[Longitudinal melanonychia. Diagnosis, differential diagnosis and therapy].
Explore the source record for details and available documents.
Humans↗
Biomedical subjects
E Haneke
Publications and source records attributed to E Haneke.
Itraconazole pulse therapy for the treatment of Candida onychomycosis.
In this open label, multicentre trial, 44 patients with clinical and mycological evidence of Candida onychomycosis were treated with itraconazole pulse therapy. Onychomycosis of the toes alone and concomitant disease involving the fingers and toes was treated with three pulses, and onychomycosis of the fingers alone with two pulses. Final evaluation for patients with finger and toe onychomycosis was at 6-9 months and 9-12 months, respectively. There were 29 patients with toe onychomycosis (C. albicans, 27; C. glabrata, one; Candida species, one), 12 patients with finger onychomycosis (C. albicans, two; C. glabrata, one) and three patients had combined toe and finger onychomycosis (C. albicans, two; C. guillermondii, one). In the patients with toe onychomycosis mycological cure was observed in 29 of 32 patients (90.6%). There was complete cure [mycological cure (negative culture and KOH at endpoint evaluation) with clinical cure] or marked improvement (mycological cure with 75% or greater decrease in area of involvement of target nail compared with pretherapy) in 24 of 32 patients (75.0%). All 12 patients with finger onychomycosis alone due to Candida species achieved a mycological cure (100%). In this group of patients complete cure or marked improvement was observed in 11 of 12 patients (91.7%). Itraconazole pulse therapy was well tolerated and no serious adverse events were reported in the patients treated with this triazole. In conclusion, itraconazole pulse therapy is an effective and safe treatment for both finger and toe onychomycosis associated with Candida.
Adult↗
Pincer nails: definition and surgical treatment.
BACKGROUND: There are four main types of ingrown nail. These are distal nail embedding, juvenile (subcutaneous) ingrown nail, hypertrophy of the lateral nail fold (lip), and pincer nail. OBJECTIVE: The etiology of pincer nail may be hereditary or acquired. The mechanism of the most common form, an enlarged base of the distal bony phalanx, is discussed. METHODS: Use of roentgenogram and magnetic resonance imaging highlights exophytes of the base and dorsal hyperostosis of the distal phalanx. RESULTS: Global assessment may lead in mild cases to medical therapy. Usually, however, the lateral matrix horn must be surgically removed or cauterized by phenol. Dermal grafting under the nail matrix provides excellent long-term results.
Humans↗
Longitudinal melanonychia.
BACKGROUND: Ungual melanoma is the most serious disease affecting the nail. The majority start with a longitudinal brown streak in the nail. OBJECTIVE: To outline the different nail pigmentations, their differential diagnoses, treatment, and prognosis. METHOD: Clinical and histologic evaluation of dark nail pigmentations. CONCLUSION: Brown to black nail pigmentation may be due to different coloring substances of exogenous and endogenous origin. Exogenous pigmentations usually are not streaky or do not present as a stripe of even width with regular borders. Bacterial pigmentation, most commonly due to Pseudomonas aeruginosa or Proteus spp., have a greenish or grayish hue and the discoloration is often confined to the lateral edge of the nail. Subungual hematoma may result from a single heavy trauma or repeated microtrauma which often escapes notice. The latter is usually found on the medial aspect of the great toe. Although oval in shape, it commonly does not form a neat streak. Melanin pigmentation in the form of a longitudinal streak in the nail is due to a pigment-producing focus of melanocytes in the matrix. Neither the color intensity nor the age of the patient are proof of benignity or malignancy although subungual melanomas are very rare in children and malignant longitudinal melanonychia is usually wider than 5 mm. Hutchinson's melanotic whitlow, nail dystrophy, and a bleeding mass strongly suggest malignancy. Treatment is as conservative as possible in order to keep the tip of the digit; once the melanoma is completely removed, amputations have not been shown to prolong the disease-free survival time.
Bacterial Infections↗
Terminology in dermatology: logical or arbitrary?
Explore the source record for details and available documents.
Dermatology↗
Methods for diagnosing onychomycosis: a comparative study and review of the literature.
