No abstract available.
Onycholysis*

Onycholysis is defined as a distal or distal lateral separation of the nail plate from the underlying or lateral supporting structures including nail bed, hyponychium, and lateral nail fold. Trauma, infection, psoriasis, thyrotoxicosis, and numerous drugs are common causes of onycholysis. However, there are few specific data on nail findings in Behcet's disease (BD). In this paper, we report on a 60-year-old man with BD, with no past history except BD, who developed recurrent onycholysis. The symptoms of onycholysis are considered to be recurrent depending on the activity of BD. The nail lesion showed improvement after classic treatment of BD and topical steroid ointment.
Humans ; Middle Aged ; Onycholysis* ; Psoriasis ; Thyrotoxicosis

BACKGROUND: Intra-lesional triamcinolone injection is a widely used treatment modality of onychodystrophy. However, clinical evaluation has rarely been performed for the therapeutic effect of intra-lesional triamcinolone injection in the treatment of idiopathic onychodystrophy, except for psoriatic nail. OBJECTIVE: The purpose of this study was to investigate the therapeutic effect of intra-lesional triamcinolone injection on idiopathic onychodystrophy. METHODS: A total of 43 patients diagnosed as idiopathic onychodystrophy were enrolled in this study. At first 2 visits, triamcinolone acetonide (2.5mg/ml) was injected into the proximal nail fold of each nail using the dermo-jet. Thereafter, intra-lesional injection was performed at 4-week intervals with two-fold increased concentration of triamcinolone acetonide (5mg/ml). After a total of 7 treatments, the treated nails were scored by both doctor and patient between 0 and 10 according to the severity. RESULTS: In 26 patients treated for more than 12-weeks, 189 nails were eventually assessed by four grade scale. Therapeutic effects were as follows; excellent improvement in 19.8%, good in 28.8%, moderate in 11.6%, and poor in 38.6%. Onycholysis responded well to this treatment, with 81.1% of good to excellent improvement, whereas trachyonychia was resistent with 78.1% of poor to moderate improvement. There was no significant side effect, except pain on the injection site. CONCLUSION: According to our results, intra-lesional injection of triamcinolone acetonide is an effective and safe treatment modality of idiopathic onychodystrophy. It is suggested that, with intra-lesional triamcinolone injection, the morphologic classification is an important prognostic factor in the treatment of idiopathic onychodystrophy.
Classification ; Humans ; Onycholysis ; Triamcinolone Acetonide ; Triamcinolone*

No abstract available.
Humans ; Mucocutaneous Lymph Node Syndrome* ; Onycholysis*

BACKGROUND: Onychomycosis is a common fungal nail infection. Characteristic features include ungual and subungual hyperkeratosis, discoloration, onycholysis, nail dystrophy, and periungal pain which may cause cosmetic, social, and psychologic problem to the patients. OBJECTIVE: Our purpose is to evaluate quality of life in patients with onychomycosis. METHOD: We interviewed 100 patients with onychomycosis which was diagnosed by clinical finding and KOH preparation. RESULT: Frequently observed signs and symptoms of onychomycosis were discoloration of nail, hyperkeratosis, nail dystrophy, onycholysis, periungual pain, and periungual inflammation, in descending order Source of infection suspected by patients included military service, shoes, tines pedis, prolonged contact with water, trauma, etc. Most patients suffered from problems with daily and social activity, and psychologic problem at the rate of 64%, 58%, 66%, respectively. Patients who wanted to take medication or treatment were 73%, but they also had several worries about treatment. CONCLUSION: Many patients with onychomycosis suffered from problems with daily and social activity, and psychologic problem. Therefore, more attention should be paid to the patients with onychomycosis as the development of cultural, social, and economic status.
Humans ; Inflammation ; Military Personnel ; Onycholysis ; Onychomycosis* ; Quality of Life* ; Shoes ; Water

