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de Almeida CÁ, Nakamura R, Leverone A, Costa F, Estrada BD, Haui P, Luz F, Yamada AF, Werner H, Canella C. Imaging features for the evaluation of skin and nail infections. Skeletal Radiol 2024; 53:2051-2065. [PMID: 38194095 DOI: 10.1007/s00256-023-04557-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/10/2024]
Abstract
Clinical manifestations of dermatological and musculoskeletal conditions can sometimes overlap, leading to confusion in diagnosis. Patients with nail and skin infections may undergo imaging examinations with suspicions of muscle, tendon, or joint injuries. Dermatological infections often involve soft tissues and musculoskeletal structures, and their etiology can range from fungi, bacteria, viruses, to protozoa. Relying solely on physical examination may not be sufficient for accurate diagnosis and treatment planning, necessitating the use of complementary imaging exams. The objective of this paper is to present and discuss imaging findings of the main infectious conditions affecting the nail apparatus and skin. The paper also highlights the importance of imaging in clarifying diagnostic uncertainties and guiding appropriate treatment for dermatological conditions.
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Affiliation(s)
- Carolina Ávila de Almeida
- Diagnósticos da América S/A, DASA, Avenida das Américas 4666, Sala 325, Rio de Janeiro, RJ, 22640-100, Brazil.
| | - Robertha Nakamura
- Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia Do Rio de Janeiro, Rio de Janeiro, Brazil
- Centro de Estudos das Unhas (CEU), Santa Casa de Misericórdia Do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andreia Leverone
- Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia Do Rio de Janeiro, Rio de Janeiro, Brazil
- Centro de Estudos das Unhas (CEU), Santa Casa de Misericórdia Do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Flávia Costa
- DASA, Clínica Alta Excelência Diagnóstica, Rio de Janeiro, Brazil
| | - Bruna Duque Estrada
- Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia Do Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Evidence-Based, Health of the Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Priscilla Haui
- Diagnósticos da América S/A, DASA, Avenida das Américas 4666, Sala 325, Rio de Janeiro, RJ, 22640-100, Brazil
| | - Flavio Luz
- Department of Dermatology, Universidade Federal Fluminense (UFF), Rio de Janeiro, Brazil
| | - Andre Fukunishi Yamada
- Department of Radiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
- Hospital Do Coração, HCOR, São Paulo, Brazil
| | - Heron Werner
- Diagnósticos da América S/A, DASA, Avenida das Américas 4666, Sala 325, Rio de Janeiro, RJ, 22640-100, Brazil
- Bio Design Laboratory, Pontifícia Universidade Católica (PUC-Rio), Rio de Janeiro, Brazil
| | - Clarissa Canella
- DASA, Clínica Alta Excelência Diagnóstica, Rio de Janeiro, Brazil
- Bio Design Laboratory, Pontifícia Universidade Católica (PUC-Rio), Rio de Janeiro, Brazil
- Department of Radiology of Universidade Federal Fluminense (UFF), Rio de Janeiro, Brazil
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Vargas EAT, Finato VML, Azulay-Abulafia L, Leverone A, Nakamura R, Wortsman X. Ultrasound of Nails: Why, How, When. Semin Ultrasound CT MR 2024; 45:233-250. [PMID: 38056789 DOI: 10.1053/j.sult.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Nail disorders are frequently a challenge to diagnose correctly only based on clinical findings. Moreover, biopsies may leave scars due to damage to the nail matrix. Currently, high-frequency ultrasound (HFUS) with probes >15 MHz is the first-choice imaging technique to study the nail. Compared with other imaging tests such as computed tomography and magnetic resonance imaging, HFUS has the advantage of high-resolution imaging of the nail apparatus without exposure to radiation, contrast media, and the risk of claustrophobia of these other expensive imaging methods. Notably, the axial spatial resolution of HFUS is higher than computed tomography and magnetic resonance imaging; therefore, it can better discriminate the anatomical alterations. Our objective is to review the main applications of HFUS of the nail through literature analysis and illustration of cases of the most frequent pathologies found in our experience, exemplifying why, how, and when HFUS could help diagnose nail diseases.
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Affiliation(s)
- Estêvão A T Vargas
- Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Department of Dermatology, Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, Brazil
| | | | - Luna Azulay-Abulafia
- Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Department of Dermatology, Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, Brazil
| | - Andreia Leverone
- Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Robertha Nakamura
- Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Ximena Wortsman
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues (IDIEP), Santiago, Chile; Department of Dermatology, Universidad de Chile, Santiago, Chile; Department of Dermatology, Pontificia Universidad Catolica de Chile, Santiago, Chile.
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Gonzalez C, Wortsman X. How to Start on Dermatologic Ultrasound: Basic Anatomical Concepts, Guidelines, Technical Considerations, and Best Tips. Semin Ultrasound CT MR 2024; 45:180-191. [PMID: 38056787 DOI: 10.1053/j.sult.2023.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Dermatologic ultrasound has grown exponentially during the last decades and has passed from the experimental phase to the routine daily practice in multiple countries. The performance of this imaging technique requires color Doppler ultrasound devices working with high-frequency probes, a trained operator on imaging and dermatologic conditions, and the performance of standardized protocols for obtaining the anatomical data properly. In this review, we analyze the ultrasonographic anatomy of the skin, hair, and nails, the technical requirements and considerations, the guidelines, and the recommended protocols, and provide the best tips for practicing this type of examination confidently.
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Affiliation(s)
| | - Ximena Wortsman
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile; Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile; Department of Dermatology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.
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Myers B, Abudu B, Breen I, Chan LS, Fung M, Joo J. Venous hemangioma arising within the nailbed: A rare clinical presentation. JAAD Case Rep 2024; 48:66-68. [PMID: 38778890 PMCID: PMC11108790 DOI: 10.1016/j.jdcr.2024.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Affiliation(s)
- Bridget Myers
- Department of Dermatology, University of California, Davis, Davis, California
| | - Boya Abudu
- Department of Dermatology, University of California, Davis, Davis, California
| | - Ilana Breen
- Department of Dermatology, University of California, Davis, Davis, California
| | - Lawrence S. Chan
- Department of Dermatology, University of California, Davis, Davis, California
| | - Maxwell Fung
- Department of Dermatology, University of California, Davis, Davis, California
| | - Jayne Joo
- Department of Dermatology, University of California, Davis, Davis, California
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Kulaksız B, Palamar D, Misirlioglu TO, Akgun K, Terlemez R. Ultrasonographic Evaluation of Nail Involvement in Patients With Axial Spondyloarthritis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:967-978. [PMID: 38323351 DOI: 10.1002/jum.16426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVES This study aimed to evaluate the nail units of patients with axial spondyloarthritis (ax-SpA) using ultrasound and to identify any subclinical changes. We also aimed to examine the relationship between clinical enthesitis scores and nail involvement in patients with ax-SpA. METHODS The study included 40 patients with ax-Spa, 40 patients with psoriatic arthritis (PsA), and 40 healthy controls. The thickness of the nail plates, morphological changes, the thickness of the proximal nail units, the thickness of the nail beds, and power Doppler signal intensities were evaluated and compared. Maastricht Ankylosing Spondylitis Enthesitis Score and Spondyloarthritis Research Consortium of Canada Enthesitis Index were also evaluated in patients with ax-SpA. RESULTS There was no significant difference between the thickness of the nail plates of the three groups (P > .05). The first nail bed thickness of ax-SpA cases was significantly higher than the control group (P = .046), and the fourth and fifth nail proximal unit thicknesses of the control group were significantly lower than the ax-SpA and PsA groups (P = .023, P = .017). We also found that the Wortsman scores of the cases with PsA were significantly higher than the ax-SpA and control groups (P = .0001). CONCLUSION The thickness of the proximal nail unit adjacent to the insertion of the digital extensor tendon, which is considered as the enthesis area, is similar to the patients with PsA in patients with ax-SpA, especially in the fourth and fifth fingers compared to the control group. On the other hand, almost no structural changes in nail plates were observed in patients with ax-SpA group.
