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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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2
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Giordano A, Löser CR, Dippel E, Hofmann SC, Mohr P, Schneider SW, Balakirski G. Telefonische Verlaufskontrolle nach ambulanten nagelchirurgischen Eingriffen – eine retrospektive Analyse. J Dtsch Dermatol Ges 2024; 22:522-530. [PMID: 38574008 DOI: 10.1111/ddg.15341_g] [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: 04/15/2023] [Accepted: 11/16/2023] [Indexed: 04/06/2024]
Abstract
ZusammenfassungHintergrundZu den Versorgungsgebieten der Dermatochirurgie gehört die operative Behandlung von Erkrankungen des Nagelorgans. Untersucht wurden Beschwerden und Nebenwirkungen nach Nageleingriffen mittels telefonischer Verlaufskontrolle (TFU) und deren Eignung für die postoperative Kontrolle und Beratung.Patienten und MethodikAlle Patienten, die von Oktober 2019 bis Dezember 2021 in der Hautklinik am Klinikum der Stadt Ludwigshafen am Rhein ambulant am Nagelorgan operiert wurden, wurden am zweiten bis dritten postoperativen Tag telefonisch kontaktiert und standardisiert zu postoperativen Beschwerden befragt.ErgebnisseInsgesamt wurden 100 Fälle nachverfolgt. Die am häufigsten durchgeführten Eingriffe waren Phenolkaustik (41%), Nagelavulsion (16%) und Nagelmatrixbiopsien (9%). 50% und 21% der Patienten berichteten jeweils am Tag des Eingriffs und am Folgetag Schmerzen gehabt zu haben. Nach Nagelavulsion wurden signifikant häufiger Schmerzen am Folgetag nach dem Eingriff berichtet und Schmerzmittel benötigt (p = 0,002). Schwerwiegende Nebenwirkungen traten nicht auf. Zehn Prozent der Befragten äußerten bei der TFU konkrete Fragen und benötigten eine Beratung.SchlussfolgerungenAlle Nageleingriffe wurden gut vertragen. Schmerzen stellten die häufigsten Beschwerden dar, allerdings gab nur die Hälfte aller Angerufenen an, am Operationstag Schmerzen gehabt zu haben, am Folgetag nur noch 21%. Die TFU stellt eine effektive, praktikable sowie einfach zu etablierende Methode zur postoperativen Verlaufskontrolle und Beratung nach ambulanten Nageleingriffen dar.
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Affiliation(s)
- Anna Giordano
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Christoph R Löser
- Hautklinik, Klinikum der Stadt Ludwigshafen am Rhein gGmbH, Ludwigshafen
| | - Edgar Dippel
- Hautklinik, Klinikum der Stadt Ludwigshafen am Rhein gGmbH, Ludwigshafen
| | - Silke C Hofmann
- Zentrum für Dermatologie, Allergologie und Dermatochirurgie, Helios Universitätsklinikum Wuppertal, Universität Witten/Herdecke, Wuppertal
| | - Peter Mohr
- Klinik für Dermatologie, Elbe Kliniken GmbH, akademisches Lehrkrankenhaus des Universitätsklinikums Hamburg-Eppendorf, Buxtehude
| | - Stefan W Schneider
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Galina Balakirski
- Zentrum für Dermatologie, Allergologie und Dermatochirurgie, Helios Universitätsklinikum Wuppertal, Universität Witten/Herdecke, Wuppertal
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Samson P, Curvale C, Iniesta A, Gay A. Managing longitudinal melanonychia. HAND SURGERY & REHABILITATION 2024; 43S:101526. [PMID: 38879227 DOI: 10.1016/j.hansur.2022.12.007] [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: 12/14/2022] [Accepted: 12/29/2022] [Indexed: 06/25/2024]
Abstract
Longitudinal melanonychia (LM) is a pigmented band extending from the matrix to the distal edge of a nail. It is caused by increased production of melanin within the matrix, and integration into the nail plate. The origin of this production is usually benign, due to activation, hyperplasia or proliferation of melanocytes normally present in the matrix. In some cases, however, LM is the manifestation of a subungual melanoma, the diagnosis of which must be made early. Biographical, clinical and dermoscopic criteria make it possible to suspect melanoma and decide whether to perform biopsy. None of these criteria, however, are specific and definitive diagnosis requires pathologic examination of a matrix biopsy. The biopsy technique should enable reliable histological study while limiting the risk of secondary nail dystrophy. Initial resection should ideally involve the entire lesion. Complete elevation of the nail plate enables the lesion to be precisely located. Lesions up to 3 mm can be removed by longitudinal resection biopsies without significant sequelae. In more extensive lesions, incision or tangential ("shave") biopsy can be performed without impairing prognosis. In clinical presentations strongly suggestive of melanoma, immediate complete resection of the entire nail unit may be proposed.
