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The diagnosis of pigmented nail lesions is a concern for both general practitioners and dermatologists, due to the possibility of indicating nail melanoma. The origin of the dark pigmentation can be either melanocytic or non-melanocytic (fungi, bacteria, or blood), and clinical evaluation alone may not be sufficient for differentiation, requiring additional exams. Onychoscopy provides valuable information prior to biopsy. The causes of nail pigmentation will be described to aid in the differential diagnosis.
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INTRODUCTION: Transverse overcurvature of the nail (TON) represents one of the main reasons for dermatological consultations due to nail conditions. Association between TON and subungual hyperkeratosis is common and simulates onychomycosis, constituting a difficult differential diagnosis by clinical features. Many cases are treated in daily practice with antifungal therapy even without mycological confirmation. The aim of this study was to determine the prevalence of onychomycosis among patients with TON associated with subungual hyperkeratosis. METHODS: All subjects with clinical diagnosis of TON and subungual hyperkeratosis were subjected to a thorough clinical history, detailed clinical examination, digital photography, and collection of nail clipping and subungual debris for histopathological and microbiological examination (direct microscopy). RESULTS: Sixty-five samples were collected from 62 female (95.4%) and 3 male (4.6%) participants. Age range was between 34 and 83 years (mean age, 61.2 years). Twenty-eight samples were positive for onychomycosis, giving a 43.07% prevalence rate of onychomycosis among TON associated with hyperkeratosis. DISCUSSION/CONCLUSION: According to our data, the prevalence of onychomycosis in patients with TON associated with subungual hyperkeratosis was 43.07%, confirming the need to rule out fungal infection in TON associated with subungual hyperkeratosis prior to considering any unnecessary antifungal treatment.
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Onychomatricoma is a rare and specific benign tumor of the nail complex, with uncertain etiology. The avulsion of the nail plate reveals cavitations and orifices in its proximal extremity. These are associated with villous tumor formations generating digitiform projections at the nail matrix - typical intraoperative findings. We report a rare case of onychomatricoma in which the nail bed was predominantly affected and show evidence of its clinical, intraoperative, and histopathological presentation. The various descriptions of the disease report that its origin is restricted to the nail matrix, leading to secondary changes in the nail plate.
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Abstract: Retronychia is a recently described disorder caused by ingrowth of the proximal nail plate into the proximal nail fold. It is suspected when there is persistent paronychia, particularly in the setting of trauma. This disease is probably underdiagnosed due to limited knowledge among dermatologists and the presence of incomplete clinical forms. Nail plate avulsion is the diagnostic and curative procedure of choice, despite reports of relapse.
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Humanos , Doenças da Unha/diagnóstico , Paroniquia/etiologia , Onicólise/complicações , Doenças da Unha/terapia , Unhas Encravadas/complicaçõesRESUMO
Retronychia is a recently described disorder caused by ingrowth of the proximal nail plate into the proximal nail fold. It is suspected when there is persistent paronychia, particularly in the setting of trauma. This disease is probably underdiagnosed due to limited knowledge among dermatologists and the presence of incomplete clinical forms. Nail plate avulsion is the diagnostic and curative procedure of choice, despite reports of relapse.
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Doenças da Unha/diagnóstico , Humanos , Doenças da Unha/terapia , Unhas Encravadas/complicações , Onicólise/complicações , Paroniquia/etiologiaRESUMO
Acquired fibrokeratoma is a rare benign skin tumor that usually manifests as a slow-growing solitary nodular lesion of the digits. We report a case of plantar acquired fibrokeratoma evidencing its atypical size and topography, in addition to the treatment with simple surgical excision followed by healing by second intention. Nondigital fibrokeratomas may occur in 18% of cases and rarely affect the palmoplantar region. These lesions are usually asymptomatic and show ≥ 3cm in size at the time of diagnosis due to delayed diagnosis. Complete surgical excision is the treatment of choice, which is usually curative. In general, primary closure is chosen; however healing by second intention becomes an option in regions of difficult approach.