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Affiliation(s)
- Bilal Kulaksız
- Department of Physical Medicine and Rehabilitation, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Deniz Palamar
- Department of Physical Medicine and Rehabilitation, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Tugce Ozekli Misirlioglu
- Department of Physical Medicine and Rehabilitation, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Kenan Akgun
- Department of Physical Medicine and Rehabilitation, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Rana Terlemez
- Department of Physical Medicine and Rehabilitation, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Tanaka AA, Werner B, Bragatto ACB, Skare TL, Stadler B. Ultrasonographic and power doppler parameters of nails fail to differentiate between onychodystrophy in patients with psoriasis vulgaris or psoriatic arthritis. Adv Rheumatol 2024; 64:25. [PMID: 38605415 DOI: 10.1186/s42358-024-00367-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/30/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Nail involvement is frequent in patients with psoriasis (Pso) and psoriatic arthritis (PsA) and there is a relationship between nail involvement and inflammation of the enthesis. The main objective of the present study is to describe the ultrasound findings and clinical characteristics of nails from patients with psoriasis and psoriatic arthritis with and without nail dystrophy. METHODS A cross-sectional study including consecutive patients with PsO and PsA was carried out. The study patients were divided into 4 groups, totaling 120 participants. Group 1: patients with psoriasis vulgaris and clinically normal nails; Group 2: patients with psoriasis vulgaris and onychodystrophy; Group 3: patients with psoriatic arthritis and clinically normal nails; Group 4: patients with psoriatic arthritis and onychodystrophy; All patients were submitted to dermatological and rheumatological clinical analysis. Ultrasound examinations was performed by a single examiner, blinded to all clinical data, with ultrasound high resolution, in B-mode or gray-scale (GS), Power Doppler (PD) and Spectral Doppler. RESULTS A significant difference was found between the groups regarding the variable Psoriasis Area and Severity Index (PASI) (p = 0.008) and body surface area (BSA) (p = 0.005), with patients with psoriatic arthritis having lower PASI and BSA compared to patients with only cutaneous psoriasis. A positive relationship was found with the average ultrasound thickness of the nail bed and the Nail Psoriasis Severity Index (NAPSI) in correlation analysis (rho = 0.344). When we grouped patients with psoriasis and psoriatic arthritis, there was no significant difference between the cutaneous psoriasis groups and the psoriatic arthritis groups in terms of nail plate GS (p = 0.442), nail bed PD (p = 0.124). CONCLUSION Greater nail bed thickness indicates early psoriatic nail disease, as confirmed in our study correlating NAPSI with nail bed thickness. Ultrasonography is a low-cost exam, promising in the evaluation, showing that the ultrasound grayscale is consistent with those who have dystrophic nails, but it can't distinguish psoriasis from psoriatic arthritis, even in those with nail dystrophy.
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Affiliation(s)
- Anber Ancel Tanaka
- Dermatology Service, Mackenzie Evangelical University Hospital, Avenida Sete de Setembro 4698 Sala 201, CEP: 80730-320, Curitiba, Paraná, Brazil.
| | - Betina Werner
- Post-graduate Program - Internal Medicine and Health Sciences, Federal University of Paraná, Curitiba, Paraná, Brazil
- Department of Pathology, Clinics Hospital of the Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Annelise Correa Bueno Bragatto
- Dermatology Service, Mackenzie Evangelical University Hospital, Avenida Sete de Setembro 4698 Sala 201, CEP: 80730-320, Curitiba, Paraná, Brazil
| | - Thelma Larocca Skare
- Reumathology Service, Mackenzie Evangelical University Hospital, Curitiba, Paraná, Brazil
| | - Bárbara Stadler
- Reumathology Service, Mackenzie Evangelical University Hospital, Curitiba, Paraná, Brazil
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Turner VL, Wortsman X. Ultrasound Features of Nail Lichen Planus. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:781-788. [PMID: 38189552 DOI: 10.1002/jum.16410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 12/25/2023] [Accepted: 12/26/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVES To describe the ultrasonographic features of nail lichen planus (NLP), which, so far, have not been reported in the literature. METHODS A retrospective single-center study of NLP patients' color Doppler ultrasound examinations was performed between March 2014 and January 2023. Inclusion criteria were patients ≥15 years with a confirmed clinical diagnosis of NLP in sequential order. Exclusion criteria included concomitant systemic or local cutaneous or nail diseases and systemic or local nail treatments before the ultrasound examination. The ultrasound protocol included the examination of all fingernails or toenails following the reported protocol for dermatologic ultrasound examinations at high and ultra-high frequencies. Patient demographics and ultrasound features of the nail bed, periungual region, nail plate, and regional vascularity were registered and analyzed statistically. RESULTS A total of 36 patients met the criteria. All cases presented thickened and decreased echogenicity of the nail bed. A hypoechoic halo surrounding the origin of the nail plate was present in 78% of cases. Exactly 58% of patients presented decreased echogenicity of the proximal periungual dermis, and 86% showed thickening of the periungual dermis. Hypervascularity of the nail bed was seen in 94% of cases. The mean maximum thickness of vessels, the peak systolic velocity of the arterial vessels, and other blood flow findings are provided. CONCLUSION Ultrasonography can support the diagnosis of NLP, which benefits the non-invasive discrimination of nail conditions and can avoid the potential permanent scars derived from nail biopsies. Furthermore, ultrasound may be a powerful tool to monitor this disease's treatment.
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Affiliation(s)
| | - Ximena Wortsman
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile
- Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile
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López Ripado O, Villar Rodríguez J, Mingorance Álvarez E, Pérez Pico AM, García Nogales A, Mayordomo Acevedo R. Ultrasound clinical references of the healthy toenail unit. Clin Anat 2024; 37:366-374. [PMID: 38351855 DOI: 10.1002/ca.24145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 01/26/2024] [Accepted: 02/06/2024] [Indexed: 02/22/2024]
Abstract
The toenail unit, commonly called the nail, is one of the most frequently examined and treated structures in clinical podiatry. Ultrasound is a standard clinical technique because it is a noninvasive, painless, and rapid diagnostic tool. The main objective of this study was to obtain morphometric data of the healthy toenail unit by ultrasound for clinical application. The nails of 76 participants (152 hallux nails; 38 men, 38 women, average age 26.83 ± 12.20) were examined using a VINNO E35 ultrasound system and an X6-16L linear probe with a frequency of 18 MHz. Five ultrasound measures of the healthy toenail unit were obtained, of which only the distance from the center of the distal phalange to the nail plate varied with age, sex, weight, and foot (p-values ≤ 0.050). The other four parameters were less influenced by the variables analyzed, except sex, which influenced nearly all (p-values ≤ 0.050). In one of these variables, indications of significance were observed (p-values = 0.060), with greater distances in the men than in the women, except for nail plate curvature, which showed a higher value. The other variables studied did not influence the parameters analyzed. High-frequency ultrasound can be used to examine the healthy toenail unit and define anthropometric reference measurements that can be used for more accurate and comparative diagnosis.
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Affiliation(s)
- Olga López Ripado
- Department of Anatomy, Cellular Biology and Zoology, University Centre of Plasencia, University of Extremadura, Plasencia, Cáceres, Spain
| | - Julia Villar Rodríguez
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, University of Castilla la Mancha, Talavera de la Reina, Toledo, Spain
| | - Esther Mingorance Álvarez
- Department of Physiology, University Centre of Mérida, University of Extremadura, Mérida, Badajoz, Spain
| | - Ana Mª Pérez Pico
- Department of Nursing, University Centre of Plasencia, University of Extremadura, Plasencia, Cáceres, Spain
| | - Agustín García Nogales
- Department of Mathematics, Faculty of Medicine and Health Sciences, University Centre of Plasencia, University of Extremadura, Badajoz, Badajoz, Spain
| | - Raquel Mayordomo Acevedo
- Department of Anatomy, Cellular Biology and Zoology, University Centre of Plasencia, University of Extremadura, Plasencia, Cáceres, Spain
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Nakabayashi A, Tsujii A, Kim D, Tamada T, Yoshimura M, Isoda K, Ohshima S. Ultrasound and magnetic resonance image findings in a patient with a subungual abscess: A case report. Clin Case Rep 2024; 12:e8593. [PMID: 38444921 PMCID: PMC10912096 DOI: 10.1002/ccr3.8593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/04/2023] [Accepted: 01/04/2024] [Indexed: 03/07/2024] Open
Abstract
Subungual abscesses are rare, and information about them through imaging findings is lacking. Carbon dioxide laser drainage and antibiotics are effective treatment strategies for subungual abscesses. We report a case of a 47-year-old male healthcare worker with a subungual abscess that improved after manual drainage alone. Ultrasound and magnetic resonance images showed a tumor (with blood flow) between the nail plate and distal phalanx. Culture tests revealed Staphylococcus aureus. The patient's symptoms resolved quickly and the nail returned to normal after 4 months. This is possibly the first report of a subungual abscess with ultrasound and magnetic resonance imaging findings.