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Affiliation(s)
- P Samson
- Institut de la Main et du Membre Supérieur, Marseille, France.
| | - C Curvale
- Institut de la Main et du Membre Supérieur, Marseille, France
| | - A Iniesta
- Institut de la Main et du Membre Supérieur, Marseille, France
| | - A Gay
- Institut de la Main et du Membre Supérieur, Marseille, France
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Giordano A, Löser CR, Dippel E, Hofmann SC, Mohr P, Schneider SW, Balakirski G. Telephone follow-up after outpatient nail surgery - a retrospective analysis. J Dtsch Dermatol Ges 2024; 22:522-529. [PMID: 38459639 DOI: 10.1111/ddg.15341] [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: 04/15/2023] [Accepted: 11/16/2023] [Indexed: 03/10/2024]
Abstract
BACKGROUND One of the areas of care in dermatosurgery is the surgical treatment of diseases of the nail organ. Side effects and complications after nail surgery were investigated by telephone follow-up (TFU), and its suitability for postoperative monitoring and consultation was assessed. PATIENTS AND METHODS All patients who underwent nail surgery at the Department of Dermatology at the Ludwigshafen City Hospital from October 2019 to December 2021 in outpatient setting were contacted by telephone on the second to third postoperative day and questioned in a standardized manner about postoperative complaints and counselled if necessary. RESULTS A total of 100 cases were followed up. The most common procedures performed were phenol matricectomy (41%), nail avulsion (16%), and nail matrix biopsies (9%). 50% and 21% of patients reported pain on the day of the procedure and the day after surgery, respectively. After nail avulsion, pain was statistically significantly more frequently reported on the day following the procedure and pain medication was statistically significantly more frequently required (p = 0.002). Serious adverse events did not occur after nail surgery. 10% of the respondents raised specific questions and needed counseling by TFU. CONCLUSIONS All nail surgeries were well tolerated in the outpatient setting. Pain was the most common side effect, although only half of all patients reported pain on the day of surgery and only 21% on the day after the procedure. The TFU proved to be an effective and practical as well as easy to establish method for postoperative follow-up and consultation after outpatient nail surgery.
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Affiliation(s)
- Anna Giordano
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph R Löser
- Department of Dermatology, Ludwigshafen City Hospital, Ludwigshafen, Germany
| | - Edgar Dippel
- Department of Dermatology, Ludwigshafen City Hospital, Ludwigshafen, Germany
| | - Silke C Hofmann
- Center for Dermatology, Allergology and Dermatosurgery, Helios University Hospital Wuppertal, University of Witten/Herdecke, Wuppertal, Germany
| | - Peter Mohr
- Department of Dermatology, Elbe Hospital, Academic Teaching Hospital of the University Medical Center Hamburg-Eppendorf, Buxtehude, Germany
| | - Stefan W Schneider
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Galina Balakirski
- Center for Dermatology, Allergology and Dermatosurgery, Helios University Hospital Wuppertal, University of Witten/Herdecke, Wuppertal, Germany
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5
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Kutlu Ö, Wollina U, Göktay F. A new hope in the treatment of onychogryphosis due to acquired malalignment of great toenails due to: intramatrix dexpanthenol injection. J DERMATOL TREAT 2023; 34:2187658. [PMID: 36877818 DOI: 10.1080/09546634.2023.2187658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Onychogryphosis is a form of nail deformity characterized by a distorted, yellowish-brown thickened nail plate that is skewed, grossly thickened, and partly curved like a ram's horn. Although onychogryphosis has been described for more than one hundred years, there is no curative treatment for onychogryphosis. Nonsurgical conservative procedures and nail avulsion with or without matricectomy are the common treatment procedures. The recurrence rate is high, so patients' needs are not met in many cases. Herein, we report for the first time the intramatrix injection of dexpanthenol in the treatment of onychogryphosis with excellent result.