OBJECTIVE: To identify the sensitivity of several readily available diagnostic tests for onychomycosis. DESIGN: Cross-sectional study. SETTING: Dermatology and podiatry departments at a teaching hospital. PATIENTS: Sixty-three adult men and women with a clinical examination highly suggestive of onychomycosis. MAIN OUTCOME MEASURES: Sensitivity of each test and of several test combinations. RESULTS: Nail samples underwent 6 diagnostic tests. Routine histopathologic examination with periodic acid-Schiff stain (PAS) (PATHPAS) was 85% sensitive. Sensitivities for potassium hydroxide dissolution and centrifugation combined with PAS, fluorescent brightener, or chlorazol black E were 57%, 53%, and 53%, respectively. Culture on Sabouraud agar withchloramphenicol and cycloheximide (Mycosel agar) was 32% sensitive; on Littman-oxgall agar, 23% sensitive. The most sensitive combination of tests, both culture methods plus PATHPAS, was 94% sensitive (not statistically different from the sensitivity of PATHPAS alone [P = .26]). CONCLUSIONS: When onychomycosis is suspected clinically, PATHPAS of the nail is the single most sensitive of the diagnostic tests we evaluated. Because it is quickly performed and relatively operator independent, PATHPAS is practical for clinical and research purposes. Further study is needed to determine if sensitivity may be enhanced by combining PATHPAS with cultures obtained by several collection methods (clipping, curettage, and shaving). Such combinations may serve as sensitive and efficient strategies for diagnosing onychomycosis.
Adult↗
The impact of onychomycosis on quality of life: development of an international onychomycosis-specific questionnaire to measure patient quality of life.
BACKGROUND: Onychomycosis is a widespread refractory disease deleteriously affecting quality of life via social stigma and disrupting daily activities. Many physicians perceive onychomycosis as a cosmetic rather than a medical problem. OBJECTIVE: Our purpose was to develop a questionnaire-based instrument to quantify the impact of onychomycosis on patients' quality of life. METHODS: The questionnaire was developed and validated in a multinational cross-sectional study. Completed questionnaires from 532 patients were analyzed: 284 toenail, 248 fingernail (onychomycosis or paronychia). RESULTS: The degree of quality of life impairment from onychomycosis varied by country studied, possibly reflecting cross-national health perception differences. Longer duration of disease, greater involvement of individual nails, and greater number of nails involved were associated with more serious adverse effects. Many physicians underestimated the associated degree of pain. CONCLUSION: The study confirms that onychomycosis physically and psychologically affects patients' lives. The questionnaire may be a valuable tool in evaluating the effect of therapeutic agents on quality of life of patients with onychomycosis.
Cross-Sectional Studies↗
The scope of onychomycosis: epidemiology and clinical features.
Explore the source record for details and available documents.
Adolescent↗
Adverse cutaneous reactions to cosmetic allergens.
Explore the source record for details and available documents.
Cosmetics↗
Achilles foot-screening project: background, objectives and design.
OBJECTIVE: A description of the background, objectives and design of the Achilles foot screening project. SUBJECT: Foot diseases, especially tinea pedis and onychomycosis. METHODS: Literature review and description of the Achilles set-up. RESULTS: The prevalence of tinea pedis and onychomycosis has sharply increased since 1950. Tinea pedis is one of the most common mycological diseases and onychomycosis is the most frequent nail disorder. They occur mainly in adults with an estimated overall prevalence of 10-20%, although epidemiological data are limited. The pan-European Achilles foot-screening project was undertaken to gather basic information on foot diseases, using a survey by questionnaire and a mycological assessment study. CONCLUSION: The prevalence of foot mycoses, particularly onychomycoses, is much higher than anticipated.
Adult↗
The effect of addition of calcipotriol ointment (50 micrograms/g) to acitretin therapy in psoriasis.
