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

BACKGROUND: Hair and nails are known to be related in their origin and anatomical structures, and they are similar in their structure and growth pattern. Nail changes were first reported to be associated with alopecia areata (AA) in 1898. One of the clinical features of AA is nail abnormalities, and these are found in 7% to 66% of patients with AA. OBJECTIVE: We evaluated the frequency, clinical presentation, and associated factors of nail changes in patients with AA. METHODS: A prospective study of 121 patients with AA was performed. The diagnosis of AA was made on clinical grounds. Patients' medical history was obtained, and thorough examinations were performed. Patients with other diseases associated with nail changes were all excluded from the study. The association between the clinical features of patients with AA and the prevalence of nail changes was evaluated using logistic regression analysis. RESULTS: Of the 121 patients, 40 (33%) presented with nail changes. In multivariable analysis, younger age (compared with ≥19 years old; odds ratio [OR] 3.663, 95% confidence interval [CI] 1.094~12.346, p=0.035), chronicity (disease duration ≥2 years; OR 2.852, 95% CI 1.230~6.613, p=0.015), and disease subtype (alopecia totalis and alopecia universalis); OR 5.846, 95% CI 1.078~31.717, p=0.041) were identified as independent factors associated with nail changes in patients with AA. Among the nail abnormalities identified, nail pitting was the most common, observed in 20 patients (50%). Trachyonychia was present in 7 patients (16%), leukonychia in 7 (16%), and Beau line in 5 (11%). Other changes were also observed, including melanonychia, onycholysis, absence of lunula, and onychoschizia. CONCLUSION: In conclusion, younger age, chronicity, and disease subtype (alopecia totalis and alopecia universalis) were shown to be independent relevant indicators of the nail changes in patients with AA.
Alopecia Areata* ; Alopecia* ; Diagnosis ; Hair ; Humans ; Logistic Models ; Nails, Malformed ; Odds Ratio ; Onycholysis ; Prevalence ; Prospective Studies

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: There have been a few reported cases of congenital great toenail dystrophy (GTND), described as a congenital malalignment of the great toenails. However, acquired GTDN is rare, and has not been documented extensively. This study aimed to describe the clinical features of 21 patients with acquired GTND. METHODS: Twenty-one patients with acquired GTND who visited Yeouido St. Mary's Hospital between June 2005 and August 2012 were retrospectively reviewed. RESULTS: The mean patient age was 43.1 years (range, 17 to 88 years), and the cohort predominantly comprised women (18/21). In our experience, all acquired GTND patients presented with yellow or yellow-brownish chromonychia, onychotrophy, and onycholysis. Conservative treatment with tape methods and grinding, as well as nail extraction, was provided and yielded little improvement in any case. CONCLUSION: This study provides initial data on the nail changes affecting the great toenail, such as yellowish chromonychia, onychomadesis, and onycholysis. These data may help physicians to distinguish various nail disorders, including onychomycosis, congenital malalignment of the great toenails, and yellow nail syndrome.
Cohort Studies ; Female ; Humans ; Nails* ; Onycholysis ; Onychomycosis ; Retrospective Studies ; Yellow Nail Syndrome

Psoriatic onycho-pachydermo-periostitis (POPP) causes severe nail dystrophy, painful soft tissue swelling, and marked periosteal reaction of the involved distal phalanx. There are few reports of POPP involving the great toe. We report on 2 cases of POPP involving the fingertips. A 60-year-old woman presented with fusiform swelling of her right 4th fingertip with severe tenderness, and her fingernails and toenails had varying degrees of onycholysis. She had mixed multiple erosions and meta-epiphyseal periostitis at the distal phalanx of the right 4th finger but was treated successfully with methotrexate and cyclosporine. A 39-year-old woman presented with painful swelling of the left 2nd and 5th fingertip, psoriatic lesions on the knees and soles of the feet, and onycholysis without reactive periostitis of the left 2nd and 5th fingers. She was treated successfully with cyclosporine. Despite its rarity, POPP should be considered when diagnosing arthritic or infectious conditions affecting the distal interphalangeal joint.
Adult ; Arthritis ; Cyclosporine ; Female ; Fingers ; Foot ; Humans ; Joints ; Knee ; Methotrexate ; Middle Aged ; Nails ; Onycholysis ; Periostitis ; Psoriasis ; Toes