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Affiliation(s)
- Ö Kutlu
- Gaziosmanpasa University, School of Medicine, Department of Dermatology and Venereology
| | - U Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany
| | - F Göktay
- Department of Dermatology and Venereology, University of Health Sciences, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
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Post-Traumatic Single-Digit Onychomycosis. J Fungi (Basel) 2023; 9:jof9030313. [PMID: 36983481 PMCID: PMC10051499 DOI: 10.3390/jof9030313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 02/21/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Onychomycoses are a group of fungal nail infections commonly classified either according to the pathogenic fungus, to the duration of the disease or to the mode of fungal invasion. Most cases are diagnosed clinically, although there is a general consensus that the pathogen should be identified prior to initiating a treatment. However, this is often difficult as the classical mycologic methods of direct microscopy and culture frequently remain negative. We came across a particular subset of onychomycoses, which posed extreme diagnostic and therapeutic challenges. Over a period of 15 years, 44 patients were seen in specialized nail clinics with a single nail dystrophy that was examined and treated in vain by many practitioners and dermatologists prior to their consultation. Of the forty-four cases, thirty-nine patients had a fingernail affected and five had a toenail affected. The nail was almost completely onycholytic, the nail bed visibly keratotic, the proximal nail fold smooth and shiny and slightly swollen. All patients except five brought the results of negative mycologic cultures. Thirty-four patients had received antifungal therapy, mostly topical, as a single nail would not qualify for systemic treatment according to most national and international guidelines. The diagnosis was finally confirmed by histopathology of the nail plate showing an invasive onychomycosis in all cases. After nail avulsion and combined topical and systemic antifungal therapy, thirty-six patients were cured, three were lost from follow-up, and five showed improved nails but not a complete clinical and mycologic cure. A single-digit nail disease raises the suspicion of a tumor or a trauma; although, in rare cases, diseases normally affecting several nails may only affect a single nail. Such a case should prompt the clinician to ask for a previous trauma to this digit and to intensify the search for a specific pathogen. This study also underlines the importance of histopathology for the diagnosis of onychomycoses.
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How We Do It: The Longitudinal Nail Strip Biopsy for Nail Unit Inflammatory Dermatoses. Dermatol Surg 2023; 49:311-313. [PMID: 36716426 DOI: 10.1097/dss.0000000000003707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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8
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Delgado-Miguel C, Muñoz-Serrano AJ, Moratilla L, Sarmiento MDC, Miguel-Ferrero M, Martínez L. The effectiveness of matrix ablation with silver nitrate in the treatment of ingrown toenails. A single-center case-control study. Pediatr Dermatol 2022; 40:282-287. [PMID: 36461609 DOI: 10.1111/pde.15217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 11/14/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Partial onychectomy with chemical matrixectomy is considered the gold standard treatment for stage II-III ingrown toenails (IT). However, there are scarce reports describing the use of silver nitrate in IT management in adolescents. Our aim is to analyze the effectiveness of matrix ablation with silver nitrate and compare it with partial onychectomy by electrocautery. METHODS A retrospective study of adolescent patients with stage II-III IT was performed. Those who underwent electrocautery matricectomy in a major outpatient surgical center (Group A) and those who were treated with silver nitrate at an outpatient clinic (Group B) were compared. Efficacy was determined by recurrence and postoperative infection rates. RESULTS Two hundred and nine patients were included (86 group A; 123 group B), with a total of 382 partial onychectomies (151 group A; 231 group B). Group B patients exhibited a lower recurrence rate (4.7%) when compared to group A (11.2%, p = .02), and had a lower postoperative infection rate (4.0% group A vs. 1.7% group B; p = .18), although not statistically significant. CONCLUSION Silver nitrate chemical matricectomy after partial onychectomy is an effective treatment for IT in adolescents, with few postoperative complications and low recurrence rate. Therefore, it should be considered as a possible alternative to electrocautery matricectomy.
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Affiliation(s)
| | | | - Lucas Moratilla
- Pediatric Surgery Department, La Paz Children's Hospital, Madrid, Spain
| | | | | | - Leopoldo Martínez
- Pediatric Surgery Department, La Paz Children's Hospital, Madrid, Spain.,Institute for Biomedical Resarch La Paz (IdiPaz), Network for Maternal and Children Health (SAMID), La Paz Children's Hospital, Madrid, Spain
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9
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Sarikaya Solak S, Akman Karakas A, Sindel M, Atis G, Gunes P, Goktay F. Integrated Cadaveric Nail Surgery Course Improves Self-Assessed Knowledge and Competency of Dermatologists. Skin Appendage Disord 2021; 7:460-467. [PMID: 34901177 DOI: 10.1159/000518044] [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: 04/20/2021] [Accepted: 06/21/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Dermatologists see many patients with nail disorders requiring surgical interventions. However, nail surgery is often found to be difficult by dermatologists. The aim of this study was to evaluate the effectiveness of an integrated nail surgery course. Methods A nail surgery course model, combining anatomy, pathology, and dermatology with theoretical lectures and hands-on training on fresh-frozen cadaver, was designed for dermatologists. Before and after the course, the participants were asked to complete a questionnaire in which they assessed their knowledge and competence levels. Results Twenty-eight dermatologists completed the questionnaires. The majority of the dermatologists (79.6%) had limited nail surgery experience, previously. The most commonly cited reasons for lack of knowledge or low or moderate theoretical and/or practical level of knowledge of nail surgery were not having received theoretical and practical education during dermatology residency. The median scores of self-assessed knowledge and competency improved significantly after the course (p < 0.001). The majority (82.1%) of the participants were "quite" or "very" well satisfied. Conclusion An integrative nail surgery course model seems beneficial and encouraging for dermatologists. Organizing this type of nail surgery course, especially in medical schools using fresh-frozen cadavers, may significantly improve dermatologists' knowledge and skills.
