Nail changes in diabetes

Acrokeratosis paraneoplastica (Bazex syndrome) is a rare paraneoplastic dermatosis associated with internal malignancies. Clinical presentation is characterized by erythematous or violaceous scaly plaques involving the digits, nose, ears, palms, and soles. Nail changes commonly present concurrently with cutaneous manifestations. In this review, we characterize nail changes associated with acrokeratosis paraneoplastica. A total of 48 cases were analyzed. Nail findings were nonspecific, with the most common being nail plate thickening, onycholysis, subungual hyperkeratosis, longitudinal ridging, discoloration, and nail plate loss. In most patients, nail changes involved the majority of fingernails and toenails and most often appeared prior to the diagnosis of malignancy. The most common associated underlying malignancies were squamous cell carcinomas of the head and neck. A diagnosis of acrokeratosis paraneoplastica should be considered in patients with onychodystrophy involving multiple nails with accompanying atypical psoriasiform dermatoses. Screening for internal malignancies may significantly decrease morbidity and mortality for these patients.

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Incidence of Adverse Cutaneous Reactions to Epidermal Growth Factor Receptor Inhibitors in Patients with Non-Small-Cell Lung Cancer

Dermatology ◽

10.1159/000513233 ◽

2021 ◽

pp. 1-5

Author(s):

Paolo Gisondi ◽

Davide Geat ◽

Alessandra Mattiucci ◽

Fiorella Lombardo ◽

Antonio Santo ◽

...

Keyword(s):

Lung Cancer ◽

Epidermal Growth Factor Receptor ◽

Growth Factor Receptor ◽

Small Cell ◽

Egfr Inhibitor ◽

Small Cell Lung ◽

Nail Changes ◽

Cutaneous Reactions ◽

Epidermal Growth ◽

Oncologic Treatment

Background: Epidermal growth factor receptor (EGFR) inhibitors are routinely used in advanced non-small-cell lung cancer (NSCLC) harboring EGFR mutations. However, their use is associated with gastrointestinal and cutaneous toxicities, including acneiform eruptions, pruritus, xerosis, nail and hair changes. Aside from reducing patients’ quality of life, such cutaneous reactions have a considerable impact on the oncologic treatment given that dose reduction or even drug discontinuation may be necessary, especially for the severe forms. Objectives: To assess the incidence, impact on treatment and management of EGFR inhibitor-related cutaneous reactions in patients with NSCLC. Methods: We conducted a prospective observational study on 87 consecutive patients with advanced NSCLC treated with EGFR-tyrosine kinase inhibitors from January to December 2019. Patients who developed mucocutaneous reactions were evaluated and treated by both oncologists and dermatologists, and underwent dermatologic follow-up until resolution of the cutaneous reaction. Demographic and clinical data were collected for each patient, and the severity of the cutaneous reaction was graded using the Common Terminology Criteria for Adverse Events. Results: Seventy-one patients (81.6%) developed cutaneous reactions. The number of cutaneous reactions per patient was 1 in 37%, 2 in 41% and 3 or more in 22%. The most common cutaneous reactions included acneiform eruptions (56.3%), xerosis ± asteatotic eczema (48.3%), nail changes (39.1%), mucositis (29.9%), pruritus (24.1%) and hair changes (12.6%). Afatinib was associated with a higher rate of nail changes and mucositis (p < 0.01 and p < 0.005, respectively) compared to other agents, while no patient-related predictive factors were identified. Dose reduction was performed in 18% of patients. Multidisciplinary management involving dermatologists allowed to resume the drug in all patients who had discontinued it due to the cutaneous reactions. Conclusions: A multidisciplinary approach to EGFR inhibitor-related cutaneous reactions is advantageous and can reduce the need to discontinue oncologic treatment.

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A woman with nail changes

BMJ ◽

10.1136/bmj.l7007 ◽

2020 ◽

pp. l7007

Author(s):

Yingyuan Yu ◽

Yuling Shi

Keyword(s):

Nail Changes

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Nail Changes and Association of Osteoarthritis in Digital Myxoid Cyst

Dermatologic Surgery ◽

10.1097/00042728-200803000-00011 ◽

2008 ◽

Vol 34 (3) ◽

pp. 364-369

Author(s):

YANG-CHIH LIN ◽

YU-HUNG WU ◽

RICHARD K. SCHER

Keyword(s):

Nail Changes

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Nail changes in lichen planus may resemble those of yellow nail syndrome

British Journal of Dermatology ◽

10.1046/j.1365-2133.2000.03460.x ◽

2000 ◽

Vol 142 (4) ◽

pp. 848-849 ◽

Cited By ~ 20

Author(s):