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Affiliation(s)
- Akihiko Nakabayashi
- Department of RheumatologyNational Hospital Organization Osaka Minami Medical CenterOsakaJapan
| | - Atsuko Tsujii
- Department of RheumatologyNational Hospital Organization Osaka Minami Medical CenterOsakaJapan
| | - Dong‐seop Kim
- Department of RheumatologyNational Hospital Organization Osaka Minami Medical CenterOsakaJapan
| | - Tatsuya Tamada
- Department of RheumatologyNational Hospital Organization Osaka Minami Medical CenterOsakaJapan
| | - Maiko Yoshimura
- Department of RheumatologyNational Hospital Organization Osaka Minami Medical CenterOsakaJapan
| | - Kentaro Isoda
- Department of RheumatologyNational Hospital Organization Osaka Minami Medical CenterOsakaJapan
- Department of Clinical ResearchNational Hospital Organization Osaka Minami Medical CenterOsakaJapan
| | - Shiro Ohshima
- Department of RheumatologyNational Hospital Organization Osaka Minami Medical CenterOsakaJapan
- Department of Clinical ResearchNational Hospital Organization Osaka Minami Medical CenterOsakaJapan
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Canella C, Nakamura R, Leverone A, de Almeida CÁ, Iorizzo M, Yamada AF. Ultrasound imaging of onychopapilloma: Evaluation of 43 cases. Eur J Radiol 2024; 170:111236. [PMID: 38039784 DOI: 10.1016/j.ejrad.2023.111236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/20/2023] [Accepted: 11/25/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION Onychopapilloma is a benign tumor presenting as an isolated benign warty distal matrix and bed lesion in association with longitudinal erythronychia for which no underlying cause can be identified. Diagnosis might be challenging due to other, more severe, causes of erythronychia. OBJECTIVES This study aimed to investigate the clinical and sonographic features of onychopapilloma using high-frequency ultrasound. METHODS Between February 2022 and May 2023, a cross-sectional study was conducted, involving 39 patients displaying clinical features suggestive of onychopapilloma. These patients were selected at random and underwent examination using high-frequency ultrasound. High-frequency ultrasound assessments of the nail unit were carried out using 33 MHz and 24 MHz high-frequency linear transducers. An experienced radiologist performed the ultrasound scans while participants assumed an orthostatic seated position. Subsequently, the collected ultrasound images were independently evaluated by two radiologists specializing in nail injuries, ensuring a blinded assessment. This evaluation aimed to provide comprehensive insights into the imaging characteristics of onychopapilloma. RESULTS High-frequency ultrasound revealed oval or linear hyperechoic masses located in the middle of the nail plate, without vascularity or posterior acoustic shadowing. Nail plate irregularity, thickening, and nail bed indentation were observed in some cases. These findings demonstrate that high-frequency ultrasound can aid in the diagnosis and surgical planning of onychopapilloma, providing detailed visualization of the lesion and surrounding structures. CONCLUSIONS This imaging method could represent a potential tool to differentiate onychopapilloma from other nail conditions, especially malignant neoplasms. However, further research is needed to validate these findings and assess long-term outcomes.
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Affiliation(s)
- Clarissa Canella
- Department of Radiology of Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Department of Radiology of Universidade Federal Fluminense (UFF), Rio de Janeiro, Brazil; Clínica Alta Excelência Diagnóstica, DASA, Rio de Janeiro, Brazil.
| | - Robertha Nakamura
- Centro de Estudos das Unhas (CEU), Santa Casa de Misericórdia do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andreia Leverone
- Centro de Estudos das Unhas (CEU), Santa Casa de Misericórdia do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carolina Ávila de Almeida
- Clínica Alta Excelência Diagnóstica, DASA, Rio de Janeiro, Brazil; Department of Radiology of Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
| | - Matilde Iorizzo
- Private Dermatologic Practice, Lugano/Bellinzona, Switzerland
| | - Andre Fukunishi Yamada
- Department of Radiology of Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Hospital do Coração - HCOR, São Paulo, Brazil
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Michelucci A, Dini V, Salvia G, Granieri G, Manzo Margiotta F, Panduri S, Morganti R, Romanelli M. Assessment and Monitoring of Nail Psoriasis with Ultra-High Frequency Ultrasound: Preliminary Results. Diagnostics (Basel) 2023; 13:2716. [PMID: 37627974 PMCID: PMC10453049 DOI: 10.3390/diagnostics13162716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/25/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
Psoriatic onychopathy is one of the clinical presentations of psoriasis and a well-known risk factor for the development of psoriatic arthritis. High-frequency ultrasounds (HFUS > 20 MHz) have recently been used to evaluate the nail apparatus of healthy and psoriatic subjects. The aim of our study was to detect by means of ultra-high-frequency ultrasound (UHFUS 70-100 MHz) alterations of the nail bed and matrix in patients with psoriatic onychopathy and to monitor these parameters during the treatment with monoclonal antibody (mAb). We enrolled 10 patients with psoriatic onychopathy and naive to previous biologic therapies. Patients were evaluated at baseline, after 1 month and after 3 months from the beginning of mAb therapy by a complete clinical assessment and US evaluation. A UHFUS examination with a 70 MHz probe was performed on the thumbnail (I), the index fingernail (II) and the nail with greater clinical impairment (W). The following measurements were analyzed: nail plate thickness (A), nail bed thickness (B), nail insertion length (C), nail matrix length (D) and nail matrix thickness (E). Among the various parameters analyzed, some measures showed a statistically significant decrease with p-value < 0.05 (t0 WA = 0.52 mm vs. t2 WA = 0.42 mm; t0 WB = 2.8 mm vs. t2 WB = 2.4 mm; t0 WE = 0.76 mm vs. t2 WE = 0.64 mm; t0 IIA = 0.49 mm vs. t2 IIA = 0.39 mm). In conclusion, UHFUS could represent a viable imaging technique for the real-time evaluation and monitoring of psoriatic onychopathy, thus supporting the clinical parameters and revealing any subclinical signs of early drug response.
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Affiliation(s)
- Alessandra Michelucci
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (A.M.); (G.S.); (G.G.); (F.M.M.); (S.P.); (M.R.)
| | - Valentina Dini
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (A.M.); (G.S.); (G.G.); (F.M.M.); (S.P.); (M.R.)
| | - Giorgia Salvia
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (A.M.); (G.S.); (G.G.); (F.M.M.); (S.P.); (M.R.)
| | - Giammarco Granieri
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (A.M.); (G.S.); (G.G.); (F.M.M.); (S.P.); (M.R.)
| | - Flavia Manzo Margiotta
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (A.M.); (G.S.); (G.G.); (F.M.M.); (S.P.); (M.R.)
| | - Salvatore Panduri
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (A.M.); (G.S.); (G.G.); (F.M.M.); (S.P.); (M.R.)
| | - Riccardo Morganti
- Statistical Support to Clinical Trials Department, University of Pisa, 56126 Pisa, Italy;
| | - Marco Romanelli
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (A.M.); (G.S.); (G.G.); (F.M.M.); (S.P.); (M.R.)
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Reginelli A, Russo A, Berritto D, Patane V, Cantisani C, Grassi R. Ultra-High-Frequency Ultrasound: A Modern Diagnostic Technique for Studying Melanoma. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:360-378. [PMID: 37068509 DOI: 10.1055/a-2028-6182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
The development of new ultra-high-frequency devices with a resolution of 30 μm makes it possible to use ultrasound in the study of new small anatomical units and to apply this tool to new fields of pathology. Cutaneous melanoma is a severe skin disease with an incidence of approximately 160 000 new cases each year and 48 000 deaths. In this paper, we evaluate the role of HFUS in the diagnosis of cutaneous melanoma, describe the sonographic appearance of skin layers in the pre-excision phase as well as of lesion features, and correlate the characteristics with pathological examination.