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Affiliation(s)
| | - Ayse Akman Karakas
- Department of Dermatology, Medical Faculty, Akdeniz University, Antalya, Turkey
| | - Muzaffer Sindel
- Department of Anatomy, Medical Faculty, Akdeniz University, Antalya, Turkey
| | - Guldehan Atis
- Department of Dermatology, Haydarpasa Numune Training and Research Hospital, Hamidiye Medical Faculty, University of Health Sciences, Istanbul, Turkey
| | - Pembegul Gunes
- Department of Pathology, Haydarpasa Numune Training and Research Hospital, Hamidiye Medical Faculty, University of Health Sciences, Istanbul, Turkey
| | - Fatih Goktay
- Department of Dermatology, Haydarpasa Numune Training and Research Hospital, Hamidiye Medical Faculty, University of Health Sciences, Istanbul, Turkey
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Kim BS, Kim K, Day J, Seilern Und Aspang J, Kim J. Ultrasound-Guided Popliteal Nerve Block with Short-Acting Lidocaine in the Surgical Treatment of Ingrown Toenails. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105059. [PMID: 34064708 PMCID: PMC8151049 DOI: 10.3390/ijerph18105059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/06/2021] [Accepted: 05/08/2021] [Indexed: 11/16/2022]
Abstract
Background: Digital nerve block (DB) is a commonly utilized anesthetic procedure in ingrown toenail surgery. However, severe procedure-related pain has been reported. Although the popliteal sciatic nerve block (PB) is widely accepted in foot and ankle surgery, its use in ingrown toenail surgery has not been reported. Therefore, this study aimed to investigate the safety and effectiveness of PB in the surgical treatment of ingrown toenails. Methods: One-hundred-ten patients surgically treated for an ingrown toenail were enrolled. Sixty-six patients underwent DB, and 44 underwent PB. PB was performed under ultrasound-guidance via a 22-gauge needle with 15 mL of 1% lidocaine in the popliteal region. The visual analogue scale was used to assess pain at two-time points: pain with skin penetration and pain with the solution injection. Time to sensory block, duration of sensory block, need for additional injections, and adverse events were recorded. Results: PB group demonstrated significantly lower procedure-related pain than the DB group. Time to sensory block was significantly longer in the PB group (20.8 ± 4.6 versus 6.5 ± 1.6 minutes). The sensory block duration was significantly longer in the PB group (187.9 ± 22.0 versus 106.5 ± 19.1 minutes). Additional injections were required in 16 (24.2%) DB cases, while no additional injections were required in PB cases. Four adverse events occurred in the DB group and two in the PB group. Conclusion: PB was a less painful anesthetic procedure associated with a longer sensory block duration and fewer repeat injections compared with DB. The result of this study implicates that PB can be an alternative anesthetic option in the surgical treatment of ingrown toenails.
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Affiliation(s)
- Beom Suk Kim
- Uijeongbu Eulji Medical Center, Department of Physical Medicine and Rehabilitation, Eulji University, Daejeon 11759, Korea;
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul 02841, Korea
| | - Kyungho Kim
- Department of Orthopedic Surgery, Armed Forces Daejeon Hospital, Daejeon 34059, Korea;
- Samsung Medical Center, Department of Orthopedic Surgery, Seoul 06351, Korea
| | - Jonathan Day
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA; (J.D.); (J.S.U.A.)
- School of Medicine, Georgetown University, Washington, DC 20007, USA
| | - Jesse Seilern Und Aspang
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA; (J.D.); (J.S.U.A.)
- Department of Orthopedic Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Jaeyoung Kim
- Department of Orthopedic Surgery, Armed Forces Daejeon Hospital, Daejeon 34059, Korea;
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA; (J.D.); (J.S.U.A.)
