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Ng CX, Lau Xer Min N, Choi ECE, Long V, Chandran NS. Nail changes in pemphigus: a systematic review and meta-analysis. Int J Dermatol 2024. [PMID: 38887088 DOI: 10.1111/ijd.17257] [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: 03/09/2024] [Revised: 04/21/2024] [Accepted: 05/07/2024] [Indexed: 06/20/2024]
Abstract
Pemphigus is a group of autoimmune mucocutaneous bullous disorders characterized by acantholysis resulting from autoantibodies targeting epithelial cell surface antigens. Studies reflect the presence of nail manifestations in some patients and suggest a potential correlation with clinical severity. This study examines the overall prevalence and characterizes the diverse manifestations of nail changes in pemphigus. We searched Cochrane, MEDLINE, EMBASE, and LILACS from 1990 to June 26, 2023 for studies reporting different nail changes in pemphigus patients. Data were collected and pooled to obtain proportions of the prevalence of nail changes in patients with pemphigus and subgroup analysis for pemphigus foliaceous and pemphigus vulgaris. The risk of bias was assessed with the Joanna Briggs Institute Checklist. Of 321 studies screened, 14 studies with 1,208 patients were included. Paronychia (n = 185) and Beau's lines (n = 104) were the most common nail changes identified. The pooled prevalence of nail disease in pemphigus patients was 0.389 (number of studies; [95% CI]: n = 9; [0.160-0.680], with high heterogeneity between studies (I2 = 95.0%, P < 0.001). Subgroup analysis revealed the highest prevalence in pemphigus foliaceous at 0.342 (n = 3; [0.109-0.688]) and pemphigus vulgaris at 0.396 (n = 5; [0.114-0.769]). Nail changes exhibited varied temporal relationships with disease onset and flares, preceding, concurrent, or following these events. Correlation with disease severity was noted, although discrepancies between studies were reported. Nail changes in pemphigus, particularly pemphigus vulgaris and pemphigus foliaceous, may be underrecognized. Observations regarding temporal associations and potential correlations with disease severity highlight the diagnostic and prognostic implications of nail changes in pemphigus. The limitations of this study include study heterogeneity and possible bias. Further research to establish the correlation of the presence and severity of nail changes on the overall disease course would be helpful.
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Affiliation(s)
- Clara X Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicole Lau Xer Min
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ellie Ci-En Choi
- Division of Dermatology, Department of Medicine, National University Healthcare System, Singapore, Singapore
| | - Valencia Long
- Division of Dermatology, Department of Medicine, National University Healthcare System, Singapore, Singapore
| | - Nisha Suyien Chandran
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Dermatology, Department of Medicine, National University Healthcare System, Singapore, Singapore
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2
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Katsiaunis A, Lipner SR. Atypical Presentation of Pemphigus Vulgaris: Nail Involvement in a 20-Year-Old Male. Cureus 2024; 16:e53609. [PMID: 38449993 PMCID: PMC10915700 DOI: 10.7759/cureus.53609] [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] [Accepted: 02/01/2024] [Indexed: 03/08/2024] Open
Abstract
Pemphigus vulgaris (PV) mainly causes blistering of the skin and mucous membranes, with nail unit involvement being rare. Nail involvement may serve as an indicator of disease severity. We present a case of a 20-year-old male with PV who had both cutaneous and nail findings, with nail changes corresponding with disease severity. The patient with biopsy-confirmed PV, on prednisone and mycophenolate, presented to the emergency department with an acute flare of PV and severe mandibular pain and lymphadenopathy. At follow-up in our outpatient department, the physical examination was significant for onychomadesis and onycholysis of the fingernails. Prednisone and mycophenolate dosages were increased, and rituximab infusions were initiated. Bullae and mucosal lesions resolved on the follow-up, and nail changes improved. This case appends an unusual perspective to the limited literature on PV-associated nail changes, especially in younger patients. It advocates for meticulous history taking and physical examination and supports a correlation between nail symptoms and PV disease severity.
