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BACKGROUND: Retronychia is characterized by proximal ingrowing of the nail plate into the proximal nail fold. It is always associated with the presence of two or more overlapping nail plates under the proximal nail fold, clinical signs of chronic proximal paronychia refractory to antimicrobial treatment, and a yellowish nail that does not grow. It mainly affects young female adults, with less than 30 pediatric cases described in the literature so far. METHODS: Retrospective and observational study of patients between 0 and 18 years with a clinical and/or ultrasound diagnosis of retronychia attending a pediatric dermatology service between December 2020 and January 2022. RESULTS: We identified 9 patients with retronychia, 7 girls and 2 boys. In all cases, the hallux nails were affected with 5 unilateral and 4 bilateral cases. On physical examination we observed the following signs: thickened and opaque nail plate (one patient), yellowish nail plate (7 patients), double nail plate (6 patients), and erythema with edema, pain, and suppuration of the proximal nail fold (7 patients). Ultrasound was performed in 7 patients and specific findings of retronychia were found in 5 of them. All patients received topical treatment and were referred for the appropriate surgical treatment. To date, only one patient underwent nail avulsion, which was followed by complete recovery. CONCLUSIONS: Retronychia is underdiagnosed, particularly in the pediatric population. We present a series of 9 cases of retronychia in children, with clinical and ultrasonographic findings consistent with those of adults. We emphasize the importance of recognizing this entity, which will allow early and adequate treatment.
Assuntos
Unhas Encravadas , Humanos , Masculino , Feminino , Criança , Estudos Retrospectivos , Unhas Encravadas/terapia , Adolescente , Pré-Escolar , Lactente , Paroniquia/terapia , Paroniquia/diagnóstico , Ultrassonografia , Unhas/patologiaRESUMO
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.
Assuntos
Humanos , Doenças da Unha/diagnóstico , Paroniquia/etiologia , Onicólise/complicações , Doenças da Unha/terapia , Unhas Encravadas/complicaçõesRESUMO
OBJECTIVES: To assess the main characteristics of retronychia on ultrasonography (US) and to propose US criteria for diagnosing unilateral and bilateral cases according to the digit. METHODS: We conducted a case-control study with retrospective, descriptive, and statistical analyses of the US images of 210 nails: 43 with retronychia and 167 normal nails. The Student t test, Fisher exact test, and Kruskal-Wallis test, among other tests, were performed. P < .05 was considered significant. RESULTS: Seventy percent of the patients were females, and the most affected digit was the big toe. Significant US diagnostic criteria were as follows: criterion 1, hypoechoic halo surrounding the origin of the nail plate; criterion 2, distance between the origin of the nail plate and the base of the distal phalanx of 5.1 mm or less in big toes and thumbs and/or a difference of 0.5 mm of this distance or greater between the affected nail and the contralateral healthy nail; and criterion 3, proximal nail fold thickness of 2.2 mm or greater for male patients or 1.9 mm or greater for female patients and/or a proximal nail fold 0.3 mm thicker or greater in comparison with the contralateral healthy nail. Cutoff points, sensitivity, and specificity with a 95% confidence interval were defined for each criterion according to the digit in cases with unilateral and bilateral involvement. CONCLUSIONS: Ultrasonography can support the diagnosis of retronychia in unilateral and bilateral cases.
Assuntos
Doenças da Unha/diagnóstico por imagem , Unhas/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Estudos RetrospectivosRESUMO
AIM: The present study evaluated the capacity of three species of Fusarium isolated from onychomycosis to form biofilms and the antibiofilm effect of propolis extract on these biofilms. MATERIALS & METHODS: The biofilms and antibiofilm effects were evaluated by quantifying the colony-forming units, mitochondrial metabolic activity assays, total biomass by crystal violet staining and scanning electron microscopy. RESULTS: Propolis extract demonstrated significant antibiofilm efficiency on Fusarium spp. isolates and reduced F. solani, F. oxysporum and F. subglutinans mature biofilms. CONCLUSION: Propolis extract can be an alternative topical treatment of onychomycosis caused by Fusarium spp.
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Antifúngicos/farmacologia , Biofilmes/efeitos dos fármacos , Fusarium/efeitos dos fármacos , Dermatoses da Mão/tratamento farmacológico , Onicomicose/tratamento farmacológico , Própole/farmacologia , Antifúngicos/uso terapêutico , Fusarium/isolamento & purificação , Fusarium/fisiologia , Dermatoses da Mão/microbiologia , Humanos , Testes de Sensibilidade Microbiana , Microscopia de Fluorescência , Onicomicose/microbiologia , Própole/uso terapêuticoRESUMO
Abstract: Periungual and paronychia-like skin lesions can mimic various diseases, setting up a diagnostic challenge that invariably requires correlation with complementary tests. We report a case of an ulcerated tumor of the nailfold diagnosed as leishmaniasis. Although paronychia-like cutaneous leishmaniasis is a rare variant, its epidemiological relevance in Brazil should prompt dermatologists to include it as a plausible diagnosis thus leading to correct work up and treatment.
