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PubMed1993

Isolated lichen planus of the nails treated with etretinate.

A 46-year-old Japanese man with isolated lichen planus of the nails is reported. The affected nails were all of the fingernails and the third and fourth toenails of both feet. Histologically, the ventral part of the proximal nail folds showed mild band-like cell infiltration below the epidermis, and the nail beds (ventral matrix) showed hypergranulosis and epidermal-dermal interphase activity with liquefaction degeneration of basal cells and a band-like cell infiltration consisting of lymphoid cells and histiocytes. Systemic use of etretinate in combination with application of steroid lotion was evaluated as very effective. Although the use of retinoids for lichen planus of the nails remains only a suggested method of treatment, a positive trial should be attempted, since this disorder sometimes results in severe nail damage.

Etretinate↗

PubMed1995

Serial cultivation of human nail matrix cells under serum-free conditions.

We have established serial cultures of human nail matrix cells (NMCs) under serum-free conditions. We cultured NMCs using two different methods depending upon the volume of nail matrix obtained. When a sufficient amount of nail matrix was obtained, they were minced and treated with 0.25% trypsin and 0.03% EDTA. The NMCs were transferred directly as a dispersed cell culture into KGM medium. Because a sufficient amount of matrix was rarely obtained, we developed a method by which NMCs were cultured primarily as implanted small matrices in Eagle's MEM (high Ca+ medium) supplemented with 15% fetal bovine serum for the first 4 to 5 days; during this time, the NMCs expanded from the matrices and formed colonies around them. NMCs then were cultured with KGM. In both methods, KGM medium supported the growth of NMCs without a biological feeder layer. These cells could be cultivated serially for at least seven passages. Half of the cells were positively stained with a monoclonal antibody against hair (hard) keratin which is expressed in nail matrix in vivo, indicating that the cells originated from the nail matrix. These methods will now permit investigations of nail matrix cells that previously were unfeasible because of the relative lack of cells and difficulties with propagation.

Animals↗

PubMed1998

Topical anthralin therapy for refractory nail psoriasis.

The nail is commonly involved in psoriasis; however, very few therapies are satisfactory. In this study, we treated for 20 cases of psoriasis vulgaris with nail involvement with topical anthralin therapy. An ointment of 0.4-2.0% anthralin in petrolatum was applied to the affected nail bed once a day and washed away with water after 30 minutes. Then, 10% triethanolamine cream was applied to prevent undesired pigmentation. Within five months of therapy, twelve out of twenty psoriatic patients (60%) showed moderate and obvious improvement, four patients (20%) showed no response to this regimen. Onycholysis and pachyonychia both responded clinically, and the number of pitting was markedly decreased in some cases. The main side effect of anthralin therapy was reversible pigmentation of the nail plate. Topical anthralin therapy is effective for nail psoriasis and considered to be a useful treatment for refractory nail psoriasis.

Administration, Topical↗

PubMed2001

An association of twenty-nail dystrophy with vitiligo.

A rare association of twenty-nail dystrophy with segmental vitiligo is described in two patients. Vitiligo preceded the nail dystrophy. In both cases, all twenty nails were uniformly affected with the nail plates showing longitudinal striations and loss of luster. Longitudinal nail biopsy revealed a histological picture suggestive of eczematous changes and lichen planus respectively. Intramatrix injections of triamcinolone acetonide into the proximal and lateral nail folds were administered with considerable improvement.

Adolescent↗

PubMed1990

Ultrasound velocity in human fingernail and effects of hydration: validation of in vivo nail thickness measurement techniques.