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Affiliation(s)
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, USA
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3
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Vander Does A, Gamret AC, Yosipovitch G. Nail Loss in Mild to Moderate Pemphigus Vulgaris. Skin Appendage Disord 2022; 8:504-507. [PMID: 36407650 PMCID: PMC9672869 DOI: 10.1159/000525462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/05/2022] [Indexed: 07/27/2023] Open
Abstract
Introduction Symptoms of pemphigus vulgaris (PV) rarely include nail findings. When ungual involvement does occur, the most common manifestations are paronychia and onychomadesis. Onycholysis is very uncommon, and complete nail loss has not been reported in the literature. Ungual involvement is thought to be closely correlated with disease severity, with only severe PV cases demonstrating nail symptoms. Case Presentation We report a case of a 34-year-old female presenting with mild to moderate PV yet severe onycholysis of her first toe leading to secondary nail loss in conjunction with paronychia of her bilateral thumbs. Oral tofacitinib and rituximab infusions led to strikingly rapid improvement in her nail symptoms. Discussion/Conclusion This case illustrates the importance of a thorough history and physical exam, as a primary complaint of nail symptoms in these patients may lead to unrecognized PV by even the most skilled practitioners. Tofacitinib and rituximab in combination may rapidly improve nail involvement.
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Affiliation(s)
| | | | - Gil Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, Miami, Florida, USA
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Cao S, Cui X, Li J, Pan F, Yan X, Yang Q, Chen M, Zhou S, Du D, Wang W, Sun Y, Shi Z, Wu M, Yang B, Zhang F. Nail changes in pemphigus and bullous pemphigoid: A single-center study in China. Front Med (Lausanne) 2022; 9:933608. [PMID: 36203762 PMCID: PMC9530441 DOI: 10.3389/fmed.2022.933608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022] Open
Abstract
Common autoimmune bullous diseases (AIBDs) include pemphigus and bullous pemphigoid (BP), which are primarily caused by IgG autoantibodies against the structural proteins of desmosomes at the cell–cell junction and hemidesmosomes at the epidermal–dermal junction. Few studies have assessed nail changes in patients with pemphigus or BP. In the present study, we collected the clinical data of 191 patients with AIBDs (108 patients with pemphigus and 83 patients with BP) and 200 control subjects. Nail changes were observed in 77.0% (147/191), 77.8% (84/108), and 75.9% (63/83) of patients with AIBDs, pemphigus, and BP, respectively, and 14.5% (29/200) of control subjects. Beau's lines and paronychia were the most common nail involvement, observed in 22.5% (43/191) and 22.5% (43/191) of patients with AIBDs, 25.0% (27/108) and 25.9% (28/108) of patients with pemphigus, 19.3% (16/83) and 18.1% (15/83) of patients with BP, respectively. The autoimmune bullous skin disorder intensity score (ABSIS) and the onset time of patients with pemphigus or BP with nail changes were different. Onychomycosis accounted for 21.5% (41/191) of all patients with AIBDs. The ABSIS was correlated with nail involvement in patients with BP (r = 0.46, p < 0.001), and weakly correlated with nail involvement in patients with AIBDs (r = 0.37, p < 0.001), pemphigus (r = 0.29, p = 0.009), and pemphigus vulgaris (PV; r = 0.35, p = 0.008). No correlation was observed between nail involvement and disease antibody titers. In conclusion, nail changes are frequently observed in patients with pemphigus and BP. The type and onset time of nail changes may indicate the severity of pemphigus and BP, which warrants the attention of dermatologists.
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De D, Kaushik A, Handa S, Mahajan R, Chatterjee D, Saikia B, Saikia UN, Radotra BD, Minz RW. Bullous pemphigoid in India: Review of cases registered in an autoimmune bullous disease clinic. Indian J Dermatol Venereol Leprol 2022:1-5. [DOI: 10.25259/ijdvl_1417_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/01/2022] [Indexed: 11/04/2022]
Abstract
Background
Information on bullous pemphigoid in an Indian context is scarce.
Aim
To report clinico-demographic profile, associated comorbidities and prescription pattern of bullous pemphigoid patients in India.
