Response of psoriatic nails to the aromatic retinoid etretinate.
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Biomedical subjects
Publications and source records attributed to R K Scher.
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Cosmetics and ancillary preparations for care of the nails have long been used in abundance by women and to a much lesser extent by men. In this article, types of such cosmetics and ancillary preparations, their composition, and something of the chemistry of their ingredients are given. Several examples of adverse reactions to them are described and illustrated. The incidence of adverse reactions to them is small as a percentage, but significant as an absolute number because the number of them used is huge. When adverse reactions occur they may be severe.
A case of onychogryphosis of the left index nail is presented. This classical toenail dystrophy in our case involves a fingernail and is associated with onychomycosis.
Melanonychia strata longitudinalis is a pigmented (dark brown-tan-black) band running in the long axis of the nail. This abnormal color of the nail plate is caused by a focal increase of melanin because of increased number and/or function of normal or abnormal melanocytes in the nail matrix. Pigmented streaks in nails due to melanocytic hyperplasia are said to be so exceedingly common in black persons as to be normal and the phenomenon is benign in the majority of cases. In our white patient reported here the pigmentation is due to epithelial hyperpigmentation without melanocytic hyperplasia or evidence of malignancy, hormonal abnormality, or other adventitious influence.
Squamous-cell carcinoma of the nail bed is uncommon and is frequently misdiagnosed as a verruca vulgaris. Causes, clinical and histologic features, and procedures of treatment of subungual carcinoma are reviewed. In our patient the clinical appearance was that of a chronic infection associated with onycholysis.
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Ten patients with generalized psoriasis, which included nail involvement, were treated with total-body oral photochemotherapy. A combination of methoxsalen and high-intensity ultraviolet A radiation was employed and its therapeutic efficacy in nail psoriasis ascertained. Among the ten patients, there were 26 instances of the following nail signs: pitting, onycholysis, "oil drop" change, subungual hyperkeratosis, nail-plate crumbling, proximal nail-fold psoriasis, and onychorrhexis. Of the 26, eighteen improved by 50% or more. Only pitting failed to respond to therapy in all of the eight patients who had this change.
A simple technique for punch biopsies of nails is described. Local anesthesia with a solution of lidocaine, without epinephrine, is used. Digital block and tourniquet hemostasis are not required. The simplicity of the method ought to encourage more nail biopsies, increase the accuracy of diagnosis and improve treatment of diseases of the nails.