Our purpose was to find out whether the addition of calcipotriol ointment (50 micrograms/g) to systemic treatment with acitretin produces additional therapeutic effects and thereby an acitretin-sparing effect, and further to investigate the safety and tolerability of this combination. A multicentre, randomized, double-blind placebo-controlled study was designed. Patients were randomized to receive calcipotriol or placebo. All patients were treated with a starting dose of 20 mg acitretin per day and doses were adjusted at 2-weekly intervals with increments of 10 mg per day up to a maximum of 70 mg per day. The dose requirement for acitretin, clinical signs and adverse events were recorded. Seventy-six patients were randomized to treatment with calcipotriol 50 micrograms/g ointment twice daily and 59 patients to treatment with the vehicle only twice daily. Clearance or marked improvement was achieved by 67% of the patients in the calcipotriol group and by 41% of the patients in the placebo group (P = 0.006). Calcipotriol treatment proved to have a statistically significant additional effect to acitretin on the Psoriasis Area and Severity Index, redness, thickness and scaliness as compared with placebo. Clearance or marked improvement was achieved with a statistically significantly lower cumulative dose of acitretin by the patients in the calcipotriol group as compared with the placebo group. The number of patients reporting adverse events was pronounced and largely related to acitretin. No significant differences were observed between the two treatment groups with respect to adverse events. Laboratory assessments were essentially normal. The addition of calcipotriol ointment to acitretin treatment contributes to the efficacy, reduces the cumulative dose of acitretin to reach marked improvement or clearance, and is well-tolerated and safe.
Acitretin↗
A new classification of onychomycosis.
This new classification of onychomycosis is a development of previous schemes and depends on the recognition of different clinical patterns of nail plate involvement associated with fungal infection as well as histopathology. The main types are distal and lateral subungual onychomycosis, superficial onychomycosis, proximal subungual onychomycosis, endonyx onychomycosis and total dystrophic onychomycosis. In addition, patients may show different combinations of these patterns. The identification of clinical patterns of disease may be useful in defining differences in clinical behaviour, treatment response and associated disease.
Acremonium↗
Itraconazole for the treatment of onychomycosis.
BACKGROUND: The broad spectrum of activity of itraconazole in vitro manifests itself clinically with the drug being effective for the treatment of onychomycosis caused by dermatophytes, Candida and some non-dermatophyte molds. The pharmacokinetics of itraconazole in the nail results in drug remaining at therapeutic levels for 6-9 months after completion of therapy. METHODS: An overview of studies where continuous or pulse itraconazole therapy has been used in the treatment of fingernail and toenail onychomycosis. RESULTS: Following continuous therapy at 200 mg/day for 3 months for toenail onychomycosis (n = 1741), the rates of clinical cure, clinical response and mycologic cure were: (meta-average +/- 95% standard error (SE)), 52 +/- 9%, 86 +/- 2%, and 74 +/- 3%, respectively, at follow-up 12 months following start of therapy. In fingernail onychomycosis (n = 211), the duration of therapy was 6 weeks and the corresponding efficacy rates at follow-up, 9 months after start of therapy, were meta-average (+/- S.E.) 82 +/- 5%, 90 +/- 2%, and 86 +/- 3%, respectively. In toenail onychomycosis treated with 3 pulses of therapy (n = 1389), the clinical response, clinical cure and mycologic cure were observed in meta-average (+/- S.E.) 58 +/- 10%, 82 +/- 3%, and 77 +/- 5% patients, respectively, at follow-up 12 months after the start of therapy. In fingernail onychomycosis treated with 2 pulses of therapy (n = 210), at follow-up 9 months after the start of therapy, the corresponding efficacy rates were meta-average (+/- S.E.) 78 +/- 10%, 89 +/- 6%, and 87 +/- 8%, respectively. CONCLUSIONS: Both the continuous and pulse therapy regimens are safe with few adverse effects. Compared to continuous therapy, the pulse regimen has an improved adverse-effects profile, is more cost-effective, and is preferred by many patients.
Antifungal Agents↗
Safety and efficacy of intermittent therapy with itraconazole in finger- and toenail onychomycosis: a multicentre trial.
