Psoriatic Onycho-Pachydermo-Periostitis

Psoriatic onycho-pachydermo-periostitis (POPP) is an unfamiliar and poorly recognised condition first described in 1989 by Fournie et al. It is a variant of psoriatic arthritis comprising the triad of onycholysis, soft tissue thickening and radiographically apparent periostitis. Whilst typically affecting the great toe, any of the digits of the hands and feet may be affected. A ‘drumstick’ appearance to the digits of the foot is the most common clinical presentation and can be extremely painful. Nail changes are another hallmark of POPP and can be mistakenly diagnosed as fungal infection leading to lengthy periods of incorrect treatment. In this article, we will outline the clinical presentation, imaging features, pathogenesis and treatment options for POPP. Currently, the existence of POPP is not widely known. Awareness of this unusual condition will allow early appropriate treatment and can aid in the diagnosis of indeterminate seronegative disease.

The clinical study of dermatophytosis in a tertiary care hospital of konkan region, Maharashtra

Dermatophytes are aerobic fungi that produce proteases that digest keratin and allows colonization, invasion and infection of the stratum corneum of the skin, the hair shaft, and the nail. This study was an attempt on the part of the author to find out the incidence and various clinico-epidemiological characteristics of Dermatophytosis in skin OPD of Tertiary care Hospital, B.K.L.W.R.M.C., Dervan. The study was carried on 2444 patients of Dermatophytosis attending the OPD, out of which 49.79% of the cases were Tinea Cruris (TC). The age group of 11-20 years showed maximum prevalence of Dermatophytosis (22.17%). 58% of the patients had diffuse lesions. Body involvement was seen in 87% of cases. Itching was the most common condition associated with Dermatophytosis. 35% of the patients reported with family history of Tinea Cruris.Circumscribed variety of TC was found to be most common variant mostly observed in 2and 4 decade, with a male preponderance. Groin was the most common site with multiple lesions. Nail changes was most commonly associated with TC.

Clinico-etiological Study of Nail Disorders at a Tertiary Care Center in Maharashtra, India

Background: Nail abnormalities comprise a significant proportion of dermatological disorders. Nail is a window that provides vital clues for any underlying, dermatological, and systemic diseases. Any cutaneous assessment is incomplete without examining nails despite which it is a fairly neglected appendage. Objectives: This study was carried out to document the clinical pattern, determine the etiology, and identify risk factors for various nail changes. Methods: This cross-sectional observational study was conducted on 200 consecutive patients presenting with nail changes to the outpatient department of dermatology and venereal diseases of a tertiary care hospital. The patients were enrolled after obtaining informed consent. A case record form was designed for every patient, including demographic data, nail characteristics, associated dermatological and systemic disease, and investigation details. Results: The mean age of the patients was 37.98 ± 16.79 years with a male preponderance. Occupation (housewife and manual laborer) was observed to be a significant risk factor (P < 0.001) for onychomycosis. The chief complaint related to nails was cosmetic in 49.5% of the cases. Etiology-wise nail changes secondary to dermatological diseases (44%) were the most common, followed by infections (36%); however, among dermatological diseases, psoriasis (42.2%) followed by lichen planus (16.6%) predominated. Although nail pitting was noticed in various conditions, there was a significant association between nail pitting and psoriasis (P < 0.001). Onychomycosis showed a significant association (P < 0.001) with nail discoloration and onycholysis. Distal lateral subungual onychomycosis (61.4%) was the most frequently observed pattern; nevertheless, the most common causative agent was dermatophyte Trichophyton rubrum (58.26%). A nail biopsy was performed on 15 cases, with conclusive findings in 12 patients. Conclusions: Nails should be considered an integral part of the complete dermatological evaluation. The meticulous examination of nails facilitates the early diagnosis of hitherto undetected cutaneous/systemic disease. The nail unit deserves greater attention for better understanding and utilization as a diagnostic tool.

NAIL VARIATIONS IN PAPULO-SQUAMOUS DISORDERS: A CLINICAL INVESTIGATION

Background: Nail diseases account for about 10% of all dermatological conditions. Any abnormality that affects any part of the nail unit is classified as a nail condition. The plate, matrix, bed, proximal and lateral folds, hyponychium, and underlying distal phalanx are all part of the nail unit. Heredity, skin problems, infections, systemic disease, and the ageing process, as well as internal and external drugs, physical and environmental agents, trauma, and benign and malignant tumours, can all affect these tissues. Papulo-squamous disorder is one of the main causes. Nail changes in Papulo-squamous disease have received insufficient attention, with only a few research available. Aims & Objectives: This study attempts to shed some information on the frequency and patterns of nail involvement in Papulo-squamous illnesses. Methodology: This is a descriptive research project. Over the course of two years, it was conducted at the dermatology department of a tertiary healthcare centre in central India. Examinations of the general, systemic, and dermatological systems were performed. The nails were meticulously examined. In pertinent cases, special examinations such as skin biopsy and potassium hydroxide (KOH) mount were performed. Results: Papulo-squamous disorder affected 100 people. Psoriasis was the most frequent Papulo-squamous condition, followed by lichen-planus and PRP. Pitting was the most prevalent nail alteration (81%) while dorsal pterygium was the least common. Conclusion: The nail is an important appendage that affects a variety of dermatoses and serves as a diagnostic window. Knowing the normal and abnormal variations, as well as their relationship to various Papulo-squamous illnesses, aids not only in diagnosis but also in treatment. Key words: Papulo-squamous disorder, nail changes, psoriasis, lichen-planus.

A Single Nail Dystrophy as a Unique Manifestation of Sarcoidosis: A Case Report

Sarcoidosis with nail involvement is rare and most commonly affecting plural digits. Nail changes are frequently an indication of systemic disease and underlying bone involvement, thus complete clinical evaluation with bone and thorax radiological examination is a necessity in suspected cases. We report a case of onychodystrophy with osseous involvement of only one finger as unique manifestation of sarcoidosis, which is very rare.

Nail Manifestations in COVID-19: Insight into a Systemic Viral Disease

Nail manifestations are 1 of the several extrapulmonary findings associated with COVID-19 caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Nail changes, however, have been largely ignored and not yet summarized. This article is intended to increase awareness of nail manifestations of SARS-CoV-2, which occur weeks to months after acute infection and the periungual pernio-like changes may occur concomitantly with infection. An electronic search was carried out in PubMed (Medline), Science Direct, and Scopus databases. The following keywords and all of their possible combinations were used to identify studies: “SARS-CoV-2,” “COVID-19,” “Coronavirus,” “2019-ncov,” “nail,” and “nails.” Six case reports were included in this study. Manifestations identified included red half-moon sign, transverse orange nail lesions, Mees’ lines, and Beau’s lines. Though largely nonspecific, these findings can be recognized with the onset of symptom onset or as late as 16 weeks following the disease. Some of these findings are shared with other conditions associated with a proinflammatory state. Nail changes offer unique insight into the pathophysiologic basis for SARS-CoV-2 and they may serve as diagnostic clues.

Nail Changes following Hand-Foot-Mouth Disease in North India

: Hand-foot-mouth disease (HFMD) is common, but nail changes have not been well described. We described nail changes in HFMD. Nail changes following (HFMD) in two outpatient clinics were assessed over two years. Out of 524 cases of HFMD, 40 patients (7.6%) presented with nail problems, 29 cases had onychomadesis, and 11 cases had Beau’s lines. The median age of the subjects was 36 (15 - 126) months, and slight male preponderance (23:17) was seen. HFMD is a common disease having delayed nail changes also. So identification of and preventive strategies are required to limit complications.