- Correspondence:
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11
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Ríos-Viñuela E, Nájera-Botello L, Requena L, Nagore E, Requena C. Subungual Melanocytic Lesions: Key Clinical and Pathologic Concepts and Biopsy Techniques. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:S1578-2190(21)00166-9. [PMID: 34053897 DOI: 10.1016/j.adengl.2021.05.007] [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: 11/09/2020] [Accepted: 12/26/2020] [Indexed: 11/15/2022] Open
Abstract
Both dermatologists and pathologists sometimes find daunting the evaluation of melanonychia (especially subungual melanocytic lesions) because of the fear of performing nail surgery due to the risk of dystrophy, difficulties processing and interpreting nail biopsy specimens, and a general lack of experience in the field. Nevertheless, mastery of nail biopsy techniques, correct processing and orientation of specimens, and familiarity with the histologic particularities of the nail apparatus can attenuate the undoubted complexity and facilitate the tasks involved. Longitudinal excision is the biopsy technique that ensures the simplest histologic interpretation, and it is associated with a low risk of nail dystrophy when performed correctly. Clinical and epidemiological data are crucial. Subungual melanoma in childhood, for instance, is very rare and even lesions with atypical clinical and/or histologic features are probably benign. The presence of suprabasal melanocytes and other findings that would suggest malignancy at other sites are considered normal in the nail apparatus. Subungual melanoma shows a lentiginous pattern in the early stages of disease, and detection of an inflammatory infiltrate accompanying atypical lentiginous subungual lesions would appear to be one of the first diagnostic findings.
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Affiliation(s)
- E Ríos-Viñuela
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, Spain.
| | - L Nájera-Botello
- Servicio de Anatomía Patológica, Hospital Universitario Puerta del Hierro, Madrid, Spain
| | - L Requena
- Servicio de Dermatología, Fundación Jiménez Díaz, Madrid, Spain
| | - E Nagore
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - C Requena
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, Spain
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12
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Moellhoff N, Polzer H, Baumbach SF, Kanz KG, Böcker W, Bogner-Flatz V. [Unguis incarnatus-conservative or operative treatment? A practical treatment algorithm]. Unfallchirurg 2021; 124:311-318. [PMID: 33111185 PMCID: PMC7985053 DOI: 10.1007/s00113-020-00903-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2020] [Indexed: 12/02/2022]
Abstract
Unguis incarnatus, an ingrown toenail, is a common condition in primary care, which is encountered by various medical professions. Inconsistent conservative treatment and nonindicated surgical treatment often result in complications and recurrence of the disease. Patients must be thoroughly informed about the complexity of the nail organ. This is a prerequisite to prevent trivialization of the disease and to achieve appropriate patient compliance for treatment. In this article a practical diagnostic and treatment algorithm for unguis incarnatus is presented. In mild cases of acute unguis incarnatus a consistent conservative treatment is the first-line strategy showing promising results. In cases of moderate to severe forms of acute unguis incarnatus, surgical procedures that preserve the nail matrix should be applied. For cases of chronic unguis incarnatus without an acute infection, elective partial matrixectomy can be indicated. Prior to any surgical intervention, detailed informed consent must be obtained from the patients.
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Affiliation(s)
- N Moellhoff
- Abteilung für Hand‑, Plastische und Ästhetische Chirurgie, Klinikum der Universität München, LMU München, Pettenkoferstr. 8a, 80336, München, Deutschland.
| | - H Polzer
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, LMU München, München, Deutschland
| | - S F Baumbach
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, LMU München, München, Deutschland
| | - K G Kanz
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - W Böcker
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, LMU München, München, Deutschland
| | - V Bogner-Flatz
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, LMU München, München, Deutschland
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13
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Baltz JO, Jellinek NJ. Nail Surgery: Six Essential Techniques. Dermatol Clin 2021; 39:305-318. [PMID: 33745642 DOI: 10.1016/j.det.2020.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Successful nail surgery requires an understanding of specific disease processes, the anatomy of the nail unit, and fluency with only a few key techniques. This article focuses on 6 high-yield procedures, facility with which will allow the clinician to approach most of the clinical scenarios requiring surgical intervention. These encompass surgical approaches to inflammatory nail diseases, melanonychia, erythronychia, and nail melanoma in situ.
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Affiliation(s)
- Julia O Baltz
- Dermatology Professionals, Inc, 1672 South County Trail, Suite 101, East Greenwich, RI 02818, USA; Department of Dermatology, University of Massachusetts Medical School, 281 Lincoln Street, Worcester, MA 01605, USA
| | - Nathaniel J Jellinek
- Dermatology Professionals, Inc, 1672 South County Trail, Suite 101, East Greenwich, RI 02818, USA; Department of Dermatology, University of Massachusetts Medical School, 281 Lincoln Street, Worcester, MA 01605, USA; Department of Dermatology, The Warren Alpert Medical School at Brown University, 593 Eddy Street, Providence, RI 02903, USA.
