A 70-year-old woman with yellow nail syndrome and right-sided pleural effusion, lower extremity edema, and hypoalbuminemia was followed for 18 months. She reported an 8-year history of asthma. She had four children (3 boys and 1 girl). Dystrophy, changes in color and shape of nails both hands and foot, along with lower extremity edema was observed in the daughter and two of her sons. One son had asthma. The patient reported that her grandmother had similar nail abnormality and lower extremity edema. Other family members and patient's grandchildren were healthy. This report demonstrates a case of familial yellow-nail syndrome. (+info)
Cutaneous manifestations in patients with chronic renal failure on hemodialysis.
BACKGROUND: Chronic renal failure (CRF) presents with an array of cutaneous manifestations. Newer changes are being described since the advent of hemodialysis, which prolongs the life expectancy, giving time for these changes to manifest. AIM: The aim of this study was to evaluate the prevalence of dermatologic problems among patients with chronic renal failure (CRF) undergoing hemodialysis. METHODS: One hundred patients with CRF on hemodialysis were examined for cutaneous changes. RESULTS: Eighty-two per cent patients complained of some skin problem. However, on examination, all patients had at least one skin lesion attributable to CRF. The most prevalent finding was xerosis (79%), followed by pallor (60%), pruritus (53%) and cutaneous pigmentation (43%). Other cutaneous manifestations included Kyrle's disease (21%); fungal (30%), bacterial (13%) and viral (12%) infections; uremic frost (3%); purpura (9%); gynecomastia (1%); and dermatitis (2%). The nail changes included half and half nail (21%), koilonychia (18%), onychomycosis (19%), subungual hyperkeratosis (12%), onycholysis (10%), splinter hemorrhages (5%), Mees' lines (7%), Muehrcke's lines (5%) and Beau's lines (2%). Hair changes included sparse body hair (30%), sparse scalp hair (11%) and brittle and lusterless hair (16%). Oral changes included macroglossia with teeth markings (35%), xerostomia (31%), ulcerative stomatitis (29%), angular cheilitis (12%) and uremic breath (8%). Some rare manifestations of CRF like uremic frost, gynecomastia and pseudo-Kaposi's sarcoma were also observed. CONCLUSIONS: CRF is associated with a complex array of cutaneous manifestations caused either by the disease or by treatment. The commonest are xerosis and pruritus and the early recognition of cutaneous signs can relieve suffering and decrease morbidity. (+info)
The relationship between the extensor tendon enthesis and the nail in distal interphalangeal joint disease in psoriatic arthritis--a high-resolution MRI and histological study.
OBJECTIVES: Diffuse swelling of the distal interphalangeal (DIP) joint beyond the joint margin is a common feature of arthritis in psoriatic arthritis (PsA). The purpose of this study was to explore the microanatomical basis for the inflammation and nail disease in PsA using a combined high-resolution magnetic resonance imaging (MRI) and histological studies. METHODS: High-resolution MRIs of the DIP joint were obtained in 30 subjects [10 PsA, 10 osteoarthritis (OA) and 10 normal volunteers]. The relationship between the DIP joint capsule and associated tendon enthesis and the nail bed and root were evaluated. Histological studies to define the relationship between the normal cadaveric DIP joint capsule and the nail root were performed on the middle and ring fingers of 10 dissecting room cadavers. RESULTS: On MRI, the dorsal capsular enthesis was the epicentre of an inflammatory reaction. This extended to involve the soft tissues adjacent to the nail in 8 of 10 cases in PsA, but only 4 of 10 cases in OA where the inflammation is less intense and in none of the normal fingers. The DIP joint capsule was intimately linked with the nail complex on histology, with the dorsal, volar and lateral aspects of the nail bed being ensheathed in fibres extending from the entheses. CONCLUSION: The study suggests that the extended nature of the enthesis organ associated with the DIP joint may explain the diffuse nature of the inflammatory response around the nail in PsA. Therefore the nail is as much an integral part of the enthesis organ as it is of the skin, which has implications for a better understanding of the disease. (+info)
Histologic features and clinical outcomes of melanomas of lip, haired skin, and nail bed locations of dogs.