Distal nail thickness was measured using an electronic micrometer and both distal and proximal nail ultrasound times were recorded in 20 volunteers (10 male, 10 female), aged 20-39. The fingernail ultrasound velocity was 2.26 X 10(3) m/s (subject range 2.03-2.69) (analysis of variance technique). The proximal ultrasound transit time was greater than distal ultrasound transit time. In three volunteers, five micrometer and one distal midline ultrasound measurement of five nails were repeated on 10 occasions over 2 weeks. For the micrometer readings the average coefficient of variation was 5.3% (SD +/- 2.4%), and for the ultrasound reading the average coefficient of variation was 4.0% (SD +/- 1.3%). To assess the influence of hydration, in five volunteers the distal nail micrometer thickness and the distal nail ultrasound transit time were measured on five nails before and after 30 min of immersion in water initially at 37 degrees C. The mean distal ultrasound transmission time increased from 0.20 +/- 0.04 microseconds to 0.22 +/- 0.04 microseconds (P less than 0.001) after water immersion. The micrometer measurements and ultrasound velocity did not change significantly (mean ultrasound velocity = 2.01 X 10(3) m/s before, 2.04 X 10(3) m/s after immersion).

Adult↗

PubMed1995

Nail changes in epidermolysis bullosa: clinical and pathogenetic considerations.

Nail changes in epidermolysis bullosa (EB) are common, but although they are highly suggestive of the disease, they are not pathognomonic. They are the result of abnormalities of the nail matrix and nail bed, associated with the pathogenetic alterations of the dermo-epidermal junction which occur in EB. In addition, secondary trauma in the areas of epidermal-dermal separation, and chronic inflammation of the nail matrix, are probable contributory factors, even in non-scarring forms of EB. Recent developments in the molecular and cell biology of the cutaneous basement membrane zone have greatly advanced our understanding of the pathomechanisms underlying different subtypes of EB. Defects in genes coding for the structural proteins of the basement membrane zone have been defined in some EB subtypes, and abnormal expression of structural proteins in others. The data accumulated from study of these genetic disorders will contribute to knowledge of the role of the dermo-epidermal junction in the normal physiology and differentiation of the nails, and be of value in discerning the aetiopathogenesis of acquired nail diseases.

Basement Membrane↗

PubMed1998

Subungual squamous cell carcinoma presenting with minimal nail changes: a factor in delayed diagnosis?

Squamous cell carcinoma of the nail bed is a relatively uncommon tumour that may be diagnosed only after considerable delay. The first case presented is a 79-year-old man with a history of discomfort and discoloration affecting the right thumbnail of 3 years duration. The second case is a 70-year-old man who presented with a recurrent, offensive discharge from beneath the left thumbnail of 40 years duration. Clinical examination of the affected digits revealed minor nail abnormalities. The presence of tumour was fully apparent only after removal of the nail plate and inspection and biopsy of the nail bed. The cases demonstrate that subungual squamous cell carcinoma may present with prolonged symptoms and a deceptively benign appearance. The importance of consideration of the possibility of malignancy, removal of the nail plate for inspection of the nail bed and appropriate biopsy is emphasized.

Aged↗

PubMed2004

Squamous cell carcinoma of the nail unit with evidence of bony involvement: a multidisciplinary approach to resection and reconstruction.

BACKGROUND: Squamous cell carcinoma (SCC) of the nail bed is a rare disorder that is often misdiagnosed for years before definitive diagnosis with biopsy. Proper evaluation of this carcinoma includes radiographic evaluation for bony involvement of the phalanges of the affected digit. If bony involvement is evident by x-ray, amputation of the distal phalanx or the affected digit is warranted. Mohs micrographic surgery of the affected nail unit is advantageous in preserving vital tissue for reconstruction after phalangeal amputation by a hand surgeon, thus maximizing preservation of the densely innervated tissue from the volar finger pulp. This approach may maximize functional capacity of the reconstructed digit. OBJECTIVE: To describe a multidisciplinary approach to resection, amputation, and reconstruction of digits with SCC of the nail bed. METHODS: This is a description of three cases and a review of the pertinent medical literature. RESULTS: Three SCCs of the nail bed were excised with Mohs micrographic surgery, preserving the volar pulp and skin of the distal finger. The patients were then referred for distal phalanx amputation and reconstruction by a hand surgeon. All patients remained disease free with acceptable function of the reconstructed digits at 15, 17, and 38 months of follow-up. CONCLUSION: Although uncommon, SCC of the nail bed must be considered in all nails with chronic disease. Preoperative evaluation should include hand radiographs in search of bony involvement. Tissue-sparing excision combined with distal amputation of the affected phalanx and reconstruction of the digit using spared tissue may maximize hand and digit function.