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14
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Ríos-Viñuela E, Nájera-Botello L, Requena L, Nagore E, Requena C. Subungual Melanocytic Lesions: Key Clinical and Pathologic Concepts and Biopsy Techniques. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:S0001-7310(21)00003-X. [PMID: 33465340 DOI: 10.1016/j.ad.2020.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/11/2020] [Accepted: 12/26/2020] [Indexed: 12/11/2022] Open
Abstract
Both dermatologists and pathologists sometimes find daunting the evaluation of melanonychia (especially subungual melanocytic lesions) because of the fear of performing nail surgery due to the risk of dystrophy, difficulties processing and interpreting nail biopsy specimens, and a general lack of experience in the field. Nevertheless, mastery of nail biopsy techniques, correct processing and orientation of specimens, and familiarity with the histologic particularities of the nail apparatus can attenuate the undoubted complexity and facilitate the tasks involved. Longitudinal excision is the biopsy technique that ensures the simplest histologic interpretation, and it is associated with a low risk of nail dystrophy when performed correctly. Clinical and epidemiological data are crucial. Subungual melanoma in childhood, for instance, is very rare and even lesions with atypical clinical and/or histologic features are probably benign. The presence of suprabasal melanocytes and other findings that would suggest malignancy at other sites are considered normal in the nail apparatus. Subungual melanoma shows a lentiginous pattern in the early stages of disease, and detection of an inflammatory infiltrate accompanying atypical lentiginous subungual lesions would appear to be one of the first diagnostic findings.
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Affiliation(s)
- E Ríos-Viñuela
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España.
| | - L Nájera-Botello
- Servicio de Anatomía Patológica, Hospital Universitario Puerta de Hierro, Madrid, España
| | - L Requena
- Servicio de Dermatología, Fundación Jiménez Díaz, Madrid, España
| | - E Nagore
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - C Requena
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
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15
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A rare case of a subungual epidermoid cyst treated by surgical excision maintaining maximal functionality. JAAD Case Rep 2020; 8:67-70. [PMID: 33521214 PMCID: PMC7820304 DOI: 10.1016/j.jdcr.2020.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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16
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Noula AGM, Tochie JN, Tchuenkam LW, Abang DA, Essomba R. Surgical site infection leading to gangrene and amputation after ambulatory surgical care of an ingrown toenail: a case report. Patient Saf Surg 2019; 13:44. [PMID: 31890029 PMCID: PMC6913014 DOI: 10.1186/s13037-019-0225-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/09/2019] [Indexed: 11/15/2022] Open
Abstract
Background Currently, the management of ingrown toenail (onychocryptosis) ranges from conservative medical management to surgical treatment. Surgical management is typically performed as an outpatient procedure due to it numerous advantages such as the simplicity of the technique and the low incidence of postoperative complications. The most common postoperative complications are recurrences and surgical site infections, whereas gangrene complicating a surgical site infection has been scarcely reported. We are reporting a rare complication following ambulatory surgery untimely requiring amputation. Case presentation A twelve-year-old boy was referred to our orthopedic surgical department for a surgical site infection complicating an initial surgical management of a left ingrown big toenail leading to a dry gangrene of the affected toe. The gangrene toe was amputated under peripheral nerve block and the patient was discharged home the same day on antibiotics, analgesics and with sessions of rehabilitation and psychological support planned. The postoperative course was uneventful at 6 months of follow-up. Conclusion The authors report this case to draw clinicians’ attention, especially wound care specialists, orthopedists and podiatrists to this rare but potentially debilitating disease.
