Biomedical subjects
Publications and source records attributed to R Baran.
Seven cases of trauma-induced dermatitis of the neck, are described. They were all the result of violin playing (Fiddler's neck). The histological, clinical and the therapeutic characteristics of our cases are similar to those of mechanical acne.
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Melanonychia striata longitudinalis is due to a focal increase in number and/or activity of melanocytes in the nail matrix, resulting in the continuous production of large amounts of melanin which are transferred to the nail cells and grow out with the nail plate. Histologically, either benign melanocytic hyperplasia, lentigo simplex, nevocellular nevus, atypical melanocytic hyperplasia or acral lentiginous melanoma may be found. Longitudinal pigmented streaks in the nails of Caucasians tend to be malignant rather than benign. Thus a biopsy for proper histological diagnosis is strongly advised. Melanonychia striata may also occur as a symptom of rare syndromes and diseases or be due to therapy. Differentiating this condition from subungual hematoma and infections with chromogenic bacteria and fungi may be difficult.
Keratosis lichenoides chronica may be seen clinically and histologically as a variant of lichen planus. One in three patients have nail involvement with changes that may superficially resemble psoriasis, but pitting and pustulosis do not occur. Hyperkeratotic hypertrophy of the periungual tissues is a distinctive feature. Psoralens and UV-A therapy as well as etretinate have improved some cases.
Congenital onychodysplasia of the index fingers (Iso and Kikuchi syndrome) is characterized by five criteria: (1) congenital occurrence, (2) unilateral or bilateral index finger involvement, (3) variability in nail appearance, (4) possible hereditary involvement, and (5) frequently associated bone anomalies. Emphasis is placed on the configuration of the lunula, which is deformed and plays an important role in shaping the free edge of the nail plate. To our knowledge, this deformity has not been previously described in this syndrome.
A test implant of Zyderm collagen was carried out on 250 patients using the volar forearm site. The behaviour of the implant in the host tissue was followed-up in 6 cases by both direct and electron microscopy. There were 14 positive reactions. Biopsy was carried out in 3 cases, all of which exhibited severe reactions; foreign body granulomata were found in 2 of these, perivascular lymphocytic infiltration in the third. All 3 had a follow-up for 3 months and the biopsy sites healed normally. Trial implants are always advisable with collagen material. In order to avoid the possibility of such delayed hypersensitivity reactions, the test implant should be investigated at 72 hours and kept under observation for 4 weeks prior to carrying out the full corrective procedure. In two cases, reactive adverse reactions at the collagen implant treatment site were observed in spite of negative reaction at the test site. Nevertheless evidence suggests that Zyderm injectable collagen is a suitable material, leading to good cosmetic results; it carries minimal risk and is well tolerated even after a long period of time.
A disabling case of keratodermia palmoplantare papuloverrucoides progressiva is described. Less severe cases have been reported in the American literature as keratodermia punctata. The verrucoid lesions of our patient were spontaneously shed during treatment with the aromatic retinoid etretinate, and a daily maintenance dose of 25 mg was necessary to prevent recurrence.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Operations of the nail apparatus are done under sterile conditions and regional anaesthesia and in local anaemia. The knowledge of the complicated anatomy and physiology is the prerequisite for good surgical results. Nail extractions are commonly done too frequently. Subungual haematomas require a different treatment depending on the severity. Removal of the proximal third of the nail plate quickly clears acute paronychia resistent to antibiotics. The treatment of choice for the ingrown toenail is the surgical narrowing of the matrix. Kind and size of subungual tumours determine their surgical treatment. Diagnostic nail biopsies are best performed laterally.
The differential diagnosis of subungual tumours is often very difficult, since the same tumor located in another area looks entirely different. Former infections or traumata may further mask the tumour. Pain is usually not characteristic. Infection and the history of a trauma may further mask this tumour. Pain is usually not characteristic. both malignant and benign tumours may develop from all tissues present in the distal phalanx. Subungual melanomas are the most common malignant subungual tumours, whereas a variety of benign tumours occurs in the subungual region, the most characteristic of them is the glomus tumour.
We have reviewed the clinical and microbiological features of 113 cases of idiopathic onycholysis primarily affecting the great toenails. It is suggested that the majority of these cases were traumatic in origin. Although dermatophytes and potentially pathogenic bacteria were frequently found in the lesions, they were thought to be commensal in most cases. This is of considerable significance with regard to the selection of appropriate therapy.
PUVA-induced generalized bullous pemphigoid is reported is 8 patients with psoriasis and compared with the bullous pemphigoid described in 25 patients treated by other techniques (Goeckerman, UVB, anthralin, sun exposure, topical steroids). Furthermore they must be differentiated from all the other types of bullae induced by photochemotherapy in psoriatic patients. Diagnostic criteria should be improved in order to allow a better classification of these bullous diseases and to separate the photo-toxic bullae which are the commonest, from other bullae such as epidermolysis bullosa acquisita, localized bullous pemphigoid and drug-induced bullous pemphigoid.
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Therapeutic benefits from aromatic retinoid have been described in the treatment of a variety of dermatological disorders. Stress is given on some of them which coexist with ungual abnormalities and the results are reported. These diseases include psoriasis, acropustulosis, keratosis lichenoides chronica. Drug-induced modifications of the epidermal structures of the nail apparatus are emphasized: fragility with onychorrhexis and onychoschizia is the commonest finding. Onychomadesis and nail shedding can be seen. Onycholysis is rare. Painful paronychia which is sometimes accompanied by granulation tissue and ingrowing nails is the most interesting alteration due to this synthetic retinoid and as yet unexplained.