The efficacy and safety of intermittent itraconazole therapy were investigated in patients with onychomycosis. Patients were divided into two groups according to site and extent of infection. Group A comprised 635 patients with toenail onychomycosis (at least one nail with > or = 20% involvement; n = 560) or fingernail onychomycosis (at least one nail with > 75% involvement; n = 63) or both (n = 12). These patients received itraconazole 400 mg day-1 for 1 week per month for 3 months. Group B comprised 48 patients with fingernail onychomycosis (at least one nail with > or = 20% involvement but no nail with > 75% involvement) who received itraconazole 400 mg day-1 for 1 week per month for 2 months. Patients were followed for a further 18 weeks without treatment, and received another treatment cycle if not cured or markedly improved 6 weeks after the end of the last cycle. An additional cycle was administered to 76 patients with fingernail onychomycosis (group A, n = 43; group B, n = 28) and to 316 patients with toenail onychomycosis. Clinical response rates and mycological cure rates at study end point were 89.0% and 68.4% respectively for toenails, 91.4% and 85.3% respectively for group A fingernails and 84.4% and 77.1% respectively for group B fingernails. Most adverse events occurred infrequently; major changes in liver function tests were not noted. In conclusion, intermittent itraconazole therapy is highly effective and safe in patients with onychomycosis.
Adult↗
Surgical treatment of defects on the tip of the nose.
BACKGROUND: Malignant tumors frequently occur on the tip of the nose and may represent considerable therapeutic challenges. OBJECTIVE: Dermatologic surgical approaches are outlined to achieve maximum cure rates with optimal cosmesis. METHODS: Different excision techniques are shown to remove basal and squamous cell carcinomas as well as other malignant lesions on the tip of the nose. All operations can be performed under local anesthesia in a dermatologic surgical setting. RESULTS: Excisions with direct wound closure are sufficient for small tumors and may even enhance the appearance off the nose. Large tumors may require full-thickness skin grafts after extensive removal yielding acceptable cosmetic results. Multiple different local flaps are available for medium sized defects whereas large wounds including the nasal skeleton require loco-regional flap repair. CONCLUSIONS: Selection of the best defect repair allows the majority of nasal tip defects to be repaired with excellent functional and cosmetic results.
Anesthesia, Local↗
Etiology and treatment of nail malalignment.
BACKGROUND: There are three main types of nail malalignment. These are: congenital nail malalignment of the big toenail, traumatic nail malalignment, and iatrogenic malalignment of the nail plate. OBJECTIVE: Treatment is only of benefit in the first two conditions, and specific surgical approach to each condition is outlined. The probable mechanism of iatrogenic malalignment is discussed. RESULTS: Nail rotation for congenital malalignment produces its best results in early childhood. CONCLUSION: Surgery is of benefit in congenital malalignment and traumatic malalignment and is worthwhile in selected cases. Iatrogenic malalignment that is the consequence of wide lateral nail biopsies or similar excisions does not respond to treatment.
Biopsy↗
Itraconazole in the treatment of onychomycosis: a double-blind comparison with miconazole.
BACKGROUND: In recent years, itraconazole pulse therapy for onychomycosis has been developed [three 1-week pulses with itraconazole 400 (2 x 200) mg daily every month]. This has proved an effective and safe regimen which requires only 50% of the medication used for continuous dosing schedules. Parallel to the development of the new dosage schedule, additional studies were conducted to further document the safety and efficacy of itraconazole 200 mg once daily for 3 months to treat onychomycosis. OBJECTIVE: To compare the safety of itraconazole 200 mg once daily for 3 months, with or without itraconazole 200 mg once weekly for a further 3 months, with that of miconazole cream twice daily for 6 months, in the treatment of onychomycosis. Treatment efficacy was compared as a secondary objective. METHODS: In this multicenter, double-blind study, patients were randomized to receive itraconazole 200 mg once daily for 3 months followed by either itraconazole 200 mg once weekly for 3 months (ITR-ITR group, n = 599) or oral placebo once weekly for 3 months (ITR-PLAC group, n = 613), or to receive miconazole cream twice daily for 6 months (MIC-MIC group, n = 396). The primary variable was elevation of alanine amino-transferase (ALT) concentration above 50 U/I. RESULTS: Overall incidence of elevation of ALT concentration above 50 U/I, adverse events and rate of withdrawal because of adverse events were low and similar in the three treatment groups. Efficacy was significantly greater in the ITR groups than the MIC-MIC group. CONCLUSION: Itraconazole and miconazole were well tolerated and had no significant effect on liver function, but itraconazole was significantly more effective.
Administration, Oral↗