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Affiliation(s)
| | - Joel Noutakdie Tochie
- 2Department of Anaesthesiology and Critical Care Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Landry W Tchuenkam
- 3Department of Surgery and sub-Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Desmond Aji Abang
- 4Global Health System Solutions (GHSS) and Faculty of Sciences, University of Buea, Buea, Cameroon
| | - René Essomba
- Higher Institute of Medical Technology, Yaoundé, Cameroon
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17
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Rigopoulos D, Baran R, Chiheb S, Daniel CR, Di Chiacchio N, Gregoriou S, Grover C, Haneke E, Iorizzo M, Pasch M, Piraccini BM, Rich P, Richert B, Rompoti N, Rubin AI, Singal A, Starace M, Tosti A, Triantafyllopoulou I, Zaiac M. Recommendations for the definition, evaluation, and treatment of nail psoriasis in adult patients with no or mild skin psoriasis: A dermatologist and nail expert group consensus. J Am Acad Dermatol 2019; 81:228-240. [PMID: 30731172 DOI: 10.1016/j.jaad.2019.01.072] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 01/10/2019] [Accepted: 01/30/2019] [Indexed: 12/25/2022]
Abstract
Nail involvement in psoriasis is common, and the severity of it does not always parallel the intensity of cutaneous disease. We created a consensus group, of which the aim was to provide practical recommendations for the treatment of nail psoriasis in patients without skin psoriasis or with mild skin lesions with no indication for a systemic treatment. This collaborative process was conducted by an international panel of dermatologists with special expertise in nail disorders, using formal consensus methods. During this process, the panel strived to establish an agreement regarding the definition of nail psoriasis, the severity of nail psoriasis, and treatment response. Treatment recommendations are provided regarding nail psoriasis severity and matrix or bed involvement. Few-nail disease was considered as nail psoriasis affecting ≤3 nails. In the case of matrix involvement only, intralesional steroid injections were considered the treatment of choice. Topical steroids alone or in combination with topical vitamin D analogues were suggested for nail psoriasis limited to the nail bed. For the systemic treatment of nail psoriasis acitretin, methotrexate, cyclosporine, small molecules, and biologics may be employed.
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Affiliation(s)
| | - Robert Baran
- University of Franche-Comté, Nail Disease Center, Cannes, France
| | - Soumiya Chiheb
- Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco
| | - Carlton Ralph Daniel
- University of Mississippi Medical Center, Jackson, Mississippi; University of Alabama, Birmingham, Alabama
| | - Nilton Di Chiacchio
- Department of Dermatology, Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil
| | - Stamatis Gregoriou
- University Hospital of Venereal and Skin Diseases A. Sygros, Athens, Greece
| | - Chander Grover
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Eckart Haneke
- Department of Dermatology, Inselspital, University Bern, Bern, Switzerland; Centro de Dermatología, Instituto CUF, Porto, Portugal
| | | | - Marcel Pasch
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bianca Maria Piraccini
- Department of Specialized, Experimental, and Diagnostic Medicine, University of Bologna, Bologna, Italy
| | - Phoebe Rich
- Oregon Health and Science University, Portland, Oregon
| | - Bertrand Richert
- Saint Pierre-Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Natalia Rompoti
- University Hospital of Venereal and Skin Diseases A. Sygros, Athens, Greece.
| | - Adam I Rubin
- Department of Dermatology, Hospital of the University of Pennsylvania, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Archana Singal
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Michela Starace
- Department of Specialized, Experimental, and Diagnostic Medicine, University of Bologna, Bologna, Italy
| | - Antonella Tosti
- University of Miami Miller School of Medicine, Miami, Florida
| | | | - Martin Zaiac
- Greater Miami Skin and Laser Center, Department of Dermatology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
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18
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Shih S, Khachemoune A. Acquired digital fibrokeratoma: review of its clinical and dermoscopic features and differential diagnosis. Int J Dermatol 2018; 58:151-158. [PMID: 29777543 DOI: 10.1111/ijd.14046] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/07/2018] [Accepted: 04/23/2018] [Indexed: 12/17/2022]
Abstract
Acquired digital fibrokeratoma (ADFK) is a rare, benign, fibrous tumor that most often occurs on fingers. It may resemble a rudimentary supernumerary digit and is often misdiagnosed as another common benign condition, such as common wart. It is typically asymptomatic and occurs as a solitary nodule less than 1 cm in diameter. Oftentimes ADFK shares clinical and/or histologic resemblance with other benign and malignant cutaneous conditions so it is crucial that careful examination is undertaken. In this article, we will discuss the clinical presentation, epidemiology, etiology, dermoscopic and histologic findings, management, and differential diagnoses for ADFK, with the hope that this review will facilitate timely diagnosis and management for this distinct condition.