Adult↗

PubMed2004

Inherited accessory nail of the fifth toe cured by surgical matricectomy.

BACKGROUND: The inherited accessory nail of the fifth toe is a common condition in the Chinese population. OBJECTIVE: The objective was to demonstrate three lesions in two cases of inherited accessory nail of the fifth toe successfully treated with surgical matricectomy. METHODS: Under local anesthesia and use of tourniquet, the proximal nail fold was incised and the matrix of the accessory nail was exposed and then excised by scalpel surgery. The skin defect left after removal of the lesion was repaired with a rotation flap. RESULTS: Histopathologic examination of the surgical specimens revealed that the matrices of the accessory nails were completely extirpated. No recurrence was found 2 years after operation. CONCLUSION: The inherited accessory nail of the fifth toe was cured by surgical matricectomy.

Adult↗

PubMed1994

Prevalence of nail abnormalities in children with alopecia areata.

We assessed the prevalence of nail abnormalities in 272 children with alopecia areata who were seen in our department during an eight-year period. Of these, 126 (46%; 50 girls, 76 boys) had nail abnormalities that were related to alopecia areata. Nail pitting was detected in 92 patients, including 37 with alopecia totalis or alopecia universalis. Three patients experienced an onychomadesis of all 20 nails during the acute onset of alopecia areata universalis. Thirty-two (11.7%) had nail thinning and severe nail plate surface abnormalities that were consistent with a diagnosis of trachyonychia.

Adolescent↗

PubMed1997

Allergenic ingredients in nail polishes.

It has been known since the 1940s that nail polishes contain allergenic ingredients. The aim of this study was to clarify whether the nail polishes on the market today contain significant amounts of allergens, and what the solvents are. The following ingredients were determined: toluene, toluene sulfonamide formaldehyde resins, free formaldehyde, acrylates, methacrylates and certain organic solvents. The study comprised 20 brands and 42 samples. All the nail polishes analysed contained allergenic toluene sulfonamide formaldehyde resins (TSFR), in concentrations from 0.08 to 11.0%. The concentration of total formaldehyde varied from 0.02% to 0.5%. The more TSFR a nail polish contained, the higher was its formaldehyde content. Probably not only TSFR-allergic but also formaldehyde-allergic persons may get dermatitis from many of the nail polishes studied. The concentrations of acrylates and methacrylates were so small that they are of practical significance only to those previously sensitized to acrylates. Of the organic solvents, toluene was still widely used, whereas xylene was found in only 1 product. The nail polishes on the market today are not safe for all consumers. However, according to the regulations of the European Union, the packaging labeling of all cosmetic products must be supplied with a list of ingredients from the beginning of 1998. This will help the consumer to avoid allergenic products. A better alternative could, however, be to substitute the most allergenic ingredients with substances possessing minor allergy potency.

Acrylates↗

PubMed1993

Nail bleeding associated with neurological diseases: all that uncommon? Report of 3 cases.

We report 3 patients, without bleeding disorders, presenting with onychomadesis and focal haemorrhages at multiple proximal nail folds or in the nail tissue. In one of our patients it was possible to check the appearance of a drop of blood on each side, beneath the proximal nail fold when he pressed the pulp of the fingers of his previously fractured forearm on a hard surface. All patients had major peripheral or major peripheral and central neurological deficits, prior to the nail bleeding. Peripheral vascular dilatation produced by paralysis of the vasoconstrictors in the nail area slows the venous return in the dilated vessels, mainly in the proximal nail fold.

Adult↗

PubMed1989

Nail size in normal infants. Establishing standards for healthy term infants.

The nails of 48 healthy infants of 39 to 41 weeks' gestation were measured with dial calipers to establish both a method for measurement of nails and standards of nail size. Nail width and length were measured directly, and an estimated area was calculated. Nail area was compared between sexes and races and was not found to differ significantly except between races for the first fingernail. A description of the term newborn nail is presented.

Female↗

PubMed2005

Ankle arthrodesis with a retrograde femoral nail for Charcot ankle arthropathy.