Assuntos
Humanos , Masculino , Adulto Jovem , Leishmaniose Cutânea/patologia , Brasil , Leishmaniose Cutânea/tratamento farmacológico , Meglumina/análogos & derivados , Meglumina/uso terapêutico , Antimônio/uso terapêutico , Antineoplásicos/uso terapêuticoRESUMO
Abstract Introduction: Nail and fingertip injuries in children are very frequent and may range from a simple nail or fingertip injury to amputations. Objective: To present a series of cases with their clinical and demographic characteristics and to describe the current concepts for the treatment of these injuries. Materials and methods: A series of cases presenting fingertip injuries was analyzed for six months. Epidemiology of injuries is described and the current concepts of their treatment are reviewed. Results: 60% of the injuries analyzed in this study occurred in male subjects; 88% of patients suffered crush injuries, the nail was affected in 98% of the cases, sterile matrix damage was observed in 64% and germinal matrix damage was experienced in 34% of the cases. The soft tissue around the finger was affected in 40% of the cases and associated fractures were observed in 55% of the cases. Conclusion: Fingertip crush caused by closing doors was the most frequent injury, which implied a higher involvement of the nail. An adequate treatment focused on the anatomic repair of the nail bed, the relocation of the nail plate and, in some cases, the use of flaps to cover defects in the soft tissue is ideal for this type of injuries, and must be provided as fast as possible to avoid secondary deformities.
Resumen Introducción. En niños, son frecuentes las lesiones de la uña y de la punta de los dedos; estas varían desde traumas en la uña y el pulpejo hasta amputaciones. Objetivos. Describir una serie de casos con sus características clínicas y demográficas y exponer el estado actual del tratamiento de estas lesiones. Materiales y métodos. Se analiza una serie de casos con lesiones de punta de dedo durante seis meses. Se describe la epidemiología y se revisa el estado actual de tratamiento. Resultados. El 60% de las lesiones evaluadas se presentaron en varones, 88% tuvieron trauma por aplastamiento, 98% compromiso de la uña, 64% afectación en la matriz estéril, 34% en la matriz germinal y 40% en el pulpejo; 55% de los casos sufrieron fracturas asociadas. Conclusiones. La lesión por aplastamiento fue lo más frecuente, con mayor compromiso de la uña, predominando la contusión por cierre de puertas. Un buen tratamiento enfocado en la reparación anatómica de la matriz ungueal, reposición de la uña y, en algunos casos, uso de colgajos para cubrir los defectos en el pulpejo es el procedimiento ideal para este tipo de lesiones y debe hacerse rápidamente para evitar deformidades secundarias.
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Abstract This paper describes the association of two unusual side effects of treatment with isotretinoin for severe acne: paronychia and excess granulation tissue in the nails furrows. We report a case of male patient aged 19 years, who in the course of the 36th week of treatment with isotretinoin for acne grade III showed erythema, edema, excess granulation tissue and onychocryptosis in various nail beds of hands and feet, with no history of trauma associated. A literature review revealed few reports of these adverse events, and two clinical patterns of exuberant granulation tissue has been described: one in periungual location and other in lesions of previous acne. The rarity and lack of knowledge on the best treatment for granuloma-like reactions make this theme a considerable challenge.
Assuntos
Humanos , Masculino , Adulto Jovem , Paroniquia/induzido quimicamente , Isotretinoína/efeitos adversos , Acne Vulgar/tratamento farmacológico , Granuloma Piogênico/induzido quimicamente , Paroniquia/patologia , Paroniquia/tratamento farmacológico , Resultado do Tratamento , Granuloma Piogênico/patologia , Granuloma Piogênico/tratamento farmacológico , Tecido de Granulação/efeitos dos fármacos , Doenças da Unha/induzido quimicamenteRESUMO
Se presenta el caso de una paciente de 50 años de edad con cáncer de mama tratada con paclitaxel y BIBF 1120 semanal. La paciente desarrolló al final del duodécimo ciclo de quimioterapia una onicólisis distal, con exudado seroso intenso en el hiponiquio, dolor y mal olor en todas las uñas de las manos. Se trató con ácido fusídico tópico y aceponato de metilprednisolona al 1% dos veces al día, con una excelente respuesta desde los tres primeros días de tratamiento. A la semana de iniciar la terapia tópica, se observó una paroniquia bacteriana con la pérdida de la uña del quinto dedo de la mano izquierda, con cultivos positivos para Staphylococcus aureus sensible a meticilina. Hay pocos casos publicados de onicólisis exudativa asociada a quimioterapia. Sin embargo, están especialmente relacionados con paclitaxel. No se observaron recurrencias de las alteraciones ungueales semanas después de culminar la quimioterapia. Los corticoides tópicos y el ácido fusídico podrían ser considerados como una opción terapéutica cuando la onicólisis exudativa relacionada con paclitaxel esté establecida.