Methods
This was a retrospective study, where past records of all bullous pemphigoid patients diagnosed and treated between November 2013 and October 2019 were accessed and analysed. Patients having a compatible clinical presentation with either histopathological and/or direct immunofluorescence evidence of bullous pemphigoid were included.
Results
There were 96 bullous pemphigoid patients, with a male: female ratio of 1.6:1. The mean age at diagnosis was 62.5 ± 2.2 years, with mean duration of illness 27.5 ± 4.5 months before presentation. Comorbidities were present in 80 (83%) patients, with type 2 diabetes mellitus (38.5%), hypertension (36.4%) and neurological illness (16.7%) being the commonest ones. Clinically, blisters were the predominant presentation in 81 (84.4%) patients. The majority (87.5%) of patients showed a predominant eosinophilic infiltrate on histopathology. Direct immunofluorescence revealed immunoglobulin G deposits with complement C3 in 77 (80.2%) cases. The majority of patients (77.1%) were treated with oral prednisolone, either alone (11.5%) or in combination (65.6%) with other topical and systemic agents. Topical steroids were used in 29.1%, azathioprine in 28%, dapsone in 16.7% and omalizumab in 6.2% of patients.
Limitations
The study is retrospective. Immunofluorescence on salt split skin, direct immunofluorescence serration pattern analysis, and immunoblotting were not performed. Hence, there is a possibility that a few included cases were suffering from other subepidermal autoimmune bullous diseases like epidermolysis bullosa acquisita or anti-p200 pemphigoid.
Conclusion
Bullous pemphigoid patients in this study had a younger age of onset and showed male preponderance. Comorbidities like type 2 diabetes, hypertension and neurological disorders were frequent. Cutaneous blisters were the most frequent clinical presentation. Systemic corticosteroids comprised the mainstay of therapy.
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Affiliation(s)
| | | | | | | | - Debajyoti Chatterjee
- Department of Histopathology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Biman Saikia
- Department of Immunopathology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Uma Nahar Saikia
- Department of Histopathology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Bishan Dass Radotra
- Department of Histopathology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ranjana W Minz
- Department of Immunopathology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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6
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Zaouak A, Gara S, Fenniche S, Hammami H. Uncommon Nail Involvement during Bullous Pemphigoid. Skin Appendage Disord 2021; 7:315-317. [PMID: 34307481 DOI: 10.1159/000514362] [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: 11/01/2020] [Accepted: 01/07/2021] [Indexed: 11/19/2022] Open
Abstract
Bullous pemphigoid (BP) is the most frequent autoimmune blistering disorder. The immune reaction targets BP180 and BP230 antigens, 2 components of junctional adhesion complexes at the basement membrane zone. Clinical aspect includes multiple tense bullae on urticarial plaques of the skin. Although the nail apparatus may be affected by the immune process, nail changes have been rarely reported during BP. We report a case of a 72-year-old woman diagnosed with BP who subsequently developed a secondary nail loss of the 2 thumbs and the left middle finger. Also, she presented onycholysis of the fourth left finger with the aspect of roller-coaster of the proximal border at dermoscopy. Steroid therapy at high doses was ineffective and the nail atrophy was permanent.