BACKGROUND: Tibiocalcaneal arthrodesis with retrograde intramedullary nailing has gained acceptance as a salvage procedure for a multitude of ankle and hindfoot disorders and is frequently used in Charcot arthropathy of the ankle. Because of the severe osteopenia often associated with Charcot arthropathy of the ankle, an area of stress concentration leading to stress fracture at the proximal aspect of the nail has been identified. METHODS: To determine if this potential complication can be avoided, nine consecutive diabetic individuals with Charcot arthropathy of the ankle had ankle arthrodesis with a longer retrograde femoral nail. The average age of the patients was 52.3 years. Their average weight was 102.6 kg. RESULTS: Fusion was evident on radiographs in all nine patients at an average of 10.5 weeks. None of the patients developed a stress fracture or evidence of stress concentration at the proximal metaphyseal tip of the nails. One wound infection resolved after debridement and antibiotic therapy, and one postoperative hematoma resolved without surgery. At an average 32-month followup, all patients were ambulatory, using commercially available therapeutic footwear. None had developed a new foot ulcer, infection, or new episode of Charcot arthropathy. CONCLUSIONS: The use of a retrograde femoral nail for ankle arthrodesis in patients with Charcot arthropathy appears to decrease the risk of stress fracture compared with shorter nails without increasing the risk of other complications.

Ankle Joint↗

PubMed2002

Retrograde femoral interlocking nail in complex fractures.

Retrograde interlocking nail was used as the method of fixation in 35 different cases of combination of complex femoral fractures. We performed this procedure in fractures of femoral shaft associated with fracture neck femur, pathological fractures of proximal third of femur with trochanteric pathology, ipsilateral fracture of femur and tibia in polytrauma cases with multiple other injuries, in highly obese patients with fracture shaft femur. This technique was also used in cases of pregnancy with fracture shaft femur and in unstable pelvic fracture or dislocation hip associated with fracture shaft femur. Operative technique involved with retrograde insertion of un-reamed, non-cannulated custom made nail through entrance portal in intercondylar notch was applied for fixation of the shaft femur fracture. The other associated fracture around hip was stabilized separately using suitable implant according to type of fracture. In cases of ipsilateral fracture of femur and tibia, femur was stabilized by retrograde interlocking nail and tibia was stabilized by antigrade interlocking nail through same incision at the same sitting. The case was followed up for three years; the average union time was 12 to 18 weeks. Out of 35 cases, 31 cases regained full knee movement. Out of the remaining 4 cases, 2 cases could regain up to 90 degrees of movement, these were old fractures and non-cooperative patients. In one case, patellofemoral arthritis was developed because of an operative error where a nail was not put inside the articular surface. Mal-union was observed in an early case of the series and implant failure was nil. Retrograde interlocking nail was used as the method of fixation in complex fracture problems. Multiple fractures of long bones can be stabilized in one stage, preventing multiple operations at different stages in polytraumatized patients. This resulted in early recovery, lesser hospital stay, and early rehabilitation of patient with good results and is economical also.

Adolescent↗

PubMed2006

Retrograde nailing for distal third femoral shaft fractures: a prospective study.

PURPOSE: To evaluate the postoperative knee function and results of unreamed retrograde nailing for distal third femoral shaft fractures. METHODS: Between January 2002 and 2003 inclusive, a consecutive series of 27 patients (with 28 fractures) who underwent retrograde nailing were prospectively evaluated. Outcome measures were union time, initiation of weight bearing, deformity and shortening, functional length of the nail, knee function assessed using a modified Knee Society Knee Score. Correlations between union time and other variables were also studied. RESULTS: In these patients 26 (93%) of the 28 fractures achieved union, of which 5 underwent dynamisation; the mean union time for the other 21 fractures was 4.4 months. Angular malalignment was present in 4 patients and shortening in 4 others. There was negligible correlation between union time and variables of nail-canal diameter mismatch, functional length of nail, fracture geometry, or initiation of partial weight bearing ambulation. Knee flexion of more than 100 degrees was achieved in 26 patients. 19 patients had anterior knee pain and 10 had instability. By the end of one year, excellent or good scores for pain and function were recorded in 77% and 73% respectively, of the 26 patients. CONCLUSION: In view of such favourable union rates but significant deterioration in overall knee joint function, at best retrograde nailing is a reliable alternative in the management of selected complicated fractures of the distal femoral shaft.