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Affiliation(s)
- Alfonso Reginelli
- Department of Precision Medicine, University of Campania, Luigi Vanvitelli School of Medicine and Surgery, Napoli, Italy
| | - Anna Russo
- Department of Radiology, University of Campania, Luigi Vanvitelli School of Medicine and Surgery, Napoli, Italy
| | - Daniela Berritto
- Department of Clinical and Experimental Medicine, Foggia University Hospital, Foggia, Italy
| | - Vittorio Patane
- Department of Precision Medicine, University of Campania, Luigi Vanvitelli School of Medicine and Surgery, Napoli, Italy
| | | | - Roberto Grassi
- Department of Precision Medicine, University of Campania, Luigi Vanvitelli School of Medicine and Surgery, Napoli, Italy
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13
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Wortsman X. Key Points to Select a Device for Dermatologic Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:521-545. [PMID: 36394307 DOI: 10.1002/jum.16000] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 04/19/2022] [Indexed: 05/26/2023]
Abstract
What points to consider when selecting a device for practicing dermatologic ultrasound is an excellent question. After we met the requisites published in the guidelines for practicing dermatologic ultrasound, it is necessary to consider the main objective of the use because it is not the same to be focused mostly on the avoidance of the puncture of important facial vessels such as the case of injectors of cosmetic fillers in comparison to the use of operators that need to deal with the diagnosis and monitoring of a wide range of dermatologic pathologies. Currently, a broad variety of ultrasound devices meets the minimum requirements for practicing these examinations in the market. Thus, small, portable, and high-end devices may present advantages and limitations that must be balanced according to the primary purposes and the budget. Moreover, the shape and footprint of the probes can make difficult or facilitate a dermatologic procedure. Other points to consider are the type of storage and the need for technical service. In summary, there are key points that we need to consider when we select a dermatologic ultrasound device in dermatology or aesthetics.
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Affiliation(s)
- Ximena Wortsman
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile
- Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Department of Dermatology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
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Bellinato F, Gisondi P, Filippucci E, Tozzi F, Fassio A, Adami G, Idolazzi L. Systematic study on nail plate assessment: differences in nail plate shape, thickness, power Doppler signal and scanning approach. Arch Dermatol Res 2023; 315:593-600. [PMID: 36271200 PMCID: PMC10020276 DOI: 10.1007/s00403-022-02404-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/27/2022] [Accepted: 10/11/2022] [Indexed: 11/02/2022]
Abstract
Ultrasonography (US) of the nail is raising interest in the last years and its feasibility, quickness and amount of descriptive data may provide valuable information. Different authors presented several scanning approaches to nail complex in different pathological conditions, such as psoriasis, but no scanning protocol was ever proposed using healthy subjects as population of reference. The aim of the study was to establish a protocol for the US of nail plate and to assess whether the measurement of the nail plate is influenced by longitudinal vs transverse scan, sex, digit and hand dominance. Using high frequency probe and a Canon Aplio i800 machine, ultrasonographers took scans of nail plates of the hands from healthy subjects. Nail plate shape, thickness and power Doppler signal (PDUS) were evaluated and scans were taken both on longitudinal and transverse axis, at distal, middle and proximal portion of the nail plate or at a fixed angles of - 45°, 0° or + 45°. All the images were then revised and scored using a DICOM software, in order to allow good standards of accuracy and reproducibility. A total of 27 subjects (14 females and 13 males) were assessed. The measures did not result to differ in different portions or angles. Furthermore, no difference appears in sex or dominant vs not dominant hand. A decreasing and significant trend for nail plate thickness was found from the first to the fifth finger. Doppler signal was found in all but one subjects, with a range from almost absent to very evident. No difference was found between groups regarding PDUS. The data provided suggest that a proper scan protocol should include all the nails and evaluation should be done both on longitudinal and transverse axis. Since Doppler signal is highly variable in healthy subjects, its presence should be carefully considered as pathological finding. Observations provided by this study clarify important points of the scanning technique and solve doubts related to which nails should be scanned and where to evaluate quantitative parameters.
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Affiliation(s)
- Francesco Bellinato
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy.
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Emilio Filippucci
- Clinica Reumatologica, Università Politecnica Delle Marche, Ospedale "Carlo Urbani", Jesi, Ancona, Italy
| | - Francesca Tozzi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Angelo Fassio
- Section of Rheumatology, Department of Medicine, University of Verona, Verona, Italy
| | - Giovanni Adami
- Section of Rheumatology, Department of Medicine, University of Verona, Verona, Italy
| | - Luca Idolazzi
- Section of Rheumatology, Department of Medicine, University of Verona, Verona, Italy
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15
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Wortsman X. Aplicaciones frecuentes de la ecotomografía Doppler color en dermatología que permiten ayudar al diagnóstico y manejo. REVISTA MÉDICA CLÍNICA LAS CONDES 2023. [DOI: 10.1016/j.rmclc.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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16
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Mattioli MA, Aromolo IF, Spigariolo CB, Marzano AV, Nazzaro G. Sonographic Features of Onychopapilloma: A Single Center Retrospective Observational Study. J Clin Med 2023; 12:jcm12051795. [PMID: 36902582 PMCID: PMC10003362 DOI: 10.3390/jcm12051795] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/09/2023] [Accepted: 02/20/2023] [Indexed: 02/26/2023] Open
Abstract
(1) Background: Onychopapilloma is a benign tumor of the nail bed and distal matrix. which usually manifests as monodactylous longitudinal eryhtronychia associated with subungual hyperkeratosis. The impossibility to rule out a malignant neoplasm is an indication for surgical excision and histological examination. Our aim is to report and describe the ultrasonographic features of onychopapilloma. (2) Methods: we conducted a retrospective analysis of patients with a histological diagnosis of onychopapilloma who underwent ultrasonographic examination in our Dermatology Unit from January 2019 to December 2021. (3) Results: Six patients were enrolled. Erythronychia, melanonychia, and splinter hemorrhages were the main dermoscopical findings. Ultrasonography detected nail bed dishomogeneity in three patients (50%) and a distal hyperechoic mass (5 patients, 83.3%). Color Doppler imaging did not show vascular flow in any of the cases. (4) Conclusions: the detection of a subungual distal non-vascularized hyperechoic mass by US, together with classical onychopapilloma clinical features, supports the diagnosis, especially in those patients who were unable to perform excisional biopsy.
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Affiliation(s)
- Maria A. Mattioli
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20133 Milan, Italy
| | - Italo F. Aromolo
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20133 Milan, Italy
| | - Cristina B. Spigariolo
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20133 Milan, Italy
| | - Angelo V. Marzano
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20133 Milan, Italy
| | - Gianluca Nazzaro
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20133 Milan, Italy
- Correspondence: ; Tel.: +39-3492426057
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17
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Luna-Bastante L, López Negrete E, Alonso Naranjo L, Roustan G, Alfageme F. Sonography of a case series of talar callosities. J Ultrasound 2022; 25:983-987. [PMID: 35129778 PMCID: PMC9705645 DOI: 10.1007/s40477-021-00566-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/25/2021] [Indexed: 11/29/2022] Open
Abstract
Talar callosity is an uncommon condition characterized by asymptomatic hyperkeratotic plaques located on the dorsum of one or both feet. We have detected an increased number of children presenting with this condition after the COVID-19 lockdown. High-frequency ultrasound was performed in all patients who consulted because of talar callosity. All four cases shared similar ultrasound findings: thickening of the epidermis with effacement of the subepidermal low-echogenic band and diffuse thickening of the dermis and subcutaneous cellular tissue, with a diffuse decrease in echogenicity. The bone cortex was respected in all cases. No increase in vascularization was detected. Although it is a benign condition, it is important to recognize talar callosity to exclude worse conditions and to prevent unnecessary biopsies. To our knowledge, we are the first to describe ultrasonographic findings of talar callosity.