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Affiliation(s)
- Anissa Zaouak
- Department of Dermatology, Research Unit "Genodermatosis and Cancer" LR12SP03, Habib Thameur Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Soumaya Gara
- Department of Dermatology, Research Unit "Genodermatosis and Cancer" LR12SP03, Habib Thameur Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Samy Fenniche
- Department of Dermatology, Research Unit "Genodermatosis and Cancer" LR12SP03, Habib Thameur Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Houda Hammami
- Department of Dermatology, Research Unit "Genodermatosis and Cancer" LR12SP03, Habib Thameur Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Affiliation(s)
- Eckart Haneke
- Department of Dermatology, Inselspital, University Hospital of Berne, Berne, Switzerland
| | - Luca Borradori
- Department of Dermatology, Inselspital, University Hospital of Berne, Berne, Switzerland
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8
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Yu Y, Shi Y. A woman with nail changes. BMJ 2020; 368:l7007. [PMID: 32029426 DOI: 10.1136/bmj.l7007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Yingyuan Yu
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine; Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Yuling Shi
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine; Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
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9
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Baghad B, Chiheb S. Nail Involvement during Pemphigus. Skin Appendage Disord 2019; 5:362-365. [PMID: 31799264 DOI: 10.1159/000501228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 05/28/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Pemphigus is an autoimmune bullous disease affecting the skin and mucous membranes. Associated nail involvement is underestimated and is characterized by a variety of clinical manifestations. Our aim was to describe the clinical aspects of nail involvement during pemphigus. PATIENTS AND METHODS A retrospective study was conducted of patients with pemphigus over a period of 12 years. The diagnosis of pemphigus was based on clinical and immunopathological data. Clinical data were collected from patient records prior to initiation of treatment. RESULTS Overall,141 cases of pemphigus were collected. Of these, 60 patients had nail involvement. After eliminating fungal origin, we selected 37 patients in our study. The main clinical forms were paronychia and dystrophy. Two cases of destruction of the nail apparatus were found in patients with pemphigus vegetans. The disease was bilateral in 11 cases (29.7%). The presence of ungual involvement was correlated with severity of pemphigus, particularly severe oral disease (p = 0.002). CONCLUSION Nail lesions were polymorphic in our patients. These signs show accumulated inflammation of the nail after a long evolution of the disease. Nail involvement may precede, be concomitant, or follow the mucocutaneous lesions of pemphigus and be a sign of severity or relapse of the disease.
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Affiliation(s)
- Bouchra Baghad
- Department of Dermatology Venereology, Hospital Ibn Rochd, University Hassan II, Casablanca, Morocco
| | - Soumiya Chiheb
- Department of Dermatology Venereology, Hospital Ibn Rochd, University Hassan II, Casablanca, Morocco
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10
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Feng CW, Chen HC, Lu CC. Mycophenolic acid-induced onychomadesis: An easily ignorable adverse effect in patients with rheumatic diseases. Int J Rheum Dis 2019; 22:753-755. [PMID: 30864261 DOI: 10.1111/1756-185x.13544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 01/24/2019] [Accepted: 01/31/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | - Hsiang-Cheng Chen
- Division of Rheumatology/Immunology and Allergy, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan
| | - Chun-Chi Lu
- Division of Rheumatology/Immunology and Allergy, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan
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11
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Alkeraye S, Alsukait SF. Mucous membrane pemphigoid-associated paronychia with onychomadesis. BMC DERMATOLOGY 2019; 19:3. [PMID: 30674299 PMCID: PMC6343326 DOI: 10.1186/s12895-019-0083-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 01/14/2019] [Indexed: 12/03/2022]
Abstract
Background Mucous membrane pemphigoid (MMP) is an autoimmune blistering disease that is notoriously difficult to treat. Nail involvement in MMP is rare. Case presentation We report on a 58 years old man with severe MMP who presented with onychomadesis. Conclusion To our knowledge, mucous membrane pemphigoid associated paronychia and onychomadesis have not been reported before. We believe it is important for dermatologists to be aware of this entity.
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Affiliation(s)
- Salim Alkeraye
- Dermatology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Sarah F Alsukait
- Dermatology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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12
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Gopal V, Shenoy MM, Bejai V, Nargis T. Nail changes in autoimmune blistering disorders: A case-control study. Indian J Dermatol Venereol Leprol 2018; 84:373. [PMID: 29327699 DOI: 10.4103/ijdvl.ijdvl_19_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Pemphigus and pemphigoid disorders produce blistering cutaneous lesions. Earlier case reports state that nail involvement is uncommon in these autoimmune blistering disorders. Aims and Objectives To study nail changes in autoimmune blistering disorders. Methods A case-control study was conducted where 40 cases and 40 controls were evaluated for nail changes. Results Nail changes were seen in 72.5% of cases and 17.5% of controls. The most common nail findings were paronychia and onychorrhexis. Limitations Small sample size; short study duration; nail biopsy could not be done. Conclusion Our findings indicate that the inflammatory nature of the blistering cutaneous disease is often reflected conspicuously in the nails.