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Doenças do Pé/cirurgia , Ceratose/cirurgia , Neoplasias Fibroepiteliais/cirurgia , Doenças do Pé/patologia , Humanos , Ceratose/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias Fibroepiteliais/patologia , Resultado do Tratamento , Técnicas de Fechamento de FerimentosRESUMO
Abstract: Acquired fibrokeratoma is a rare benign skin tumor that usually manifests as a slow-growing solitary nodular lesion of the digits. We report a case of plantar acquired fibrokeratoma evidencing its atypical size and topography, in addition to the treatment with simple surgical excision followed by healing by second intention. Nondigital fibrokeratomas may occur in 18% of cases and rarely affect the palmoplantar region. These lesions are usually asymptomatic and show ≥ 3cm in size at the time of diagnosis due to delayed diagnosis. Complete surgical excision is the treatment of choice, which is usually curative. In general, primary closure is chosen; however healing by second intention becomes an option in regions of difficult approach.
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Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Fibroepiteliais/cirurgia , Doenças do Pé/cirurgia , Ceratose/cirurgia , Resultado do Tratamento , Neoplasias Fibroepiteliais/patologia , Técnicas de Fechamento de Ferimentos , Doenças do Pé/patologia , Ceratose/patologiaRESUMO
A verruga viral representa uma das dermatoses mais prevalentes. O quadro clínico varia de lesão única com cura espontânea até múltiplas lesões recalcitrantes. O sulfato de bleomicina é uma droga de ação citotóxica, aprovada para o tratamento quimioterápico de algumas malignidades. Há mais de 45 anos existem trabalhos demonstrando sua utilidade na dermatologia, em especial na terapia intralesional para verrugas virais, que constitui excelente opção para as lesões em topografias de difícil manejo e para os casos não responsivos a outras abordagens.
Viral warts are one of the most prevalent dermatoses. The clinical picture varies from a single lesion with spontaneous cure to multiple recalcitrant lesions. Bleomycin sulfate is a cytotoxic action drug approved for the chemotherapeutic treatment of some malignancies. There are a number of studies that have been carried out during the last 45 years demonstrating its usefulness in dermatology, especially in intralesional therapy for viral warts, meaning it is an excellent option for lesions in difficult-to-handle topographies and for cases that do not respond to other approaches.
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Congenital curved nail of the fourth toe represents an unusual deformity in which the nail of the fourth toe curves in a plantar direction. It is unknown why only this toe is affected; however, the initial descriptions suggest that this is a mesodermal defect. We describe a case of congenital curved nail of the fourth toe associated with bifid uvula. There are only 2 reports mentioning the association of this nail abnormality with cleft palate and/or lip. In our patient, there was an association with bifid uvula that is considered a minor form of palatine fissure. There seems to be an association of congenital curved nail of the fourth toe with cleft palate to different degrees; however, the pathogenesis of the deformity remains unknown.
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Several countries experience a new epidemic of syphilis, mainly due to the changes in risk behaviors. Dermatologists play an important role in the diagnosis, since cutaneous manifestations are frequent during disease progression. We report a rare case of secondary syphilis with periungual involvement. Syphilis, especially in the secondary form, may present with different clinical features, affecting different organs, and mimicking many diseases. Although nail apparatus lesions are more common in the primary form of the disease, they may also be present in the secondary and tertiary forms. Therefore, a comprehensive knowledge of the diverse forms of syphilis presentation is important for an early diagnosis and timely treatment.
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Lupus erythematosus, especially the discoid form, and lichen planopilaris may be associated and can occur in different topographies (coexistence) or in the same lesion (lupus eythematosus/lichen planus overlap syndrome). Frontal fibrosing alopecia is considered a variant form of lichen planopilaris and is characterized by frontotemporal hairline and eyebrow involvement. Of the association with lupus erythematosus we have only a few descriptions. Hydroxychloroquine and chloroquine diphosphate are antimalarial drugs described as viable treatment options for both diseases, due to an antilymphocytic effect. The association between frontal fibrosing alopecia and lupus erythematosus (discoid or systemic) is reported in this article, showing a progressive alopecia in the frontotemporal hairline despite treatment with hydroxychloroquine.