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Affiliation(s)
- Loreto Luna-Bastante
- Department of Dermatology, Hospital Universitario Rey Juan Carlos, Madrid, Spain
| | - Elena López Negrete
- Department of Dermatology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Laura Alonso Naranjo
- Department of Dermatology, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Gastón Roustan
- Department of Dermatology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Fernando Alfageme
- Department of Dermatology, Hospital Universitario Puerta de Hierro, Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
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18
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Crisan D, Wortsman X, Alfageme F, Catalano O, Badea A, Scharffetter-Kochanek K, Sindrilaru A, Crisan M. Ultraschall in der Dermatochirurgie: Enthüllen des Verborgenen für optimierte chirurgische Planung. J Dtsch Dermatol Ges 2022; 20:913-927. [PMID: 35881098 DOI: 10.1111/ddg.14781_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 03/02/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Diana Crisan
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Ulm, Deutschland
| | - Ximena Wortsman
- Klinik für Dermatologie, Institut für diagnostische Bildgebung und Erforschung der Haut und Weichteilgewebe, Medizinische Fakultät, Chile Universität, Santiago, Chile
| | - Fernando Alfageme
- Klinik für Dermatologie, Universitätsklinikum Puerta del Hierro, EFSUMB Dermatologisches Ultraschall-Lernzentrum, Majahonda, Madrid, Spanien
| | - Orlando Catalano
- Klinik für Radiologie, Diagnostisches Institut Varelli, Neapel, Italien
| | - Alexandru Badea
- Institut für Anatomie, Iuliu Hatieganu" Universität für Medizin und Pharmazie, Klausenburg, Rumänien
| | | | - Anca Sindrilaru
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Ulm, Deutschland
| | - Maria Crisan
- Klinik für Dermatologie, Abteilung Histologie, "Iuliu Hatieganu" Universität für Medizin und Pharmazie, Klausenburg, Rumänien
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19
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Becker‐Capeller D, El‐Nawab‐Becker S, Töllner M, Kleinheinz A, Witte T. The hypervascularization of the nail matrix and nail bed as a predictor of nail psoriasis. SKIN HEALTH AND DISEASE 2022; 2:e85. [PMID: 35677921 PMCID: PMC9168008 DOI: 10.1002/ski2.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
| | | | - M. Töllner
- Rheumatologic Practice Clinic Dr. Hancken Stade Germany
| | - A. Kleinheinz
- Elbe Clinic, Department of Dermatology, Buxtehude Germany
| | - T. Witte
- Rheumatology and Immunology Medical School Hannover Hannover Germany
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20
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Crisan D, Wortsman X, Alfageme F, Catalano O, Badea A, Scharffetter-Kochanek K, Sindrilaru A, Crisan M. Ultrasonography in dermatologic surgery: revealing the unseen for improved surgical planning. J Dtsch Dermatol Ges 2022; 20:913-926. [PMID: 35616215 DOI: 10.1111/ddg.14781] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 03/02/2022] [Indexed: 11/28/2022]
Abstract
Ultrasonography (US) is a modern, in vivo imaging method, which is increasingly being used in dermatology as a complementary tool to clinical examination and dermoscopy. At higher frequencies (15 MHz and above), US is an established method for assessing benign and malignant skin lesions, locoregional staging, monitoring the therapeutic efficacy in various inflammatory skin conditions, and patient follow-up. One field, which may increasingly benefit from performant imaging techniques such as US is dermatologic surgery. Preoperative imaging of cutaneous tumors, inflammatory skin conditions (hidradenitis suppurativa, abscesses, etc.), or nail pathology provide dermatologic surgeons with relevant information for an optimal surgical planning, identifying potential complex aspects which might require interdisciplinary approaches, herein sparing unnecessary surgical interventions and increasing patients' compliance. In this review, we discuss the increasing significance of US in the field of dermatologic surgery, as well as the spectrum of cutaneous pathology where sonography can aid in the preoperative setting to provide a more precise, individualized surgical planning for better counseling to our patients and improved surgical results.
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Affiliation(s)
- Diana Crisan
- Department of Dermatology and Allergic Diseases, University Clinic Ulm, Germany
| | - Ximena Wortsman
- Department of Dermatology, Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Fernando Alfageme
- Department of Dermatology, University Hospital Puerta del Hierro, EFSUMB Dermatologic Ultrasound Learning Center, Majahonda, Madrid, Spain
| | - Orlando Catalano
- Department of Radiology, Istituto Diagnostico Varelli, Naples, Italy
| | - Alexandru Badea
- Department of Anatomy, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Anca Sindrilaru
- Department of Dermatology and Allergic Diseases, University Clinic Ulm, Germany
| | - Maria Crisan
- Departments of Dermatology and Histology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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21
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Ortner VK, Mandel VD, Bertugno S, Philipsen PA, Haedersdal M. Imaging of the Nail Unit in Psoriatic Patients - a Systematic Scoping Review of Techniques and Terminology. Exp Dermatol 2022; 31:828-840. [PMID: 35353919 PMCID: PMC9323418 DOI: 10.1111/exd.14572] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/14/2022] [Accepted: 03/26/2022] [Indexed: 11/28/2022]
Abstract
Background The growing interest in the visualization of psoriatic nail unit changes has led to the discovery of an abundance of image characteristics across various modalities. Objective To identify techniques for non‐invasive imaging of nail unit structures in psoriatic patients and review extracted image features to unify the diverse terminology. Methods For this systematic scoping review, we included studies available on PubMed and Embase, independently extracted image characteristics, and semantically grouped the identified features to suggest a preferred terminology for each technique. Results After screening 753 studies, 67 articles on the visualization of clinical and subclinical psoriatic changes in the nail plate, matrix, bed, folds and hyponychium were included. We identified 4 optical and 3 radiological imaging techniques for the assessment of surface (dermoscopy [n = 16], capillaroscopy [n = 12]), sub‐surface (ultrasound imaging [n = 36], optical coherence tomography [n = 4], fluorescence optical imaging [n = 3]), and deep‐seated psoriatic changes (magnetic resonance imaging [n = 2], positron emission tomography‐computed tomography [n = 1]). By condensing 244 image feature descriptions into a glossary of 82 terms, overall redundancy was cut by 66.4% (37.5%–77.1%). More than 75% of these image features provide additional disease‐relevant information that is not captured using conventional clinical assessment scales. Conclusions This review has identified, unified, and contextualized image features and related terminology for non‐invasive imaging of the nail unit in patients with psoriatic conditions. The suggested glossary could facilitate the integrative use of non‐invasive imaging techniques for the detailed examination of psoriatic nail unit structures in research and clinical practice.
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Affiliation(s)
- V K Ortner
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiskberg, Denmark
| | - V D Mandel
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.,Porphyria and Rare Diseases Unit, San Gallicano Dermatological Institute - IRCCS, Rome, Italy
| | - S Bertugno
- Radiology Unit, Bernardino Ramazzini Hospital, Carpi, Italy
| | - P A Philipsen
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiskberg, Denmark
| | - M Haedersdal
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiskberg, Denmark
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22
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Fodor D, Rodriguez-Garcia SC, Cantisani V, Hammer HB, Hartung W, Klauser A, Martinoli C, Terslev L, Alfageme F, Bong D, Bueno A, Collado P, D'Agostino MA, de la Fuente J, Iohom G, Kessler J, Lenghel M, Malattia C, Mandl P, Mendoza-Cembranos D, Micu M, Möller I, Najm A, Özçakar L, Picasso R, Plagou A, Sala-Blanch X, Sconfienza LM, Serban O, Simoni P, Sudoł-Szopińska I, Tesch C, Todorov P, Uson J, Vlad V, Zaottini F, Bilous D, Gutiu R, Pelea M, Marian A, Naredo E. The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound - Part I: Extraarticular Pathologies. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:34-57. [PMID: 34479372 DOI: 10.1055/a-1562-1455] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The first part of the guidelines and recommendations for musculoskeletal ultrasound, produced under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), provides information about the use of musculoskeletal ultrasound for assessing extraarticular structures (muscles, tendons, entheses, ligaments, bones, bursae, fasciae, nerves, skin, subcutaneous tissues, and nails) and their pathologies. Clinical applications, practical points, limitations, and artifacts are described and discussed for every structure. After an extensive literature review, the recommendations have been developed according to the Oxford Centre for Evidence-based Medicine and GRADE criteria and the consensus level was established through a Delphi process. The document is intended to guide clinical users in their daily practice.