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Affiliation(s)
- Vaishnavi Gopal
- Department of Dermatology, Venereology and Leprosy, Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka, India
| | - Manjunath Mala Shenoy
- Department of Dermatology, Venereology and Leprosy, Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka, India
| | - Vishal Bejai
- Department of Dermatology, Venereology and Leprosy, Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka, India
| | - Thansiha Nargis
- Department of Dermatology, Venereology and Leprosy, Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka, India
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13
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Pietkiewicz P, Bowszyc-Dmochowska M, Gornowicz-Porowska J, Dmochowski M. Involvement of Nail Apparatus in Pemphigus Vulgaris in Ethnic Poles Is Infrequent. Front Med (Lausanne) 2018; 5:227. [PMID: 30155468 PMCID: PMC6102408 DOI: 10.3389/fmed.2018.00227] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/25/2018] [Indexed: 11/21/2022] Open
Abstract
Pemphigus vulgaris lesions have a tendency to localize around natural body orifices. The aim here was to analyze the involvement of nail apparatus in pemphigus vulgaris. Sixty seven ethnic Poles suffering from pemphigus vulgaris on photographic files archiving initial presentation were retrospectively evaluated. Pemphigus vulgaris was diagnosed using combination of clinical data, H+E histology, direct immunofluorescence of plucked scalp hair and/or perilesional tissue also for IgG1 and IgG4 deposits evaluation, indirect immunofluorescence on mosaic substrate and/or monkey esophagus, mono-analyte ELISA with desmoglein 1/3 or multi-analyte ELISA. The nail apparatus involvement was found in 9 of 67 patients (13.4%; 3 females and 6 males). Periungual fingernail lesions were found in 6 patients (2 females, 4 males), whereas periungual toenail lesions in just 3 patients (1 female, 2 males). Our patients nail apparatus changes included, by order of frequency, paronychia, nail discoloration, onychorrhexis, Beau lines, periungual hemorrhages, onychomadesis, cross-ridging, onycholysis, and trachyonychia. The average time between the onset, as recalled by patients, and the diagnosis of pemphigus vulgaris with direct immunofluorescence was not statistically different in PV patients with and without nail apparatus lesions. In this article the molecular and immunological rationale for of periungual involvement is discussed. Our single-center study suggests that nail apparatus involvement is infrequent in pemphigus vulgaris in ethnic Poles. Due to the fact that nail apparatus lesions in pemphigus vulgaris may clinically resemble onychomycosis, giving the proper diagnosis can be difficult particularly when other lesions are overlooked or misinterpreted.
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Affiliation(s)
- Pawel Pietkiewicz
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
- Surgical Oncology and General Surgery Clinic I, Greater Poland Cancer Center, Poznan, Poland
| | | | | | - Marian Dmochowski
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
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14
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Vélez-Ponce J, Ponce-Olivera R, Bonifaz A, Araiza-Santibañez J, Tirado-Sánchez A. Species isolated as the cause of onychomycosis in patients with pemphigus vulgaris. REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2016. [DOI: 10.1016/j.hgmx.2015.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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15
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Beau lines, onychomadesis, and retronychia: A unifying hypothesis. J Am Acad Dermatol 2015; 73:849-55. [DOI: 10.1016/j.jaad.2015.08.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/01/2015] [Accepted: 08/05/2015] [Indexed: 11/22/2022]
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16
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Patel F, Wilken R, Patel FB, Sultani H, Bustos I, Duong C, Zone JJ, Raychaudhuri SP, Maverakis E. Pathophysiology of Autoimmune Bullous Diseases: Nature Versus Nurture. Indian J Dermatol 2015; 62:262-267. [PMID: 28584368 PMCID: PMC5448260 DOI: 10.4103/0019-5154.159620] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Pemphigus and pemphigoid are the prototypical immunobullous diseases. Although it has been well established that they are caused by deposition of autoreactive antibodies directed against adherence proteins within the skin, the specific genetic and environmental factors leading to development of these diseases continue to be an area of investigation. Herein, we discuss several of the potential environmental triggers that may induce patients to develop immunobullous diseases including medications, viral infections, UV exposure or other radiation injury and dietary factors. In addition, the potential genetic and immunologic mechanisms contributing to the pathogenesis of pemphigus and pemphigoid will be reviewed. The multifactorial nature of these diseases contributes to their complexity and highlights the importance of a detailed personal and family history when caring for these patients.