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BACKGROUND: Digital mucous cysts or myxoid cysts are relatively common, benign pseudocysts of the digits typically located at the distal interphalangeal joints or in the proximal nail fold. There are several therapeutic modalities for its treatment ranging from conservative to surgical procedures; however, there is no consensus about the best approach. MATERIAL AND METHODS: We describe a surgical technique based on the excision of the digital mucous cyst and reconstruction using a self-grafting from the overlying skin lesion. RESULTS: The use of the cyst's overlying skin as a partial cutaneous graft followed by a long-term Brown's dressing, in this case, provided a satisfactory functional and esthetic result. CONCLUSIONS: This technique is a new option for the reconstruction of digital mucous cyst defects that decreases the surgical time and avoids a graft removal of healthy skin and consequently a new scar.
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Cistos Glanglionares/cirurgia , Transplante de Pele/métodos , Técnicas de Fechamento de Ferimentos , Bandagens , Humanos , Articulação do Dedo do PéRESUMO
Despite being an ancient disease, leprosy remains a public health problem in several countries -particularly in India, Brazil and Indonesia. The current operational guidelines emphasize the evaluation of disability from the time of diagnosis and stipulate as fundamental principles for disease control: early detection and proper treatment. Continued efforts are needed to establish and improve quality leprosy services. A qualified primary care network that is integrated into specialized service and the development of educational activities are part of the arsenal in the fight against the disease, considered neglected and stigmatizing.
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Hanseníase/epidemiologia , Saúde Pública , Brasil/epidemiologia , Avaliação da Deficiência , Humanos , Doenças Negligenciadas/epidemiologiaRESUMO
Resumo A hipercurvatura transversa é uma deformidade na qual a placa ungueal apresenta-se com excesso de curvatura no seu sentido transversal. A sua prevalência na população é desconhecida, no entanto sabe-se que os pododáctilos são mais acometidos. O quadro clínico pode ser assintomático ou cursar com dor intensa, onicocriptose e reabsorção óssea da falange distal. Caracteriza-se por evolução crônica e recorrente, gerando importante prejuízo estético e funcional. Compromete a qualidade de vida e pode afetar as atividades laborais das pessoas afetadas. Existem diversas hipóteses empregadas em determinar a sua etiologia, dentre elas é citada a onicomicose. Além disso, casos de hipercurvatura ungueal transversa associada à hiperqueratose subungueal constituem importante diagnóstico diferencial com a onicomicose, sendo a distinção entre as duas patologias extremamente difícil apenas através dos achados clínicos. Alguns autores sugerem ainda que a hipercurvatura transversa predisponha a onicomicose, devido a alterações estruturais locais. Foi realizado um estudo epidemiológico observacional transversal, com o objetivo de determinar a prevalência de onicomicose nas deformidades ungueais do tipo hipercurvatura transversa associada à hiperqueratose subungueal. Foram selecionados 65 participantes no ambulatório de onicopatia, no setor de Dermatologia do Hospital do Servidor Público Municipal de São Paulo, entre os meses de Fevereiro e Maio de 2016. Todos os casos foram submetidos a exame micológico direto, cultura e clipping ungueal (coloração com ácido periódico de Schiff). Na amostra analisada a prevalência de onicomicose foi de 41,5% (27 casos). Assim, em casos semelhantes a investigação complementar faz-se necessária para confirmação diagnóstica e consequentemente orientar o tratamento específico. Descritores: Doenças da unha; Onicomicose; Unhas
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Humanos , Masculino , Feminino , Onicomicose , Doenças da Unha , UnhasRESUMO
The most commonly seen nail change in sarcoidosis, often associated with chronic systemic disease, is onychodystrophy. Imaging of hands, feet and chest is of paramount importance when nail sarcoidosis is suspected, for evaluation of bone cysts and pulmonary involvement, respectively. We report 2 cases of sarcoidosis that developed nail involvement - one with pulmonary disease, and the other without any evidence of systemic involvement, which is very rare.