Paronychia is an inflammation of the folds of tissue surrounding the nail of a toe or finger. Paronychia may be classified as either acute or chronic. The main factor associated with the development of acute paronychia is direct or indirect trauma to the cuticle or nail fold. This enables pathogens to inoculate the nail, resulting in infection. Treatment options for acute paronychia include warm compresses; topical antibiotics, with or without corticosteroids; oral antibiotics; or surgical incision and drainage for more severe cases. Chronic paronychia is a multifactorial inflammatory reaction of the proximal nail fold to irritants and allergens. The patient should avoid exposure to contact irritants; treatment of underlying inflammation and infection is recommended, using a combination of a broad-spectrum topical antifungal agent and a corticosteroid. Application of emollient lotions may be beneficial. Topical steroid creams are more effective than systemic antifungals in the treatment of chronic paronychia. In recalcitrant chronic paronychia, en bloc excision of the proximal nail fold is an option. Alternatively, an eponychial marsupialization, with or without nail removal, may be performed. (+info)
Post traumatic amelanotic subungual melanoma.
Subungual melanomas are rare; a delay in the diagnosis is common and is associated with advanced stage. Part of the reason for a delay in presentation to the physician is that patients often attribute the lesion to trauma. Trauma may play a role in the pathogenesis or just draw attention to a skin tumor that may be more susceptible to injury. We report a case of subungual melanoma that was observed in an 86 year old man. The preceding trauma history and misleading clinical appearance delayed the diagnosis slightly. Biopsy of every nodular acral tumor is very important. A direct role of the trauma in the pathogenesis of melanoma remains unclear. (+info)
Subungual squamous cell carcinoma masquerading as a melanotic macule.
Subungual squamous cell carcinoma is a rare condition. Diagnosis is often delayed because it presents with minimal nail changes and mimics a number of benign nail conditions. We report a 43-year-old Chinese man who presented with a three-year history of an indolent melanotic macule of the fingernail. Histology from a punch biopsy revealed a well-differentiated squamous cell carcinoma. Wide local excision with full thickness skin grafting was performed. Physicians should have a high index of clinical suspicion as early nail biopsy and prompt tumour clearance can preserve joint function. (+info)
Adverse effects of antiretroviral treatment.
BACKGROUND: The introduction of highly active antiretroviral therapy (HAART) has led to significant reduction in acquired immune deficiency syndrome (AIDS)-related morbidity and mortality. Adverse drug reactions (ADRs) to antiretroviral treatment (ART) are however, major obstacles in its success. AIMS: We sought to study the adverse effects of ART in a resource-restricted setting in India. METHODS: Hundred patients on ART were studied prospectively over a period of two years. All patients were asked to visit the clinic if they developed any symptoms or on a monthly basis. They were screened clinically and investigated suitably for any ADRs. RESULT: Out of the 100 patients, ten patients did not come for follow-up; only 90 cases were available for evaluation. ADRs were observed in 64 cases (71.1%) - the maximal frequency of ADRs was seen with zidovudine (AZT) (50%) followed by stavudine (d4T) (47.9%), efavirenz (EFV) (45.4%) and finally, Nevirapine (NVP) (18.4%). Most common ADRs were cutaneous (44.4%) followed by hematological (32.2%), neurological (31.1%), metabolic (22.2%) and gastrointestinal (20%). Most common cutaneous ADRs observed were nail hyperpigmentation (14.4%) and rash (13.3%). Immune reconstitution inflammatory syndrome (IRIS) was observed as a paradoxical reaction to ART in 20 (22.2%) cases. CONCLUSION: To optimize adherence and thus, efficacy of ART, clinicians must focus on preventing adverse effects whenever possible, and distinguish those that are self-limited from those that are potentially serious. (+info)
Glomus tumor-induced longitudinal splitting of nail mimicking median canaliform dystrophy.
Median canaliform deformity of the nail is an uncommon entity, where there is longitudinal splitting of the nail. Longitudinal splitting of the nail is a rare phenomenon and can also occur following number of growths arising in the nail matrix. On examination there was a longitudinal split in the nail plate, beginning in the distal nail fold and extending proximally all the way to the proximal nail fold. There was a small, almost indiscernible, swelling in that area, which was exquisitely tender. The split part of the nail showed a little discoloration. There was no discharge, bleeding, or subungual mass visible. 'Love test' was positive in this case. After nail avulsion, a small 2 mm x 4 mm nodule was exposed and excised. Histopathological examination of the tumor showed a mantle of glomus cells surrounding the blood vessels. (+info)
Incidence and clinical predictors of psoriatic arthritis in patients with psoriasis: a population-based study.
Congenital hypoaldosteronism associated with nails hypothrophy - case report and review of the literature.
We report 15 years follow-up of a girl born with nails hypothrophy and primary hypoaldosteronism. The failure to thrive, troubles with feeding and vomiting were observed since the first weeks of life. The results of the laboratory examination confirmed isolated hypoaldosteronism. The growth velocity was diminished and short stature was present during first 4 years of life. Thyroid and pituitary disturbances were excluded. At the age of 4 the treatment with fludrocortisone was gradually discontinued without clinical manifestation of aldosteron deficiency. The child was on high sodium chloride diet. The growth velocity improved. At the age of 7,5 years pubarche, lipid and carbohydrate disturbances occurred. The bone age was adequate to chronological age. The treatment with Cortineff and diet modification were recommended. Further improving in growth velocity and lowering in salt consumption were observed. Menarche occurred at the age of 12 years 8 months with subsequent monthly bleedings. She finished growth with height SDS -2.52 (target height SDS -1.71), and BMI SDS 1.83. The nails hypothrophy still maintains. (+info)
Identification of 6 sentinel lymph nodes in a case of malignant melanoma on the ungual region of the finger.
We describe a case of malignant melanoma on the ungual region of the index finger with which 6 sentinel lymph nodes were detected in the axillary basin. Of these nodes, 1 of 3 brachial nodes and 2 of 3 central axillary nodes showed micrometastasis. Additional lymph nodes obtained at the subsequent complete axillary lymph node dissection showed no metastasis. Identification of as many as 6 sentinel lymph nodes was ascribed to a single lymph trunk that would branch off to afferent lymphatics draining to each nodal group; however, a gamma probe may have detected radioactive tracer passing to the sequential nodes as well as that remaining in true sentinel nodes. (+info)