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Affiliation(s)
- Forum Patel
- Department of Dermatology, University of California Davis, Sacramento, CA, USA
| | - Reason Wilken
- Department of Dermatology, University of California Davis, Sacramento, CA, USA
| | - Falin B Patel
- Department of Dermatology, University of California Davis, Sacramento, CA, USA
| | - Hawa Sultani
- Department of Dermatology, University of California Davis, Sacramento, CA, USA
| | - Itzel Bustos
- Department of Dermatology, University of California Davis, Sacramento, CA, USA
| | - Christopher Duong
- Department of Dermatology, University of California Davis, Sacramento, CA, USA
| | - John J Zone
- Department of Dermatology, University of Utah, Salt Lake City, UT
| | - Siba P Raychaudhuri
- Department of Rheumatology, VA Northern California Medical Center, Mather, CA, USA.,Division of Rheumatology, Allergy and Clinical Immunology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Emanual Maverakis
- Department of Dermatology, University of California Davis, Sacramento, CA, USA
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17
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Abstract
Nail abnormalities can arise in conjunction with or as a result of systematic pathologies. These pathologies include single-organ diseases, multisystemic diseases, and drug-induced insults. Clinical signs associated with these conditions include dyschromias, vascular alterations, periungual tissue changes, textural dystrophies, contour alterations, and growth-rate alterations. The associated systemic pathologies may affect any part of the nail apparatus, including the nail matrix, the nail plate, the nail bed, the underlying vasculature, and the periungual tissues. The anatomical location and extent of damage determine the clinically manifested anomaly.
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18
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Abstract
The authors herein describe several nail conditions, which the general pediatrician is likely to encounter in the course of routine practice. Because pediatric nail disorders represent a limited component of a general pediatric practice, it can be challenging for practitioners to establish expertise in the diagnosis and treatment of these conditions and to recognize when reassurance is appropriate or when referral to a specialist is necessary. This article summarizes the anatomy of the normal nail unit, as well as the evaluation and management of onychomycosis, melanonychia, trachyonychia, onychomadesis, and nail pitting.
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19
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Abramovici G, Keoprasom N, Winslow C, Tosti A. Onycholysis and subungual haemorrhages in a patient with hand, foot and mouth disease. Br J Dermatol 2014; 170:748-9. [DOI: 10.1111/bjd.12689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- G. Abramovici
- Department of Dermatology; Northwestern University; Chicago IL U.S.A
| | - N. Keoprasom
- Department of Dermatology; Bangkok Hospital; Bangkok Thailand
| | - C.Y. Winslow
- Department of Dermatology & Cutaneous Surgery; University of Miami Miller School of Medicine; Miami FL U.S.A
| | - A. Tosti
- Department of Dermatology & Cutaneous Surgery; University of Miami Miller School of Medicine; Miami FL U.S.A
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Benmously-Mlika R, Hammami-Ghorbel H, Mokhtar I. Onychomadesis during bullous pemphigoid. J Am Acad Dermatol 2014; 69:e306-7. [PMID: 24238190 DOI: 10.1016/j.jaad.2013.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 07/09/2013] [Accepted: 07/10/2013] [Indexed: 10/26/2022]
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Affiliation(s)
- Luis Dehesa
- University of Miami Hospital/Florida Academic Dermatology Center; Miami; Florida
| | - Antonella Tosti
- Department of Dermatology & Cutaneous Surgery; University of Miami Miller School of Medicine; Miami; Florida
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