A case of a 50 years-old breast cancer patient treated with weekly paclitaxel and BIBF 1120 is reported herein. At the end of the twelfth cycle of chemotherapy, the patient developed distal onycholysis with intense hyponychium serous exudates, pain and malodor in all her fingernails. It was treated with topical fusidic acid and 1% methylprednisolone aceponate two times daily, with an excellent clinical response from the first three days of treatment. Bacterial paronychia with nail plate loss of the fifth left fingernail was observed a week after the topical therapy was started, with positive cultures for Methicillin susceptible Staphylococcus aureus. There are few reported cases of exudative onycholysis associated with chemotherapy. However, these are especially related to paclitaxel. No recurrences of nail disturbances were observed weeks after the end of chemotherapy. Topical corticosteroids and fusidic acid could be considered as a therapeutic option when exudative onycholysis related to paclitaxel is established.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Inibidores da Angiogênese/efeitos adversos , Antineoplásicos Fitogênicos/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Indóis/efeitos adversos , Onicólise/induzido quimicamente , Paclitaxel/efeitos adversos , Paroniquia/induzido quimicamente , Infecções Cutâneas Estafilocócicas/etiologia , Inibidores da Angiogênese/administração & dosagem , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Antineoplásicos Fitogênicos/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/complicações , Suscetibilidade a Doenças , Ácido Fusídico/uso terapêutico , Mãos , Indóis/administração & dosagem , Metilprednisolona/análogos & derivados , Metilprednisolona/uso terapêutico , Onicólise/complicações , Onicólise/tratamento farmacológico , Onicólise/microbiologia , Paclitaxel/administração & dosagem , Paroniquia/tratamento farmacológico , Paroniquia/microbiologia , Infecções Cutâneas Estafilocócicas/tratamento farmacológico , Infecções Cutâneas Estafilocócicas/microbiologiaRESUMO
Introdução: A paroníquia crônica é doença inflamatória da dobra ungueal proximal, geralmente presente por mais de seis semanas. O tratamento cirúrgico está indicado nos casos resistentes ao tratamento clínico e tem como objetivo a retirada da prega ungueal proximal. Objetivo: O objetivo deste trabalho foi analisar a manutenção da resposta ao tratamento cirúrgico da paroníquia crônica a longo prazo. Métodos: Estudo de coorte prospectivo no qual foram convocados 62 pacientes que haviam realizado tratamento cirúrgico para correção de paroníquia crônica no período de novembro de 2004 a abril de 2008. Os pacientes foram convocados a retornar ao serviço para reavaliação clínica e observação da presença ou não de sinais de paroníquia crônica e divididos em dois grupos: curados e não curados. Resultados: Dos pacientes convocados, 12 compareceram à reavaliação clínica, totalizando 31 procedimentos. A média de tempo do seguimento dos pacientes foi de cinco anos e dois meses e houve manutenção do resultado em 27 (87%) dos procedimentos realizados. Conclusões: A cirurgia de remoção da dobra ungueal proximal constitui boa opção para o tratamento de paroníquia crônica, sendo simples, eficaz e duradoura.
Introduction: Chronic paronychia is an inflammatory disease of the proximal nail fold that usually lasts for more than six weeks. Surgical of removal the proximal nail fold is recommended in cases that are resistant to clinical treatment. Objective: To analyze the long-term response to the surgical treatment of chronic paronychia. Methods: Prospective cohort study of 62 patients who had undergone surgical treatment to correct chronic paronychia from November 2004 to April 2008. The patients were asked to return for reassessment and clinical observation of the presence or absence of signs of chronic paronychia and were classified into two groups: cured and uncured. Results: Of the 62 patients, 12 attended the clinical reassessment, for a total of 31 procedures for analysis. The average length of patient follow-up was 5 years and 2 months. The results were maintained in 27 (87%) of the procedures performed. Conclusions: Surgical removal of the proximal nail fold is a good option for the treatment of chronic paronychia due to its simplicity, effectiveness, and long-lasting results.
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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.