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PubMed2006

A simple and practical method in treatment of ingrown nails: splinting by flexible tube.

BACKGROUND: The ingrown nail (or onychocryptosis) is a common problem that occurs mostly in the big toe and causes high amounts of morbidity in affected patients. Many therapeutic methods have been described, most of them leading to severe damage to the nail or to frequent relapses. The nail splinting technique is a successful, simple and non-invasive therapeutic method for treating ingrown nails. OBJECTIVE: To determine efficacy of the plastic tube insertion technique in patients with ingrown toenail and its use as a standard treatment. MATERIALS AND METHODS: We encountered 32 cases (age range 9-67 years) of ingrown toenails in this clinical trial. All of the patients were treated using the plastic nail tube insertion technique for 7 to 15 days. Patients were examined daily for the first 3 days of treatment and were evaluated 3 and 6 months after treatment. All patients were followed up by a single observer. RESULTS: Recurrence was seen in only two patients after 6 months of treatment (6.25%). CONCLUSION: The low recurrence rate using the nail splinting technique in the treatment of ingrown toenail, as well as its simple application, shows that this treatment constitutes an effective, non-invasive method. It appears that this technique can substitute other more invasive surgical methods, particularly in the early stages of this disease.

Adolescent↗
PubMed1992

Laser surgery of the nail unit.

The past decade has seen a dramatic increase in the use of lasers for the treatment of dermatologic disorders. A variety of laser systems has been found to be useful in the treatment of numerous conditions found in the nail unit. The vascular lesions of the nail unit have been treated with the pulsed dye, tunable dye, copper vapor, argon, and carbon dioxide (CO2) lasers. Pigmented lesions noted in the nail unit have been effectively treated with the Q-switched ruby, copper vapor, argon, and pulsed dye lasers. The CO2 laser has been widely used for the treatment of benign and premalignant neoplasms of the nail unit as well as inflammatory processes. Investigational lasers, such as the gold vapor and excimer lasers, may provide clinical benefits for diseases of the nail unit in the near future. The potential advantages of laser surgery of the nail unit include the selective destruction of vascular and pigmented tissue as well as precise tissue destruction.

Humans↗
PubMed1998

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↗
PubMedDate not supplied

Hair and nail relationship.

Hair and nails are often stated to have much in common in relation to their origin, anatomical structures, and common involvement in many diseases. Hair and nails are predominantly epithelial structures derived from primitive epidermis and made up of keratinous fibrils embedded in a sulfur-rich matrix. It was first noted early in the 20th century that the nail unit was comparable in several respects to a hair follicle sectioned longitudinally and laid on on its side. The epithelial components of hair follicle and nail apparatus are differentiated epidermal structures that may be involved jointly in several ways as congenital and hereditary anomalies and acquired conditions such as alopecia areata, lichen planus, iatrogenic causes, and fungal infection. Multielemental characterization of human hair and nails shows that even after sample washing, many elements are enriched in the surface of the nails.

Hair↗
PubMed2002

Bowen's disease of the nail.

We present a case of Bowen's disease of the nail bed in a 60-year-old male. This case should remind us to biopsy any chronic lesion of the nail in order to reduce the delay in diagnosis. Indeed Bowen's disease of the nail unit often presents as a clinically misleading 'benign' lesion. Early diagnosis is important as this precancerous lesion appears to have a more aggressive behavior when it affects the nail unit. Bowen's disease of the nail is therefore considered as a squamous cell carcinoma, and both entities are grouped under the term 'epidermoid carcinoma'. Surgical excision is the first treatment option for those tumors without bone involvement. Our patient was treated with Mohs' micrographic surgery which is considered the ideal surgical treatment as it ensures a complete eradication of the tumor in over 90% of the cases but also maximally preserves normal tissue and function. This case illustrates the challenge of Mohs' surgery on the nail unit due to its particular anatomy and histology.

