, 22%), the trunk and/or the neck (39, 30%) and generalized skin eruptions (6, 5%) in addition to the typical presentation of skin eruptions on the hands, feet, and mouths. Sixty-six (51%) CA6 patients experienced desquamation of palms and soles after the infection episode and 48 (37%) CA6 patients developed onychomadesis, which only occurred in 7 (5%) of 145 cases with non-CA6 enterovirus infection (<it>p </it>< 0.001). The sequences of viral protein 1 of CA6 in 2010 differ from those found in Taiwan before 2010, but are similar to those found in patients in Finland in 2008.</p> <p>Conclusions</p> <p>HFMD patients with CA6 infection experienced symptoms targeting a broader spectrum of skin sites and more profound tissue destruction, i.e., desquamation and nail abnormalities.</p