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Resumen Introducción: el onicomatricoma es un tumor fibroepitelial originado en la matriz ungular, es infrecuente y suele presentarse alrededor de la quinta y sexta década de la vida. Métodos: se presenta el caso de un paciente masculino de 57 años, sin antecedentes patológicos, quien consultó por una lesión no dolorosa en la uña del tercer dedo de la mano derecha. Al examen físico presentaba cromoniquia amarilla longitudinal, estrías blanquecinas y hemorragias en astilla. Se realizó onicectomía y matricectomía proximal y se envió el especimen resecado a estudio histopatológico. Resultados: el examen histopatológico reportó una lesión fibroepitelial, con invaginaciones del epitelio y ausencia de la capa granulosa. En el estroma se observaban células ondulantes y fusocelulares acompañadas de mastocitos. Se realizaron tinciones de inmunohistoquímica, confirmando el diagnóstico de onicomatricoma, variante micropapilifera. Conclusiones: debido a los múltiples diagnósticos diferenciales de esta condición, es importante para el dermatólogo familiarizarse con la clínica, hallazgos dermatoscópicos y manejo de esta entidad.
Abstract Introduction: onychomatricoma is a fibroepithelial tumor originating in the nail matrix, it is infrequent and usually presents around the fifth and sixth decades of life. Methods: we present the case of a 57-year-old male patient, without relevant past medical history, who complained of a non-painful lesion in the nail of the third finger of the right hand. Physical exam revealed longitudinal yellow chromonychia, whitish striae, and splinter hemorrhages. Onychectomy and proximal matricectomy were performed and the resected specimen was sent for histopathological study. Results: the histopathological study reported a fibroepithelial lesion, with invaginations of the epithelium and absence of the granular layer. Undulating and spindle cell cells accompanied by mast cells were observed in the stroma. Immunohistochemical staining was performed, confirming the diagnosis of onychomatricoma, micropapiliferum variant. Conclusions: due to the multiple differential diagnoses of this condition, it´s important for the dermatologist to become familiar with the clinic, dermoscopic findings and management of this entity.
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BACKGROUND/OBJECTIVES: Nail clipping, the act of cutting the distal portion of a nail for microscopic analysis, can complement the diagnosis of skin diseases with nail involvement, such as psoriasis. This study aimed to describe histopathologic findings on 81 nails from 52 children and adolescents with skin psoriasis and to determine whether these changes correlated with the severity of skin and nail involvement. METHODS: Children with psoriasis were enrolled in this cross-sectional study to obtain Psoriasis Area and Severity Index (PASI) and Nail Psoriasis Severity Index (NAPSI) scores. The most altered nails were processed using periodic acid-Schiff with diastase staining. RESULTS: Fifty-two patients with a median age of 10.5 years were included. The median Nail Psoriasis Severity Index score of the 20 nails from these patients was 17 (range 3-80). The most common findings were pitting (94.2%), leukonychia (73.0%), and longitudinal ridges (63.5%). Eighty-one nail fragments were collected by clipping. Neutrophils were found in 6 samples (7.6%) and serous lakes in 15 (19%). Median nail plate thickness was 0.3 mm (range 0.1-0.63 mm). Patients whose nails had neutrophils had a higher median PASI score (6.1 vs 2.0, P = .03). Patients whose nails had serous lakes had higher median PASI (5.3 vs 1.9, P = .008) and NAPSI (median 45.0 vs 18.0, P = .006) scores. CONCLUSION: There seems to be a correlation between some microscopic nail features in children with psoriasis and their PASI and NAPSI scores, so nail clippings from children with suspected psoriasis may help with diagnosis, especially in the presence of neutrophils, and in excluding onychomycosis.