Green nail syndrome (chromonychia) is a nail disorder characterized by onycholysis and green-black discoloration of the nail bed. This condition is often associated with chronic paronychia. Pseudomonas aeruginosa is the most commonly identified organism in cultures from the affected area. Despite the various treatment options available, removal of the nail is still necessary in many cases. A 35-year-old man presented with dark-greenish discoloration of the nail plate and onycholysis on the left thumbnail. He had been treated with oral antifungal and antibiotic agents for several months; however, the lesion showed no improvement. The diagnosis of green nail syndrome was established after a positive bacterial culture, and on the basis of the antibiotic sensitivity test result, tobramycin eye drop (Tobrex(R)) was then prescribed. Three weeks later, the nail discoloration almost vanished but the onycholysis remained. Herein, we recommend the application of tobramycin eye drop as an easy and safe treatment option for green nail syndrome.
Adult ; Diagnosis ; Humans ; Onycholysis ; Paronychia ; Pseudomonas aeruginosa ; Tobramycin*

Subungual keratoacanthoma is a rare, benign tumor occurring mainly on the thumb of middle-aged Caucasians. It presents as a painful keratotic papule or nodule accompanied by consequential partial onycholysis and bacterial infections. Unlike keratoacanthoma of other sites, subungual keratoacanthoma is not spontaneously resolved and surgical interventions have been recommended for treatment. It also needs to be differentiated from other subungual lesions, especially squamous cell carcinoma. We describe a case of subungual keratoacanthoma, which was completely resolved with extraction of the nail followed by oral methotrexate(MTX) medication.
Bacterial Infections ; Carcinoma, Squamous Cell ; Keratoacanthoma* ; Onycholysis ; Thumb

BACKGROUND: The treatment of onychomycosis has improved recently. However, for 25% of patients, persistent disease remains a problem. Predisposing factors that contribute to a poor treatment response include a thick nail, extensive nail involvement, lateral nail involvement, dermatophytoma, onycholysis and yellow spikes. OBJECTIVES: Our purpose was to study the clinical characteristics of onychomycosis contributing to the prognosis. METHODS: On the basis of the charts, photographs and telephone-visiting of the patients who visited St. Mary's hospital from January 2000 to May 2004, we investigated the number and percentage of good-responders according to each prognostic factor and the number of factors. RESULTS: 1. KOH smear, fungus culture and KONCPA test showed positivity rates of 61.0% (347/569), 17.4% (101/581) and 75.1% (284/378), respectively. 2. Triple tests showed positivity rate of 86.9% (271/312) by one or more of the triple tests. 3. The number and percentage of good-responders as a whole was 63.0% (400/635). The 5 prognostic factors contributed to statistically significant outcomes (p< 0.05), and the number and percentage of good-responders showing statistical significance were 53.1% (139/262) in the old-age group (odds ratio (OR) 2.1), 70.0% in the non-old-age; 19.2% (9/47) in the dermatophytoma group (OR 8.4), 66.5% (391/588) in the non-dermatophytoma; 35.3% (18/51) in the yellow-spike group (OR 3.5), 65.4% (382/584) in the non-yellow-spike; 19.5% (32/164) in the thick-nail group (OR 14.7), 78.1% (368/471) in the non-thick-nail; and 35.6% (36/101) in the involvement-more-than-50% group (OR 3.9), 68.2% (364/534) in the involvement-less-than-50%. 4. The 2 prognostic factors did not contribute to the outcomes statistically (p> 0.05) and the number and percentage of good-responders showing no statistical significance were 60.4% (58/96) in the onycholysis group, 63.5% (342/539) in the non-onycholysis; and 62.9% (44/70) in the lateral-involvement group, 63.0% (356/565) in the non-lateral-involvement. 5. The number and percentage of good-responders according to the number of prognostic factors were 92.6% (162/175) in 0-factor group, 62.3% (157/252) in 1-factor, 52.0% (64/123) in 2-factor and 30.9% (17/55) in 3-factor. CONCLUSIONS: Clinical outcomes of onychomycosis depend on what kind of prognostic factor or how many factors the patient has. Therefore, the clinical prognostic factors should be considered before starting the treatment for predicting prognosis and planning therapeutic modalities.
Causality ; Fungi ; Humans ; Odds Ratio ; Onycholysis ; Onychomycosis* ; Prognosis*