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Affiliation(s)
- Daniela Fodor
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Vito Cantisani
- Department of Radiological, Oncological and Anatomo-pathological Sciences, "Sapienza" University, Rome, Italy
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Wolfgang Hartung
- Clinic for Rheumatology and Clinical Immunology, Asklepios Clinic, Bad Abbach, Germany
| | - Andrea Klauser
- Department of Radiology, Medical University Innsbruck, Section Head Rheumatology and Sports Imaging, Innsbruck, Austria
| | - Carlo Martinoli
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Fernando Alfageme
- Dermatology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - David Bong
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Angel Bueno
- Department of Musculoskeletal Radiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Paz Collado
- Rheumatology Department, Transitional Care Clinic, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Maria Antonietta D'Agostino
- Istituto di Reumatologia Università Cattolica del Sacro Cuore, UOC Reumatologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | - Gabriella Iohom
- Department of Anaesthesiology and Intensive Care Medicine, Cork University Hospital and University College Cork, Cork, Ireland
| | - Jens Kessler
- Department of Anaesthesiology, Division of Pain Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Manuela Lenghel
- Radiology Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Clara Malattia
- UOC Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI) University of Genoa, Genoa, Italy
| | - Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | | | - Mihaela Micu
- Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital Cluj-Napoca, Romania
| | - Ingrid Möller
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Aurelie Najm
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Riccardo Picasso
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Athena Plagou
- Ultrasound Unit, Private Radiological Institution, Athens, Greece
| | - Xavier Sala-Blanch
- Department of Anaesthesiology, Hospital Clinic, Department of Human Anatomy, Faculty of Medicine, University of Barcelona, Spain
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano Italy
- Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
| | - Oana Serban
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Paolo Simoni
- Paediatric Imaging Department, "Reine Fabiola" Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | | | - Plamen Todorov
- Department of Internal Disease Propaedeutic and Clinical Rheumatology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Jacqueline Uson
- Department of Rheumatology Hospital Universitario Móstoles, Universidad Rey Juan Carlos, Madrid, Spain
| | - Violeta Vlad
- Sf. Maria Hospital, Rheumatology Department, Bucharest, Romania
| | - Federico Zaottini
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Diana Bilous
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Roxana Gutiu
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Michael Pelea
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anamaria Marian
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Esperanza Naredo
- Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid, Madrid, Spain
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23
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Bansal A, Relhan V. Acute and chronic paronychia revisited: A narrative review. J Cutan Aesthet Surg 2022; 15:1-16. [PMID: 35655642 PMCID: PMC9153310 DOI: 10.4103/jcas.jcas_30_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Paronychia refers to the inflammation of the tissue which immediately surrounds the nail and it can be acute (<6 weeks duration) or chronic (>6 weeks duration). Disruption of the protective barrier between the nail plate and the adjacent nail fold preceded by infectious or noninfectious etiologies results in the development of paronychia. A combination of general protective measures, and medical and/or surgical interventions are required for management. This review explores the pathogenesis, clinical features, differential diagnosis, medical, and surgical management of paronychia. For the purpose of this review, we searched the PubMed, Cochrane, and Scopus databases using the following keywords, titles, and medical subject headings (MeSH): acute paronychia, chronic paronychia, and paronychial surgeries. Relevant review articles, original articles, and case reports/series published till February 2020 were included in this study.
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Al-Khairallah HA, Al-Yasiri MH. MOLECULAR DETECTION OF THE TWO VIRULENCE GENES HWP1 AND ALS1 IN CANDIDA SPECIES ISOLATED FROM ONYCHOMYCOSIS. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:1295-1298. [PMID: 35758446 DOI: 10.36740/wlek202205211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim: This article was aimed to assess the prevalence of Candida species causing nail infections and to investigate the most important virulence genes that cause adhesion. PATIENTS AND METHODS Materials and methods: Samples were collected from General Hospital and the outpatient's clinics in Thi-Qar Province, southern Iraq, during the period from January 2021 to May 2021. Samples were inoculated on Sabouraud Dextrose Agar plates containing 0.5 mg chloramphenicol, then Petri dishes were incubated at 30°C under aerobic conditions and observed for Candida species growth for 24-72 hrs. All isolates were identified by morphologic and chromatic properties on CHROMagar and by Api Candida. RESULTS Results: Twenty five isolates were obtained from hundred samples, which belong to five species of the genus Candida, distributed in percentage 9(36%), 4(16%), 4(16%), 4(16%) and 3(12%) of C. glabrata, C. krusei, C. albicans, C. famata and C. tropicalis consecutively and one isolate was not identified. Monoplex PCR technique was used to detect virulence genes (hwp1 and als1) of Candida species. Four Candida albicans isolates (16%) were carried of both hwp1 and als1 genes. CONCLUSION Conclusions: The virulence gene (hwp1) can be relied upon in molecular detection as a special diagnostic tool of Candida albicans species except other types causing Candidal onychomycosis.
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Grover C, Bansal S, Varma A, Jakhar D. Radiological imaging in nail unit disorders (Part I) - Modalities used. Indian Dermatol Online J 2022; 13:449-456. [PMID: 36262575 PMCID: PMC9574134 DOI: 10.4103/idoj.idoj_3_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 11/11/2022] Open
Abstract
The nail unit is a unique skin appendage, capable of mounting only a limited number of reaction patterns to a variety of insults. This makes it difficult to diagnose many nail conditions based on clinical features alone. Thus, diagnostic modalities have an important role to play in nail disorders. Emphasis is placed on non-invasive diagnostic methods, of which, radiological imaging forms an important part; however, it is a field largely under-explored with very few studies and reports available in the literature. This could be due to the problems encountered in nail unit radiology including its small size, complex anatomy, requirement for special high-frequency probes to reliably evaluate superficial structures, and non-familiarity with nail unit radiological features even amongst trained radiologists. Nevertheless, it plays a useful role in diagnosing nail disorders (especially tumors), localizing the changes, exploring differential diagnoses, estimating prognosis, and planning management. This article is aimed at collating scientific data pertaining to various radiological modalities used in the diagnosis of nail diseases. The advantages and limitations of various imaging techniques used for evaluating the nail unit, including digital radiographs, high-frequency ultrasound, ultrasound doppler (USD), computed tomography (CT), and magnetic resonance imaging (MRI), are discussed in the first part. The second part will discuss the features of common and uncommon nail diseases.
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De Rossi SD, Mendonça JA, Palominos PE, Kohem CL, Cestari TF, da Silva Chakr RM. Ultrasonographic and resistance index evaluation of nails in psoriatic arthritis, psoriasis, and control groups: a cross-sectional study. Adv Rheumatol 2021; 61:48. [PMID: 34321109 DOI: 10.1186/s42358-021-00207-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nail psoriasis occurs frequently in patients with psoriatic disease, it can lead to functional impairment, pain, discomfort, decreased quality of life and can also be a predictor for the development of arthritis. Early recognition of this condition can provide early and effective treatment and prevent structural impairment. This study aims to identify nail ultrasonographic characteristics in three groups: psoriasis (PsO), psoriatic arthritis (PsA) and controls patients, to determine if the ultrasonography (US) can identify early signs of nail psoriatic impairment or local inflammation. We conducted nail US to determine nail matrix resistance index (NMRI), nail bed resistance index (NBRI), and power Doppler (PD) and grayscale (GS) parameters in these 3 groups. METHODS Single-center, cross-sectional study. GS, PD, and spectral doppler images of bilateral 2nd and 3rd fingernails were acquired from 35 PsO, 31 PsA, and 35 controls patients. An US equipment with an 18 MHz linear transducer for GS and 8.0 MHz for PD was used. PD, NMRI, NBRI, nail plate thickness (NPT), nail bed thickness (NBT), nail matrix thickness (NMT), and morphostructural characteristics of the trilaminar structure (TS) were evaluated in saved images, blind. RESULTS Mean NMRI and NBRI did not differ between groups. Linear regression analysis detected no relationships between PsO or PsA and NMRI or NBRI. Nail PD grade did not differ between groups. Type I and IV TS changes were more frequent in PsO; types II and III changes were more frequent in PsA (p < 0.001). NPT was greater in PsA and PsO groups than controls: PsA 0.73 ± 0.14 mm, PsO 0.72 ± 0.15 mm, Controls 0.67 ± 0.10 mm (p = 0.001). CONCLUSION Echographic TS characteristics of the nail plate and NPT evaluated by GS are useful and can distinguish PsO and PsA nails from controls. NMRI, NBRI, and US nail microcirculation parameters could not distinguish psoriatic nails. TRIAL REGISTRATION 72762317.4.0000.5327 (Certificate of Presentation of Ethical Appreciation - CAAE - Plataforma Brasil) Avaiable in https://plataformabrasil.saude.gov.br/login.jsf .