A. Tosti ◽

B.M. Piraccini ◽

N. Cameli

Keyword(s):

Lichen Planus ◽

Yellow Nail Syndrome ◽

Nail Changes

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Nail changes secondary to docetaxel

The Lancet ◽

10.1016/s0140-6736(00)04210-0 ◽

2001 ◽

Vol 357 (9260) ◽

pp. 910 ◽

Cited By ~ 27

Author(s):

Gunnar Wasner ◽

Felix Hilpert ◽

Ralf Baron ◽

Jacobus Pfisterer

Keyword(s):

Nail Changes

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Atypical presentation of autoimmune polyglandular syndrome type 1 in the fifth decade

BMJ Case Reports ◽

10.1136/bcr-2021-241680 ◽

2021 ◽

Vol 14 (4) ◽

pp. e241680

Author(s):

Aditya Sanjeevi ◽

Adlyne Reena Asirvatham ◽

Karthik Balachandran ◽

Shriraam Mahadevan

Keyword(s):

Adrenal Insufficiency ◽

Vitamin D Supplementation ◽

Chronic Mucocutaneous Candidiasis ◽

Syndrome Type ◽

Primary Amenorrhoea ◽

Autoimmune Polyglandular Syndrome ◽

Nail Changes ◽

History Of ◽

Autoimmune Polyglandular Syndrome Type

A 45-year-old woman presented to us with a short-term history of nausea, vomiting and giddiness. On arrival at our hospital, examination revealed postural hypotension. Fluid resuscitation with intravenous normal saline was commenced. She also had chronic mucocutaneous candidiasis and nail changes suggestive of ectodermal dystrophy. Detailed history taking revealed that she had never attained menarche. Serum biochemistries showed hyponatraemia, hyperkalaemia, and hypocalcaemia (sodium, 127 mEq/L; potassium, 6 mEq/L; and albumin-corrected calcium, 6 mg/dL). Adrenocorticotropic hormone-stimulated cortisol (16.7 mcg/dL) was suboptimal favouring adrenal insufficiency. She was started on hydrocortisone and fludrocortisone supplementation. Additionally, the parathyroid hormone was inappropriately low (3.8 pg/mL) confirming hypoparathyroidism. Oral calcium and active vitamin D supplementation were added. With the above clinical and biochemical picture, namely, clustering of primary amenorrhoea, adrenal insufficiency and hypoparathyroidism, the diagnosis pointed towards autoimmune polyglandular syndrome. Genetic workup revealed a deletion in exon 8 of the autoimmune regulator gene confirming the diagnosis of autoimmune polyendocrinopathy–candidiasis–ectodermal dystrophy/autoimmune polyglandular syndrome type 1 .

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Nail changes due to docetaxel

British Journal of Dermatology ◽

10.1046/j.1365-2133.2002.46824.x ◽

2002 ◽

Vol 146 (4) ◽

pp. 709-710 ◽

Cited By ~ 25

Author(s):

K. Pavithran ◽

D.C. Doval

Keyword(s):

Nail Changes

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THE IMPORTANCE OF EDUCATION TO REDUCE SELF-DESTRUCTIVE NAIL HABITS

SOCIETY INTEGRATION EDUCATION Proceedings of the International Scientific Conference ◽

10.17770/sie2021vol4.6418 ◽

2021 ◽

Vol 4 ◽

pp. 491-499

Author(s):

Ilze Upeniece ◽

Monta Beltiņa

Keyword(s):

Clinical Practice ◽

General Education ◽

Statistical Significance ◽

Target Population ◽

Control Group ◽

Age Related ◽

Nail Changes ◽

Group 2 ◽

And Control ◽

Traumatic Damage

Onychophagia and onychotillomania are rarely seen in clinical practice and are considered undervalued. The study aims were to determine the prevalence of onychophagia and onychotillomania habit in the patient group with hand nail damage and control group, to determine which would be the target population to educate. Patients were interviewed about self-destructive habits. Excel and SPSS were used for data analysis. In the nail damage group, 28.6% of the respondents showed self-destructive habits and past habits – 31.4%. In the control group, the result was 22.9% and 31.4%. For 74.3% of patients the cause of nail damage was skin disease (including 61.54% of respondents with nail damage who have psoriasis), for 5.7% it was age-related nail changes, for 20% traumatic damage and for 57.14% of them it was a result of self-destructive habit. In the nail damage group both – present and past self-destructive habits are higher than in the control group, but it has no statistical significance (p=0.785). 1)The prevalence of onychophagia and onychotillomania does not differ between patients and control group. 2)General education of the population is necessary to actualize this problem, which can worsen nail changes.

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