BACKGROUND: Treatment of onychomycosis should be commenced after mycological confirmation due to the side effects and long duration of oral antifungal agents. However, many doctors treat patients with nail disorders that resemble onychomycosis without any mycological examination (ME) in clinical practice. OBJECTIVE: To investigate the various nail disorders misdiagnosed as onychomycosis and to evaluate the performing ratios of appropriate diagnostic procedures of onychomycosis. METHODS: The study was performed in a total of 48 patients who had a history of being misdiagnosed and treated for onychomycosis. We investigated the characteristics of each patient, the specialty of their previous doctor, and their previous treatment modality and duration. Whether or not they had previously received proper diagnostic procedures was also investigated. All of the data were collected by questionnaires, and their final diagnoses were also recorded. RESULTS: Among the 48 patients, 31 (31/48, 64.7%) were female, and the mean age of the patients was 45.5+/-15.7. Eighteen patients (18/48, 37.5%) were referred from dermatologists and 30 (30/48, 65.2%) from non-dermatologists. The results of the questionnaires revealed that only 10 of the dermatologists (10/18, 55.6%) performed ME before initiating treatment for onychomycosis, and none of the non-dermatologists did it. The duration of incorrect previous systemic anti-fungal treatment was also significantly longer when administered by non-dermatologists as compared with dermatologists (p=0.042), and over half of the patients (30/46, 65.2%) were treated with fluconazole. Onycholysis (22/48, 45.8%) and trachyonychia (18/48, 37.5%) were the most common final diagnoses, but various nail disorders such as pitting nail, median nail dystrophy, and subungual melanoma were also included. CONCLUSION: To avoid misdiagnosis and incorrect anti-fungal treatment, people with nail disorders that resemble onychomycosis should be recommended to visit dermatologists, and the doctors should perform appropriate mycological examinations in these patients.
Antifungal Agents ; Diagnostic Errors ; Female ; Fluconazole ; Humans ; Melanoma ; Nails ; Onycholysis ; Onychomycosis ; Questionnaires

BACKGROUND: Toenail onychomycosis still remains difficult to treat. Pulse therapy of itraconazole is frequently prescribed to lighten the patient's burden of economical problems, frequent side effects, resulting in good compliance. OBJECTIVE: The purpose of this study is to evaluate the clinical efficacy and adverse reactions of pulse therapy of itraconazole. METHODS: From March to September 1996, a total of 108 patients with onychomycosis of toenail diagnosed at Department of Dermatology of 5 university hospitals, were enrolled in a subject group for the study. Itraconazole was administered, 200 mg twice daily, in every first week of 3 consecutive months. Clinical symptoms and sings with or without mycologic findings were assessed at baseline, at the end of 4, 8, 12, 24, 36 and 48 weeks after the start of therapy. RESULTS: Fifty six patients (male 22, female 34; mean age 44.0+/-13.3) completed the follow-ups. As causative agents, Trichophyton(T.) rubrum was isolated in 51 of them, T. mentagrophytes 2, and yeast 3. Decrease in initial percentages of patients showing pathologic changes in target nail at the last follow-up 12 months after starting therapy : for onycholysis, from 51.8% to 21.4%; for subungual hyperkeratosis, from 96.4% to 39.3%; for nail discoloration, from 100.0% to 50.0%. Mycological cure rate was 82.1% at the last follow-up. Overall clinical responses evaluated at the last follow-up were cured in 28 patients (50.0%), 'markedly improved' in 15 (26.8%), 'moderately improved' in 9 (16.1%), and 'deteriorated' in 4 (7.1%), making a clinical response rate of 92.9%. During therapy, transient epigastric pain and indigestion developed in 2 patients (3.6%), respectively. CONCLUSION: With these results, itraconazole pulse therapy is considered an effective and safe treatment modality for onychomycosis of toenail.
Compliance ; Dermatology ; Dyspepsia ; Female ; Follow-Up Studies ; Hospitals, University ; Humans ; Itraconazole* ; Nails* ; Onycholysis ; Onychomycosis* ; Yeasts