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Affiliation(s)
- Samanta Daiana De Rossi
- Division of Rheumatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. .,Divisiont of Dermatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | - José Alexandre Mendonça
- Department of Rheumatology, Celso Pierro Hospital, Pontifícia Universidade Católica de Campinas, São Paulo, Brazil
| | - Penelope Ester Palominos
- Division of Rheumatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Charles Lubianca Kohem
- Division of Rheumatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Tania Ferreira Cestari
- Divisiont of Dermatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rafael Mendonça da Silva Chakr
- Division of Rheumatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Gottlieb AB, Merola JF. A clinical perspective on risk factors and signs of subclinical and early psoriatic arthritis among patients with psoriasis. J DERMATOL TREAT 2021; 33:1907-1915. [PMID: 34176399 DOI: 10.1080/09546634.2021.1942423] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Psoriasis is a chronic, immune-mediated disease that includes a broad spectrum of systemic manifestations, complications, and comorbidities. Approximately 20%-30% of patients with psoriasis eventually develop psoriatic arthritis, and up to half of those without psoriatic arthritis experience subclinical musculoskeletal abnormalities. Recognition of early musculoskeletal inflammatory signs in patients with psoriasis is important to understand the extent and severity of this systemic disease, assess the risk of structural joint damage, and ensure timely and effective treatment of the complete spectrum of psoriatic disease. Delayed or ineffective treatment can lead to decreased quality of life, irreversible musculoskeletal damage, and loss of function. In this review, we highlight features of subclinical or early psoriatic arthritis among patients with psoriasis of which dermatologists should be aware. Recent knowledge of features of preclinical psoriatic arthritis in patients with psoriasis is presented. We briefly discuss important risk factors, clinical features, and other characteristics of patients likely to progress from psoriasis to psoriatic arthritis that should be known by dermatologists. Screening tools commonly used in the dermatology clinic to detect psoriatic arthritis are also critically reviewed. Finally, we provide expert commentary for dermatologists concerning the treatment of patients with psoriasis and subclinical signs of early psoriatic arthritis.
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Affiliation(s)
- Alice B Gottlieb
- Mount Sinai-Beth Israel Hospital, Icahn School of Medicine at Mount Sina, New York, NY, USA
| | - Joseph F Merola
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Acer Kasman S, Gezer HH, Baklacıoğlu HŞ, Erdem Gürsoy D, Duruöz MT. A standardized sonographic analysis of nails in psoriatic arthritis and healthy controls: Feasibility, reliability, diagnostic performance, and demographic and clinical associations. Joint Bone Spine 2021; 88:105197. [PMID: 33901660 DOI: 10.1016/j.jbspin.2021.105197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/08/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Subunits of the nail can be evaluated by nail ultrasonography (NUSG). The purposes of this study are to document NUSG properties (both nail-based and participant-based evaluations) in patients with psoriatic arthritis (PsA) and healthy controls and to explore the final scorings. METHODS After the literature review and a pilot study, a consensus was reached to evaluate 12 nails and 5 parameters by NUSG: nail plate impairment (NPI), nail plate thickness (NPT), nail bed thickness (NBT), nail thickness (NT), and Doppler activity (DA); further, scorings for each parameter (NPIs, NPTs, NBTs, NTs, and DAs) were calculated. Group comparisons and diagnostic performances (with ROC curve analysis) were applied to both parameters and scorings. Final scorings to predict PsA diagnosis among the NUSG scorings were reached by regression analysis. Feasibility, reliability, and clinical associations of the scores were also performed. RESULTS Sixty-four patients with PsA and 26 controls (3240 baseline images) were assessed. The most affected nails, PsA/control comparisons, and the ROC analysis varied among the nails, within the higher values of PsA; therefore, 12 nails remained in the scorings. Participant-based scorings showed better content and diagnostic performances than the nail-based. Diagnostic performances, feasibility, reliability, and regression analysis of the scorings documented that NPIs, NTs, and DAs were the best. Some demographics, employee status, hemoglobin, and disease activity of the participants were associated with them. CONCLUSIONS The NUSG Index (NUSGI) including NPIs, NTs, and DAs is a feasible, reliable, and discriminative method to predict PsA diagnosis, with its rich content. Clinicaltrials.gov-ID: NCT04718428.
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Affiliation(s)
- Sevtap Acer Kasman
- Marmara University School of Medicine; Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Muhsin Yazıcıoğlu Caddesi, Üst Kaynarca, Pendik, Istanbul, Turkey.
| | - Halise Hande Gezer
- Marmara University School of Medicine; Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Muhsin Yazıcıoğlu Caddesi, Üst Kaynarca, Pendik, Istanbul, Turkey
| | - Hatice Şule Baklacıoğlu
- Marmara University School of Medicine; Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Muhsin Yazıcıoğlu Caddesi, Üst Kaynarca, Pendik, Istanbul, Turkey; Samsun Training and Research Hospital, Rheumatology Clinic, Samsun, Turkey
| | - Didem Erdem Gürsoy
- Marmara University School of Medicine; Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Muhsin Yazıcıoğlu Caddesi, Üst Kaynarca, Pendik, Istanbul, Turkey; Adıyaman Training and Research Hospital, Rheumatology Clinic, Adıyaman, Turkey
| | - Mehmet Tuncay Duruöz
- Marmara University School of Medicine; Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Muhsin Yazıcıoğlu Caddesi, Üst Kaynarca, Pendik, Istanbul, Turkey
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Almuhanna N, Wortsman X, Wohlmuth-Wieser I, Kinoshita-Ise M, Alhusayen R. Overview of Ultrasound Imaging Applications in Dermatology. J Cutan Med Surg 2021; 25:521-529. [PMID: 33682489 PMCID: PMC8474315 DOI: 10.1177/1203475421999326] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Complete visualization of lesions is critical for the accurate diagnosis and
management of dermatological diseases. Currently, the most readily available
technologies used by dermatologists include dermoscopy and photography.
Nevertheless, ultrasound has emerged as a useful non-invasive modality in
dermatology, which can be added to the clinical examination supporting an early
and more accurate diagnosis. Moreover, there are significant technological
advances in recent years, such as the development of handheld devices and
ultra-high frequency probes that have expanded the integration of ultrasound
into daily dermatology practice. In this article, we reviewed the most common
applications of ultrasound in the field of dermatology.
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Affiliation(s)
- Nouf Almuhanna
- 793831507 Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Division of Dermatology, Department of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ximena Wortsman
- 14655 Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile.,38103 Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile.,Department of Dermatology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Iris Wohlmuth-Wieser
- 793831507 Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Dermatology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | | | - Raed Alhusayen
- 793831507 Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Evaluating the Utility of Routine Imaging in Squamous Cell Carcinoma of the Nail Unit. Dermatol Surg 2021; 46:1375-1381. [PMID: 32106119 DOI: 10.1097/dss.0000000000002352] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Squamous cell carcinoma (SCC) is the most common malignant tumor of the nail unit. No guidelines currently exist regarding the role of imaging in this specific location. OBJECTIVE To investigate the utility of routine imaging in SCC of the nail apparatus. METHODS A multi-institutional retrospective review of patients treated for nail unit SCC was performed. Data were collected on patient characteristics, tumor qualities, treatment, and radiographic imaging. A change in treatment was defined as more aggressive treatment (amputation) rather than local excision or Mohs micrographic surgery (MMS). RESULTS One hundred seven patients with nail unit SCC were identified. Approximately 44/107 (41.1%) of patients were imaged and 63/107 (58.9%) were not. Mohs micrographic surgery was the most common primary treatment (66.4%). Mohs micrographic surgery was more commonly performed in nonimaged patients, and amputation was more commonly performed in imaged patients (p < .001). Bony changes were identified in 13/44 (29.5%) of imaged patients. In 8/44 (18.2%), imaging findings caused a change in treatment. In 99/107 (92.5%) of the cohort, imaging was either not performed or did not change management. CONCLUSION In select cases, imaging may help guide patient management. Sufficient evidence does not yet exist to support routine imaging for patients with nail unit SCC.