Bowen's Disease↗
PubMed2000

[Nail pathology in children].

In children the nail has physiologic characteristics that imply specific abnormalities. The most common dermatological localisation in psoriasis in the child; it is seen as trachyonychia, pitting, and occasionally pachyonychia. Ingrowth of the large toenail is a common problem, whether due to congenital hypertrophy of the lateral nail folds of the hallux in the newborn, to congenital malalignment of the nail of the big toe, or to a juvenile ingrown nail. Many other nail disorders are observed in the child: parakeratosis pustulosa, nail lichen, lichen striatus, melanonychia, dermatophyte onychomycosis, candida infection, herpes.... Aside from warts, tumours are rare.

Age Factors↗
PubMed1991

Congenital and hereditary nail disorders.

An accurate description of nail changes in congenital and hereditary conditions is complicated both by vague terminology and by errors introduced by the effects of trauma. This article attempts to identify primary developmental abnormalities in the nails and divides them into those caused by defects in the nail matrix, the nail field, or the nail bed and those originating from combined ectodermal and mesodermal defects. Attempting to identify underlying embryological defects may allow a more logical approach to both description and classification of congenital and hereditary nail abnormalities.

Humans↗
PubMed1989

Heritable nail diseases.

Heritable nail diseases are associated with a great variety of inherited diseases and syndromes. Well over 60 HEDs and numerous other inherited nail abnormalities are known to exist. A classification system of these disorders, as well as the specific nail change found in each, has been presented. Table 1 has been included to correlate many of the nail disorders with their corresponding inherited disease or syndrome. Clinically, inherited nail diseases may appear to be of questionable importance. In cases of primary presentation or poor historical background, however, these subtle nail changes may prove useful in arriving at or substantiating a diagnosis.

Ectodermal Dysplasia↗
PubMed1987

[Local rotational flap of the nail].

An original pattern of nail flap is described. It consists of a longitudinal band of lateral nail matrix and bed associated with its lateral wall. A vascular anatomic study with latex neopren infusion has been performed. The dorsal branch of the medial phalangeal artery could be shown to be the arterial pedicle of the flap. The venous system was shown to be concomitant. Eight nail autoplasties have been performed in eight cases, proving the reliability of the flap. It provides an interesting way of reconstruction of the nail in tumors, black longitudinal nail bands, posttraumatic and also post-infectious lesions of the nail.

Adult↗
PubMed1984

Nailing down a diagnosis.

Nails can act as a barometer of an individual's health, offer clues to nutritional disturbances and serve as windows through which to view capillary changes associated with constitutional disease. Understanding growth and development of normal nails is essential to the identification and interpretation of nail pathology. Causes of onychopathology include genetic disease, trauma, tumors, dermatologic disease, miscellaneous acquired disorders and generalized systemic disease. Diagnosis is aided by the realization that the nails have a limited number of reaction patterns when disturbed by disease. Any of these reactions may manifest a host of disorders. Clinicians should remember to include the nails in patient assessment. The nails are interesting anatomical and physiological areas that can help make a diagnosis.

Aging↗
PubMed1998

Nail changes in patients infected with human immunodeficiency virus. A prospective controlled study.