Adult↗

PubMed2000

Flexible intramedullary nailing for the treatment of unicameral bone cysts in long bones.

BACKGROUND: Unicameral bone cyst is characterized by its tenacity and risk of recurrence. Pathological fracture is common and is often the presenting symptom. The objective of the present study was to evaluate the results of flexible intramedullary nailing for the treatment of a unicameral bone cyst with or without a pathological fracture. METHODS: Flexible intramedullary nailing for the treatment of a unicameral bone cyst was performed in thirty-two patients. Thirty of these patients presented with a pathological fracture; twenty-four were managed immediately with intramedullary nailing, and the other six had been managed conservatively at other clinics before they were referred to our department. The remaining two cysts were detected incidentally. The cyst was located in the humerus in twenty-one patients, in the femur in nine, and in the radius in two. The mean age of the patients at the time of surgery was 9.8 years, and the mean duration of follow-up was 53.7 months. Radiographic evaluation was performed according to the criteria of Capanna et al., and the cyst was classified as completely healed, healed with residual radiolucency (osteolysis), recurred, or having no response. RESULTS: The healing period ranged from three to 105 months. Fourteen cysts healed completely, and sixteen healed with residual radiolucent areas visible on radiographs. There was recurrence of two cysts that had healed with residual radiolucency. All of the cysts in the present study responded to treatment. A change of nails was necessary in nine patients, as the nails had become too short after bone growth. No major complications were observed. CONCLUSIONS: Flexible intramedullary nailing provides early stability, which allows early mobilization and thus obviates the need for a plaster cast and decreases the prevalence of the most common complication: a pathological fracture. This method of treatment also allows for an early return to normal activity.

Bone Cysts↗

PubMed2004

Comparison of titanium elastic nails with traction and a spica cast to treat femoral fractures in children.

BACKGROUND: Titanium elastic nails are commonly used to stabilize femoral fractures in school-aged children, but there have been few studies assessing the risks and benefits of this procedure compared with those of traditional traction and application of a spica cast. This prospective cohort study was designed to evaluate these two methods of treatment, with a specific focus on the first year after injury, the period when the treatment method should have the greatest impact. METHODS: Eighty-three consecutive children, six to sixteen years of age, were studied prospectively. Factors that were analyzed included clinical and radiographic data, complications, hospital charges, and outcome data. Outcome and recovery were assessed both with the American Academy of Orthopaedic Surgeons Pediatric Outcomes Data Collections Instrument, version 2.0, and according to a series of important recovery milestones including the time to walking with aids, time to independent walking, time absent from school, and time until full activity was allowed. RESULTS: Thirty-five children (thirty-five fractures), with a mean age of 8.7 years, were treated with traction and application of a spica cast, and forty-eight children (forty-nine fractures), with a mean age of 10.2 years, were treated with titanium elastic nails. All fractures healed, and no child sustained a complication that was expected to cause permanent disability. At one year after the fracture, eighty of the children had acceptable alignment and no inequality between the lengths of the lower extremities. The remaining three children, who had an unsatisfactory result, had been treated with traction and a spica cast. Twelve patients (34%) treated with traction and a cast had a complication compared with ten patients (21%) treated with titanium elastic nails. Compared with the children treated with traction and a cast, those treated with titanium elastic nails had shorter hospitalization, walked with support sooner, walked independently sooner, and returned to school earlier. These differences were significant (p < 0.0001). We could detect no difference in total hospital charges between the two groups. CONCLUSIONS: The results of this prospective study support the recent empiric observations and published results of retrospective series indicating that a child in whom a femoral fracture is treated with titanium elastic nails achieves recovery milestones significantly faster than a child treated with traction and a spica cast. Hospital charges for the two treatment methods are similar. The complication rate associated with nailing compares favorably with that associated with traction and application of a spica cast.

Adolescent↗