Outcomes, signalments, and the relationship of histologic features with the outcome of melanomas located in lip, nail bed, and haired skin of dogs were reviewed. These melanomas were diagnosed as benign or malignant based on histologic features. Melanomas of the lip arose from mucous membrane in most cases. 32 dogs with lip melanomas that had histologic features of malignancy, 22 died because of the tumor within 1 year and 10 were tumor free for at least 1 year following removal. Of 10 dogs with melanomas with benign histologic features on the mucous membrane of the lip, 9 were tumor free for at least 1 year. Of 4 dogs with benign appearing tumors of the haired skin of the lip, 3 were tumor free for at least 1 year. Melanomas with histologic features of malignancy occurred in many locations of haired skin, and 11 of 24 dogs were tumor free for at least 1 year. All nail bed melanomas had histologic features of malignancy and all invaded the third phalanx, but 6 of 14 dogs were tumor free for at least 1 year after amputation of the digit. Among these dogs, the 1-year survival rates for tumors classified as malignant by histologic features were 31% [corrected] for lip, 46% for haired skin, and 43% for nail bed. However, the clinical outcome of an individual malignant tumor could not be predicted accurately by any specific histologic features. (+info)
Chronic paronychia--putting a finger on the evidence.
At first glance it seemed a minor problem, but the look on my new patient's face suggested otherwise. His finger had been painful for months and this week it had become worse. His swollen, erythematous nail fold, absent cuticle, and mildly dystrophic nail painted a typical picture of chronic paronychia. Assuming an acute bacterial superinfection, I prescribed a course of antibiotics, but my patient needed advice on treatment of the underlying condition. Another general practitioner had arranged fungal cultures, which had grown candida. Would antifungals be the best treatment? My patient and I agreed to meet in a week to assess his response to the antibiotics and to discuss treatment of the underlying chronic paronychia. (+info)
"Hitting the nail on the head".
Subungual malignant melanoma is a rare form of malignancy that can present at an advanced stage. We describe a case that was diagnosed after a presentation to the emergency department for a traumatic injury of the affected area. Initial presentations of malignant disease and its complications form a relatively low proportion of the caseload of emergency doctors. In this case, a patient presented after a minor injury that had failed to recover; subsequent investigation of this injury led to the diagnosis of subungual malignant melanoma in an otherwise asymptomatic patient. This is a rare case which presented in an atypical fashion, with a confounding history of minor trauma. It is presented to highlight the differential diagnosis of destructive bone lesions. (+info)
Docetaxel-induced onycholysis: the role of subungual hemorrhage and suppuration.
Nail changes are common side effects of taxane chemotherapeutic agents. Docetaxel (Taxotere) is known to cause a great incidence of nail change. Various types of nail changes have previously been reported as a result of treatment with taxanes. We describe 2 cases of severe nail changes induced by docetaxel. The patients had previously been diagnosed with breast cancer and advanced gastric cancer, respectively. During the course of treatment with docetaxel, nail changes became apparent in both patients. Initially, they complained of nail bed purpura. Subungual hematomas with hemopurulent discharge were later observed in several fingers. Drainage of the hemopurulent material occurred spontaneously in our cases, leading to onycholysis. Following drainage, the pain in the nail with subungual hemoprulent material was relieved immediately and spontaneous healing of the patients' nails was noticed after few months. Subungual hemorrhage and suppuration therefore are considered causes of onycholysis and the pain in these patients. Although systemic or topical antibiotics were not used to treat these patients, antibiotics may be also worthwhile to hasten the drainage of the subungual hematomas and suppuration in patients for quick relief of pain. (+info)
Weakness in intercellular association of keratinocytes in severely brittle nails.
The brittle fingernail is a common complaint, but the features of the cellular structure of the nail plate remain unclear. In this study, clipped nailplates from two persons with severely brittle nails, one female aged 26 years and one male aged 82 years, were observed by light and electron microscopy and compared with normal nail plates. Numerous cracks were observed in clipped brittle nails, but not in normal nails, on light microscopy. When the deep areas of nail plates of the clipped normal nails were observed by electron microscopy, intercellular boundaries appeared intermingled, and two thin, electron-dense layers were observed in a narrow intercellular gap. In contrast, in brittle nails, marked dilatation of intercellular spaces was frequently observed and electron-dense layers were either not seen or were disrupted. When clipped normal nails were dehydrated in a desiccation chamber, similar dilatations - though not so severe -were observed, without evident cracks. These results suggest that dilatation of the intercellular space between nail keratinocytes is correlated with brittle nails and that dehydration may result in such intercellular dilatation. (+info)