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31
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Ávila de Almeida C, Guarçoni S, Leverone A, Nakamura R, Marchiori E, Canella C. Characterization of a glomus tumor using 33-MHz ultrasound and superb microvascular imaging. Skin Res Technol 2020; 27:466-468. [PMID: 33141970 DOI: 10.1111/srt.12972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 09/10/2020] [Indexed: 12/16/2022]
Affiliation(s)
| | | | - Andreia Leverone
- Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Robertha Nakamura
- Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Clarissa Canella
- Alta Excelência Diagnóstica - DASA, Rio de Janeiro, Brazil.,Universidade Federal Fluminense, Rio de Janeiro, Brazil
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García Castro R, Dominguez Luis F. Inexpensive apparatus for ultrasonographic examination of the nail unit and fingers. J Am Acad Dermatol 2020; 86:e201-e202. [PMID: 33010317 DOI: 10.1016/j.jaad.2020.09.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/05/2020] [Accepted: 09/23/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Rubén García Castro
- Servicio de Dermatología MQ y Venereología, Hospital Clínico Universitario de Salamanca, Salamanca, Spain.
| | - Francisco Dominguez Luis
- Servicio de Dermatología MQ y Venereología, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
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Sechi A, Alessandrini A, Patrizi A, Starace M, Caposiena Caro RD, Vara G, Brandi N, Golfieri R, Piraccini BM. Ultrasound features of the subungual glomus tumor and squamous cell carcinomas. Skin Res Technol 2020; 26:867-875. [PMID: 32585749 DOI: 10.1111/srt.12888] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 05/30/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Nail tumors often pose a significant challenge for the clinician, as they are burdened by a high delay in diagnosis and paucity of clinical signs in the early stage. In most cases, the onset of pain or nail plate dystrophy leads to imaging investigations such as plain radiography, magnetic resonance imaging, and ultrasonography (US) when surgery is pending. MATERIAL AND METHODS A 2-year monocentric study evaluated the histologically confirmed cases of subungual glomus tumor (GT) and squamous cell carcinoma (SCC) with a pre-surgical US assessment, and reviewed their sonography features. A total of 7 digital GTs and 6 SCCs of the nail were collected. RESULTS GT and SCC are easily distinguishable on US. Compared to SCC, GT was positively associated with an ovoid shape, well-defined borders, bone cup-scalloping without cortical erosion, and a rich intralesional vascular pattern (P < 0.05). Vice versa, SCC was significantly correlated with irregular shape, ill-circumscribed margins, an infiltrative growth pattern with peripheral hypoechoic foci, posterior acoustic shadow, cortical erosion, and a highly vascular multipolar peripheral pattern (P < 0.05). CONCLUSION The rapid assessment of GT and SCC sonographic features may contribute to reduce diagnostic delay, expedite management, and decrease the risk of surgical relapse.
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Affiliation(s)
- Andrea Sechi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Aurora Alessandrini
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Michela Starace
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | | | - Giulio Vara
- Radiology Unit, University Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Nicolò Brandi
- Radiology Unit, University Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Rita Golfieri
- Radiology Unit, University Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Bianca Maria Piraccini
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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LOPEZ-CASTILLO D, CURTO-BARREDO L, SÁNCHEZ-SCHMIDT JM, PUJOL RM. Multiple Eruptive Pyogenic Granulomas on the Proximal Nail Folds Following Cast Immobilization: A Case Report with Nail Unit Ultrasound Findings. Acta Derm Venereol 2020; 100:adv00071. [PMID: 31821515 PMCID: PMC9128891 DOI: 10.2340/00015555-3389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2019] [Indexed: 11/16/2022] Open
Affiliation(s)
- Daniel LOPEZ-CASTILLO
- Department of Dermatology, Hospital del Mar-Parc de Salut Mar, Passeig Marítim, 25-29, ES-08003 Barcelona, Spain. E-mail:
| | - Laia CURTO-BARREDO
- Department of Dermatology, Hospital del Mar-Parc de Salut Mar, Passeig Marítim, 25-29, ES-08003 Barcelona, Spain. E-mail:
| | - Júlia M. SÁNCHEZ-SCHMIDT
- Department of Dermatology, Hospital del Mar-Parc de Salut Mar, Passeig Marítim, 25-29, ES-08003 Barcelona, Spain. E-mail:
| | - Ramon M. PUJOL
- Department of Dermatology, Hospital del Mar-Parc de Salut Mar, Passeig Marítim, 25-29, ES-08003 Barcelona, Spain. E-mail:
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Zaltsberg GS, Spring S, Malic C, Koujok K, Davila J, Hurteau J, Shenouda N. Soft Tissue Lesions With High Vascular Density on Sonography in Pediatric Patients: Beyond Hemangiomas [Formula: see text]. Can Assoc Radiol J 2020; 71:505-513. [PMID: 32054306 DOI: 10.1177/0846537119899539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Infantile hemangiomas are the most frequent vascular soft tissue lumps in the pediatric population. The clinical presentation and evolution of these lesions is characteristic, while the sonographic appearance is classic but not specific. This pictorial essay illustrates the different vascular soft tissue lumps on ultrasound that may mimic infantile hemangiomas. Awareness of these mimics is crucial to avoid misdiagnosis. Clinical and sonographic discriminators for each lesion are presented.
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Affiliation(s)
| | - Shanna Spring
- Department of Dermatology, CHEO, 6363University of Ottawa, Ottawa, Ontario, Canada
| | - Claudia Malic
- Department of Plastic Surgery, CHEO, 6363University of Ottawa, Ottawa, Ontario, Canada
| | - Khaldoun Koujok
- Department of Medical Imaging, CHEO, 6363University of Ottawa, Ottawa, Ontario, Canada
| | - Jorge Davila
- Department of Medical Imaging, CHEO, 6363University of Ottawa, Ottawa, Ontario, Canada
| | - Julie Hurteau
- Department of Medical Imaging, CHEO, 6363University of Ottawa, Ottawa, Ontario, Canada
| | - Nazih Shenouda
- Department of Medical Imaging, CHEO, 6363University of Ottawa, Ottawa, Ontario, Canada
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36
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Catalano O, Roldán FA, Varelli C, Bard R, Corvino A, Wortsman X. Skin cancer: findings and role of high-resolution ultrasound. J Ultrasound 2019; 22:423-431. [PMID: 31069756 DOI: 10.1007/s40477-019-00379-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/10/2019] [Indexed: 12/11/2022] Open
Abstract
Currently available high-resolution transducers allow a detailed ultrasound (US) assessment of skin tumors. US complements clinical examination, dermoscopy, and biopsy in the initial differential diagnosis, surgical planning, locoregional staging, and follow-up of patients with skin malignancies. It is important for dermatologists, skin surgeons, and US operators to be aware of the US imaging findings and to recognize the clinical scenarios where imaging is indicated in the management of skin cancer. The purpose of this review article is to address the most common indications for US in skin oncology and to provide a comprehensive guide to the gray-scale and color-Doppler findings in cutaneous malignant tumors.
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Affiliation(s)
- Orlando Catalano
- Radiology Unit, Istituto Diagnostico Varelli, via Cornelia dei Gracchi 65, 80126, Naples, Italy.
| | | | - Carlo Varelli
- Radiology Unit, Istituto Diagnostico Varelli, via Cornelia dei Gracchi 65, 80126, Naples, Italy
| | | | - Antonio Corvino
- Department of Movement and Wellness Sciences, University of Naples Parthenope, Naples, Italy
| | - Ximena Wortsman
- Department of Dermatology, Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues Clinic, University of Chile and Pontifical Catholic University of Chile, Santiago, Chile
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Mundada P, Becker M, Lenoir V, Stefanelli S, Rougemont AL, Beaulieu JY, Boudabbous S. High resolution MRI of nail tumors and tumor-like conditions. Eur J Radiol 2019; 112:93-105. [DOI: 10.1016/j.ejrad.2019.01.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/30/2018] [Accepted: 01/04/2019] [Indexed: 11/17/2022]
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