OBJECTIVES: To study the frequency of nail changes in a population of human immunodeficiency virus (HIV)-infected patients and to evaluate the specificity of these findings by comparison with HIV-negative control subjects. DESIGN: Prospective controlled study. Nail changes were recorded by a standardized clinical examination (curvature, nail plate, color, onychomycosis). In case of clinical diagnosis of onychomycosis, mycological culture was performed. SETTING: Primary care university hospital. PATIENTS: A total of 155 HIV-1-positive patients and 103 healthy HIV-negative control subjects of comparable age and sex ratio. INTERVENTION: None. MAIN OUTCOME MEASURE: Clinical examination findings. RESULTS: Nail symptoms were present in 67.7% of HIV-positive patients vs 34.0% of controls (P << .001). The following symptoms were significantly more frequent in the HIV group: clubbing (5.8%) (P < .05), transverse lines (7.1%) (P < .01), onychoschizia (7.1%) (P < .05), leukonychia (14.3%) (P < .001), and longitudinal melanonychia (14.8%) (P < .01). The main finding was onychomycosis in 30.3% of patients vs 12.6% of controls (P < .001). Trichophyton rubrum was present in 48% of onychomycoses and unusual Candida species were also recorded. Multiple fungi were frequently cultured in a single patient. The mean CD4+ cell count was lower in patients with onychomycosis and the frequency of onychomycosis increased in advanced stages of HIV disease. Acquired total leukonychia of the 20 nails was present in 4% of patients. CONCLUSION: Nail symptoms are much more frequent in patients with HIV than in healthy controls, and some of them could be linked to the level of immunosuppression.

Adult↗
PubMed2004

Presentation, histopathologic findings, and clinical outcomes in 7 cases of melanoma in situ of the nail unit.

OBJECTIVE: To report on the presentation, histopathologic findings, and clinical outcomes for a case series of MIS of the nail apparatus because melanoma in situ (MIS) of the nail unit has not been well characterized in the literature. SETTING: A division of a tertiary academic center specializing in micrographic excision of cutaneous neoplasms. DESIGN: Surgical records were searched for cases of MIS of the nail unit for the period of January 1, 1997, to December 31, 2002. The patient demographics and disease presentation, treatment, and clinical course were reviewed. RESULTS: Seven cases of MIS of the nail unit in white patients were identified. Longitudinal melanonychia was present in all cases, but dyspigmentation of the proximal nail fold and onychodystrophy were uncommon. Histopathologic analysis revealed poorly circumscribed proliferations of single cells over nests with variable pagetoid spread. Atypia was variable. Mitotic activity was low. All cases were treated with micrographic surgery. Amputation was avoided in 3 cases and was limited to partial distal interphalangeal amputation in the remainder. Six cases did not recur locally after initial surgical intervention. With an average of 24 months of follow-up, all patients were free of disease. CONCLUSIONS: Longitudinal melanonychia in a white patient mandates consideration of MIS of the nail unit. Given the nondescript clinical presentation, the threshold for biopsy should be low. The histopathologic findings appear similar to those of MIS in other areas, with asymmetry and poor circumscription predominating. With additional study and further acceptance, micrographically controlled excision has the potential to minimize morbidity. Further investigation is warranted.

Adult↗
PubMed1991

A case-control study of oral cancer and pre-diagnostic concentrations of selenium and zinc in nail tissue.

A case-control study of oral cancer was conducted in western Washington state between 1983 and 1987. Cases (n = 379) were identified through a population-based registry, and controls (n = 514) were selected by telephone using random digit dialing. Subjects participated in a personal interview, completed a food-frequency questionnaire, and submitted clippings from the nails of each great toe for the determination of selenium and zinc concentrations. The odds ratio (OR) for low selenium levels in nail tissue (lowest 25% of the distribution compared to the upper 75%) was 1.4 (95% confidence interval (CI) 1.0-2.2). Likewise, the odds ratio for low zinc levels in nails was 1.6 (95% CI 1.0-2.3), but for low dietary zinc was 1.0 (95% CI 0.7-1.7). Men with oral cancer had lower nail selenium levels than did the controls (OR = 1.9), but women with oral cancer did not (OR = 0.6). Individuals 20 to 39 years of age with oral cancer, in particular, were more likely to have lower selenium levels in nail tissue than controls (OR = 16.4). There was a significant interaction between selenium and ascorbic acid levels which could not be explained by cigarette use. Subjects at greatest risk had low levels of both nutrients (OR = 3.8 for smokers and OR = 5.7 for non-smokers). However, since the elements were deposited in the nail matrix close to the date of diagnosis, the differences in the element concentrations between cases and controls may have been a result of the disease. Further etiologic studies of selenium, vitamin intake and oral carcinoma are warranted.