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Affiliation(s)
- Shawn Shih
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Amor Khachemoune
- Veterans Affairs Medical Center, Brooklyn, NY, USA.,SUNY Downstate, Department of Dermatology, Brooklyn, NY, USA
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19
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Göktay F, Atış G, Güneş P, Macit B, Çelik NS, Gürdal Kösem E. Subungual exostosis and subungual osteochondromas: a description of 25 cases. Int J Dermatol 2018; 57:872-881. [DOI: 10.1111/ijd.14003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/02/2018] [Accepted: 03/18/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Fatih Göktay
- Department of Dermatology; University of Health Sciences; Haydarpaşa Numune Training and Research Hospital; İstanbul Turkey
| | - Güldehan Atış
- Department of Dermatology; University of Health Sciences; Haydarpaşa Numune Training and Research Hospital; İstanbul Turkey
| | - Pembegül Güneş
- Department of Pathology; University of Health Sciences; Haydarpaşa Numune Training and Research Hospital; İstanbul Turkey
| | - Betül Macit
- Department of Dermatology; University of Health Sciences; Haydarpaşa Numune Training and Research Hospital; İstanbul Turkey
| | - Nil Su Çelik
- Department of Dermatology; University of Health Sciences; Haydarpaşa Numune Training and Research Hospital; İstanbul Turkey
| | - Esra Gürdal Kösem
- Department of Radiology; University of Health Sciences; Haydarpaşa Numune Training and Research Hospital; İstanbul Turkey
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20
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Starace M, Alessandrini A, Piraccini BM. Nail Disorders in Children. Skin Appendage Disord 2018; 4:217-229. [PMID: 30410888 DOI: 10.1159/000486020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 12/05/2017] [Indexed: 12/30/2022] Open
Abstract
Nail diseases in children do not account for a significant proportion of pediatric consultations, and most of the time the nails are not observed by the clinician, overlooking their importance. Specific examination of the nails is neglected, while localization to the nails could be an initial sign of a syndrome or a systemic disorder. Nail diseases in the pediatric population differ from those in adults in terms of diagnostic approach and management; some of them even are manifested mainly or exclusively in children. Pediatric patients with underlying systemic disorders are more likely to manifest acquired disorders of the nails. Although rare, nail diseases in children are a source of anxiety for the parents. Examination of the nails is an essential part of pediatric physical examination. A correct clinical history and careful examination help the clinician to distinguish the different conditions and to decide on the correct management of nail diseases in young patients. A classification of nail dystrophies according to age is somewhat arbitrary and a unique classification does not exist. Nail diseases in the pediatric population can be divided according to age groups where a predilection appears in most of the cases. Moreover, certain abnormalities may be lifelong once acquired, but their presentation may be modified by age, worsening or improving during life. This review describes many of the nail conditions that are seen in the pediatric population aging from newborn to toddler, starting with physiological aspects to better recognize the pathological conditions.
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Affiliation(s)
- Michela Starace
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Aurora Alessandrini
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Bianca Maria Piraccini
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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21
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Göktay F, Altan ZM, Haras ZB, Güneş P, Yaşar Ş, Aytekin S, Haneke E. Multibranched acquired periungual fibrokeratomas with confounding histopathologic findings resembling papillomavirus infection: a report of two cases. J Cutan Pathol 2015; 42:652-6. [DOI: 10.1111/cup.12497] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 04/15/2015] [Accepted: 04/18/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Fatih Göktay
- Department of Dermatology; Haydarpaşa Numune Training and Research Hospital; Istanbul Turkey
| | - Zeynep Müeyyen Altan
- Department of Dermatology; Haydarpaşa Numune Training and Research Hospital; Istanbul Turkey
| | - Zeynep Büşra Haras
- Department of Dermatology; Haydarpaşa Numune Training and Research Hospital; Istanbul Turkey
| | - Pembegül Güneş
- Department of Pathology; Haydarpaşa Numune Training and Research Hospital; Istanbul Turkey
| | - Şirin Yaşar
- Department of Dermatology; Haydarpaşa Numune Training and Research Hospital; Istanbul Turkey
| | - Sema Aytekin
- Department of Dermatology; Haydarpaşa Numune Training and Research Hospital; Istanbul Turkey
| | - Eckart Haneke
- Department of Dermatology; Inselspital Bern University Hospital; Bern Switzerland
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22
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23
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Cogrel O. [Myxoid pseudocyst: when and how to treat?]. Presse Med 2014; 43:1260-6. [PMID: 25312852 DOI: 10.1016/j.lpm.2014.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 06/03/2014] [Indexed: 10/24/2022] Open
Abstract
Myxoid pseudocysts (MPCs) are the most frequent pseudotumors of the digit and dermatologists are frequently referred. It is now believed that MPCs occur as a result of a leakage of synovial fluid through a breach in the joint capsule of the distal interphalangeal joint promoted by osteoarthritis. Many treatments have been proposed from simple repeated punctures, injections of steroids or sclerosants, cryosurgery, laser evaporation, infrared coagulation to surgical excision. Surgical procedures depend on the location of MPCs in the nail apparatus. In this review, we will discuss the best approaches to the treatment of MPCs whereas no guidelines are available for their management.
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Affiliation(s)
- Olivier Cogrel
- CHU de Bordeaux, hôpital Haut-Lévêque, service de dermatologie, avenue de Magellan, 33604 Pessac, France.
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