Assuntos
Doenças da Unha/diagnóstico , Unhas/patologia , Psoríase/diagnóstico , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Doenças da Unha/etiologia , Índice de Gravidade de DoençaAssuntos
Ceratose/diagnóstico , Doenças da Unha/diagnóstico , Doenças da Unha/cirurgia , Transtornos da Pigmentação/diagnóstico , Dedos do Pé/patologia , Criança , Seguimentos , Humanos , Ceratose/complicações , Ceratose/cirurgia , Masculino , Doenças da Unha/complicações , Transtornos da Pigmentação/complicações , Transtornos da Pigmentação/cirurgia , Recidiva , Índice de Gravidade de Doença , Dedos do Pé/cirurgiaRESUMO
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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FUNDAMENTOS: A insuficiência renal crônica atinge quase todos os sistemas do organismo, inclusive pele e anexos. As alterações ungueais mais observadas nos pacientes com insuficiência renal crônica são: unhas meio a meio, ausência de lúnula e hemorragia em estilhas. OBJETIVOS: Avaliar o espectro e a frequência de alterações ungueais nos pacientes com IRC, submetidos à hemodiálise (HD), e compará-los com uma amostra pareada da população geral. MÉTODOS: Realizado um estudo caso- controle, pareado por gênero e idade, onde 2 grupos foram estudados com relação às alterações ungueais presentes. RESULTADOS: 86 por cento dos pacientes em HD e 75 por cento do grupo controle tiveram, pelo menos, uma alteração ungueal.Ausência de lúnula (62,9 por cento) e unha meio a meio (14,4 por cento) as alterações foram estatisticamente relevantes no grupo HD, em relação ao grupo controle (p < 0,05 por cento). Estrias longitudinais foram mais comuns nos controles em relação ao grupo HD (24,1 por cento). CONCLUSÕES: Ausência de lúnula e unha meio a meio as alterações ungueais foram mais encontradas nos pacientes em HD, corroborando com achados relatados, em estudos anteriores. Estrias longitudinais foram mais observadas no grupo controle e estudos posteriores poderão elucidar se alterações estruturais, tal qual a ausência de lúnula, poderiam relacionar-se a este achado.
BACKGROUND: Chronic renal failure affects almost all the systems of the body, including the skin and appendages. The nail disorders most commonly found in patients with chronic renal failure are half and half nails, absent lunula and splinter hemorrhages. OBJECTIVES: To evaluate the spectrum and the frequency of nail disorders in patients with chronic renal failure submitted to hemodialysis and compare them with a paired sample from the general population. METHODS: A case-controlled study paired for gender and age was conducted in which nail disorders were investigated in the two groups. RESULTS: At least one nail disorder was found in 86 percent of the hemodialysis patients and in 75 percent of subjects in the control group. Absent lunula (62.9 percent) and half and half nails (14.4 percent) were more common in the hemodialysis group compared to the control group and this difference was statistically significant (p < 0.05). Longitudinal striae were more common in the control group compared to the hemodialysis group (24.1 percent). CONCLUSIONS: Absent lunula and half and half nails were the most common nail disorders found in patients on hemodialysis, corroborating the findings of previous studies. Longitudinal striae were more common in the control group and future studies may clarify whether structural abnormalities such as absent lunula may be related to this finding.
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Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Doenças da Unha/etiologia , Diálise Renal , Estudos de Casos e Controles , Doenças da Unha/epidemiologiaRESUMO
Introdução: A paroníquia crônica é uma doença infl amatória da prega ungueal proximal (PUP) com duração maior que seis semanas. Esta condição representa 18% das distrofi as ungueais. Caracteriza-se clinicamente por infl amação da PUP, ausência de cutícula e distrofi a da placa ungueal. O tratamento clínico é frequentemente insatisfatório. Já o tratamento cirúrgico consiste na retirada da PUP, que pode ser realizada pelas técnicas de incisão oblíqua ou perpendicular. Objetivo: Comparar a efi cácia entre as técnicas cirúrgicas oblíqua e perpendicular para o tratamento da paroníquia crônica. Material e métodos: Sessenta e dois pacientes com paroníquia crônica em um ou mais quirodáctilos (em um total de 138 casos operados) foram divididos de forma randomizada em dois grupos, conforme a técnica utilizada. A avaliação pós-operatória foi realizada após seis meses e foi utilizada uma escala de três pontos: sem melhora, melhorado e curado. Resultados: Cento e trinta e quatro casos (97,1%) foram considerados curados e quatro (2,9%), dois de cada grupo, foram considerados melhorados. Conclusão: Concluímos em nosso estudo que o tratamento cirúrgico é efetivo na paroníquia crônica, a despeito da técnica empregada.
Background and Objectives: Chronic paronychia is an infl ammatory disorder of the proximal nail fold (PNF) lasting more than six weeks, and accounts for 18% of nail dystrophies. Clinically, it is characterized by infl ammation of the PNF, absence of the cuticle, and dystrophy of the nail plate. Clinical treatment is, frequently, unsatisfactory. Surgical treatment consists on the removal of the PNF, which can be done using the oblique or perpendicular incision technique. The objective of the present study was to compare the effi cacy of oblique and perpendicular surgical techniques in the treatment of chronic paronychia. Methods: Sixty-two patients with chronic paronychia, in one or more fi ngers (for a total of 138 surgeries), were randomly divided in two groups according to the surgical technique used. Postoperative evaluation was done after six months using a three-point scale: absence of improvement, improved, cured. One hundred and thirty-four cases (97.1%) were considered cured, and 4 (2.9%), two in each group, were considered as having improved. Conclusion: In the present study, we concluded that the surgical treatment of chronic paronychia is effective, regardless of the technique used.