Adult↗
PubMed1995

Bone regrowth in young mice stimulated by nail organ.

Recent studies of postamputational repair following digit-tip amputation revealed an unexpected correlation between nail regrowth and bone regrowth in mice. To examine putative effects of nail on bone regrowth, phalangeal tips were amputated such that nail was artificially removed from distal levels or retained following proximal level amputations. In the absence of nail, bone did not regrow at distal levels. Conversely, when nail was surgically retained bone regrew from proximal levels. The nail organ profoundly influences bone regrowth.

Amputation, Surgical↗
PubMed2007

Computational comparison of reamed versus unreamed intramedullary tibial nails.

We compared, via a computational model, the biomechanical performance of reamed versus unreamed intramedullary tibial nails to treat fractures in three different locations: proximal, mid-diaphyseal, and distal. Two finite element models were analyzed for the two nail types and the three kinds of fractures. Several biomechanical variables were determined: interfragmentary strains in the fracture site, von Mises stresses in nails and bolts, and strain distributions in the tibia and fibula. Although good mechanical stabilization was achieved in all the simulated fractures, the best results were obtained in the proximal fracture for the unreamed nail and in the mid-diaphyseal and distal fractures for the reamed nail. The interlocking bolts, in general, were subjected to higher stresses in the unreamed tibial nail than in the reamed one; thus the former stabilization technique is more likely to fail due to fatigue.

Aged↗
PubMed1999

Nails and claws in primate evolution.

The issue of whether nails or claws were present on the digits of the last common ancestor of living primates is central to the understanding of the ecological context in which the order originated. Two lines of evidence are available, the shape (claw, nail, toilet-claw) and the histological structure (one or two horny strata). Here we review the existing data regarding the shape and histological structure of cheirideal appendages in primates and present new information from a wide range of living primates. We demonstrate the presence of a typical toilet-claw in Daubentonia madagascariensis and discuss its consequences, since the alleged lack of such structures in this species has long obscured the issue. The general view that primate nails, with the exception of those in New World primates, consist of only one layer is disproved by the presence of two distinct strata in the nails of the feet of three out of seven catarrhine species examined, as well as in Lemur catta. The combined new and old data indicate that the last common ancestor of the extant primates had lost the typical mammalian claws of its ancestors and developed nails on all pedal digits except digit II, which bore a toilet-claw. All nails as well as the toilet-claw originally consisted of two layers. We present a new hypothesis regarding the adaptational significance of these changes.

Animals↗
PubMed1994

How to predict requisite nail length in tibial fractures.

In a retrospective study involving 59 patients, a regression equation between nail length and body weight has been computed as follows: nail length = -5.05729 + 0.222 x body height (probability value for intercept P = 0.24327 and slope P = 0.0000). Graphic analysis of the residuals gave a randomly scattered blob of data points. Validation of the equation in 12 patients showed an average difference between actual and derived nail length of -0.09 (SD 0.93, minimum -1.57, maximum 1.42). It can be stated that in most cases of intramedullary tibial nailing, the length of nail required can be predicted by the regression equation using the available manufactured nail of the size nearest in length to the derived length or the next size up or down.

Body Height↗
PubMed1990

Nail involvement in osteoarthritis.

Two cases of nail involvement associated with primary interphalangeal osteoarthritis of the hand, including leukonychia and longitudinal nail ridge, are reported. Osteoarthritic changes of the distal interphalangeal joints may cause nail lesions by exerting direct pressure on the nail matrix or by interfering with local blood flow. Moreover, inflammation of the Heberden's nodes is often present and seems to participate in the development of nail alteration. In our patients, leukonychia disappeared after local steroidal anti-inflammatory treatment of the osteoarthritic node and longitudinal nail ridge disappeared after treatment with nonsteroidal anti-inflammatory agents.

Aged↗