No abstract available.
Onycholysis*

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*

Chronic mucocutaneous candidiasis is a rare syndrome characterized by persistent and refractory infection of the skin, nail and mucosal tissue by yeasts of the genus Candida. A 70-year-old woman presented with the following skin lesions: ill-defined annular shaped whitish macules on the upper and lower lips accompanying dryness, pain and burning sensation, and yellowish discoloration with onycholysis of the right 4th finger nail. The upper lip lesion showed histopathologic feature of band-like infiltration of lymphocytes in the upper dermis, consistent with lichen planus. But, systemic glucocorticoid was not effective in treating erosive lip lesions. KOH examination and fungal culture of specimens from the upper lip showed hyphal elements and growth of Candida albicans, respectively. Antifungal agent was administered. After the oral medication, skin lesions were improved but there was repeated recurrence. We report a case of chronic mucocutaneous candidiasis misdiagnosed as lichen planus.
Burns ; Candida ; Candida albicans ; Candidiasis, Chronic Mucocutaneous ; Dermis ; Female ; Fingers ; Humans ; Lichen Planus ; Lichens ; Lip ; Lymphocytes ; Mucous Membrane ; Nails ; Onycholysis ; Recurrence ; Sensation ; Skin ; Yeasts

Psoriatic arthritis (PsA) is an autoimmune arthritis related to psoriasis and one of seronegative spondyloarthropathies. PsA provokes joint pain and morning stiffness more than 30 minutes, which is relieved by exercise. PsA usually affects distal small joints and exhibits asymmetry, which is one of the typical characteristics of PsA and gives clues to make a differential diagnosis between PsA and rheumatoid arthritis. Thirty to forty patients with PsA experience arthritis in one large joint or asymmetric multiple joints. Arthritis in distal joints and arthritis mutilans often develop concurrently and patterns of PsA change along with disease progression. Spondylitis is observed in 20-30% of PsA patients. In contrast to ankylosing spondylitis, spondylitis in PsA present with mild clinical symptoms despite radiological progression, inflammation limited to one spinal tract, cervical spine dominance, non-marginal syndesmophytosis. Enthesitis is also one of the typical characteristics of PsA and it frequently affects Achilles tendon, plantar fascia and tendons inserting pelvic bones. Tenosynovitis can develop accompanied by enthesitis. Typical dactylitis (sausage digit), pitting edema and nail lesions, including nail pits, onycholysis, hyperkeratosis and splinter hemorrhage, also contribute to a differential diagnosis of PsA. Anterior uveitis, SAPHO syndrome, amyloidosis and IgA nephropathy are well-known extra-articular manifestation of PsA. In 2006, a new classification-criterion for PsA was suggested by the CASPAR study. The CASPAR criteria included 5 categories with a certain number of points; 1) skin psoriasis, 2) nail lesions, 3) dactylitis, 4) negative RF and 5) bone formation around joints. The CASPAR criteria should be applied to PsA patients having at least one of three (peripheral arthritis, spondylitis and enthesitis).
Achilles Tendon ; Acquired Hyperostosis Syndrome ; Amyloidosis ; Arthralgia ; Arthritis ; Arthritis, Psoriatic ; Arthritis, Rheumatoid ; Diagnosis, Differential ; Disease Progression ; Edema ; Fascia ; Glomerulonephritis, IGA ; Hemorrhage ; Humans ; Inflammation ; Joints ; Nails ; Onycholysis ; Osteogenesis ; Pelvic Bones ; Psoriasis ; Skin ; Spine ; Spondylarthropathies ; Spondylitis ; Spondylitis, Ankylosing ; Tendons ; Tenosynovitis ; Uveitis, Anterior

Onychomycosis is usually caused by dermatophytes, but some species of nondermatophytic molds and yeasts are also associated with nail invasion. Aspergillus niger is a nondermatophytic mold which exists as an opportunistic filamentous fungus in all environments. Here, we report a case of onychomycosis caused by A. niger in a 66-year-old female. The patient presented with a black discoloration and a milky white base and onycholysis on the proximal portion of the right thumb nail. Direct microscopic examination of scrapings after potassium hydroxide (KOH) preparation revealed dichotomous septate hyphae. Repeated cultures on Sabouraud's dextrose agar (SDA) without cycloheximide produced the same black velvety colonies. No colony growth occurred on SDA with cycloheximide slants. Biseriate phialides covering the entire vesicle with radiate conidial heads were observed on the slide culture. The DNA sequence of the internal transcribed spacer region of the clinical sample was a 100% match to that of A. niger strain ATCC 16888 (GenBank accession number AY373852). A. niger was confirmed by KOH mount, colony identification, light microscopic morphology, and DNA sequence analysis. The patient was treated orally with 250 mg terbinafine daily and topical amorolfine 5% nail lacquer for 3 months. As a result, the patient was completely cured clinically and mycologically.
Agar ; Aged ; Arthrodermataceae ; Aspergillus ; Aspergillus niger ; Base Sequence ; Cycloheximide ; Female ; Fungi ; Glucose ; Head ; Humans ; Hydroxides ; Hyphae ; Lacquer ; Light ; Morpholines ; Nails ; Naphthalenes ; Niger ; Onycholysis ; Onychomycosis ; Potassium ; Potassium Compounds ; Sequence Analysis, DNA ; Sprains and Strains ; Thumb ; Yeasts