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Hwang JK, Grover C, Iorizzo M, Lebwohl MG, Piraccini BM, Rigopoulos DG, Lipner SR. Nail psoriasis and nail lichen planus: Updates on diagnosis and management. J Am Acad Dermatol 2024; 90:585-596. [PMID: 38007038 DOI: 10.1016/j.jaad.2023.11.024] [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: 07/23/2023] [Revised: 10/30/2023] [Accepted: 11/17/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Inflammatory diseases of the nail, including nail psoriasis and nail lichen planus, are associated with significant disease burden and have a negative impact on quality of life. Diagnosis is often delayed, especially when patients present without cutaneous findings. Therefore, recognizing clinical signs and symptoms of inflammatory nail diseases, and initiating timely and appropriate treatment, is of utmost importance. OBJECTIVE We review recent studies on diagnostic techniques, discuss severity grading and scoring systems, and describe consensus treatment recommendations for nail psoriasis and nail lichen planus. METHODS An updated literature review was performed using the PubMed database on studies assessing diagnostic techniques or treatment modalities for nail psoriasis and nail lichen planus. RESULTS Recent studies on diagnostic techniques for inflammatory nail disease have focused on use of dermoscopy, capillaroscopy, and ultrasound modalities. Treatment of these conditions is dichotomized into involvement of few (≤3) or many (>3) nails. Recent psoriatic therapeutics studied for nail outcomes include brodalumab, tildrakizumab, risankizumab, deucravacitinib, and bimekizumab, while emerging treatments for nail lichen planus include JAK inhibitors and intralesional platelet rich plasma injections. CONCLUSIONS We emphasize the need for increased awareness and expanded management strategies for inflammatory nail diseases to improve patient outcomes.
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Affiliation(s)
- Jonathan K Hwang
- Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Chander Grover
- Department of Dermatology, University College of Medical Sciences, New Delhi, India
| | | | - Mark G Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Bianca M Piraccini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Dimitris G Rigopoulos
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Athens, Greece
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, New York.
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Greco P, Pham F, Duru G, Lainé X, Dalle S, Thomas L. Evaluation of the Knowledge of Primary Care Physicians About Important Nail Diseases Before and After a Short Online Training. Dermatol Pract Concept 2023; 13:e2023170. [PMID: 37557138 PMCID: PMC10412044 DOI: 10.5826/dpc.1303a170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Nail diseases are often diagnosed late with a potential prognostic and functional impact. This could be partly due to knowledge gaps among primary care physicians (PCPs). OBJECTIVES To evaluate the knowledge about diagnosis and management of ten common/important nail conditions in a population of French PCPs and its improvement after a 31-minute online training session. METHODS We submitted 10 pre-test and post-test clinical cases and an educative online course on the diagnosis and the management of nail diseases to 138 volunteer PCPs; 73 completed the whole training path. RESULTS Compared to pre-test, more PCPs in the post-test required an urgent second opinion to dermatologist for pigmented melanoma (100% versus 80.3%; P <0.05) and use of inappropriate/dangerous systemic treatment for trauma-induced nail changes was reduced after the training program (0% versus 6.8%; P <0.05). A lack of knowledge remained after training for amelanotic melanoma with an increase of mycological/bacteriological tests (9.6% versus 0%; P <0.05). CONCLUSIONS Management of nail diseases by our panel of PCPs was suboptimal and was improved after a short online training.
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Affiliation(s)
- Pauline Greco
- Dermatology department, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyons, France
- Claude Bernard Lyon-1 University, Lyon, France
| | - Félix Pham
- Dermatology department, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyons, France
- Claude Bernard Lyon-1 University, Lyon, France
| | - Gérard Duru
- Claude Bernard Lyon-1 University, Lyon, France
| | | | - Stéphane Dalle
- Dermatology department, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyons, France
- Claude Bernard Lyon-1 University, Lyon, France
- Cancer Research Center of Lyon, Lyons, France
| | - Luc Thomas
- Dermatology department, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyons, France
- Claude Bernard Lyon-1 University, Lyon, France
- Cancer Research Center of Lyon, Lyons, France
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Abstract
Nail conditions are not only aesthetic concerns, and nail changes may be a clue to an underlying systemic diseases or infection. Without timely treatment, nail diseases can continue to worsen and significantly impair performance of daily activities and reduce quality of life. Examination of the nails is essential at every medical visit, and may uncover important findings. Brittle nail syndrome, onychomycosis, paronychia, nail psoriasis, longitudinal melanonychia, Beau's lines, onychomadesis and retronychia are common nail disorders seen in clinical practice. These conditions stem from infectious, inflammatory, neoplastic and traumatic aetiologies. Though each nail condition presents with its own distinct characteristics, the clinical findings may overlap between different conditions, resulting in misdiagnosis and treatment delays. Patients can present with nail plate changes (e.g. hyperkeratosis, onycholysis, pitting), discolouration, pain and inflammation. The diagnostic work-up of nail disease should include a detailed history and clinical examination of all 20 nail units. Dermoscopy, diagnostic imaging and histopathologic and mycological analyses may be necessary for diagnosis. Nail findings concerning for malignancy should be promptly referred to a dermatologist for evaluation and biopsy. Nail disease management requires a targeted treatment approach. Treatments include topical and/or systemic medications, discontinuation of offending drugs or surgical intervention, depending on the condition. Patient education on proper nail care and techniques to minimize further damage to the affected nails is also important. This article serves to enhance familiarity of the most common nail disorders seen in clinical practice. It will highlight the key clinical manifestations, systematic approaches to diagnosis and treatment options for each nail condition to improve diagnosis and management of nail diseases, as well as patient outcomes.Key messagesNail disease is not only a cosmetic issue, as nail changes can indicate the presence of a serious underlying systemic disease, infection or malignancy.Nail pain and changes associated with NP are physically and emotionally distressing and may contribute to functional impairment and diminished quality of life.LM is a hallmark sign of subungual melanoma and this finding warrants further investigation to rule out malignancy.
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Affiliation(s)
- Debra K Lee
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine New York, NY, USA
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Tampucci S, Terreni E, Zucchetti E, Burgalassi S, Chetoni P, Monti D. Formulations Based on Natural Ingredients for the Treatment of Nail Diseases. Curr Pharm Des 2020; 26:556-565. [DOI: 10.2174/1381612826666200122150248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 12/18/2019] [Indexed: 12/21/2022]
Abstract
Nail is a strong and resistant structure, characterized by a low permeability to foreign molecules. Nails
can be subjected to many diseases, among which fungal infections (e.g. onchomycosis) are the most common and
responsible for nail structure alteration. Many formulations have been produced for the delivery of active ingredients
to treat nail disorders, based on newly synthesized active molecules or containing chemical enhancers or
chemically-modified polymers able to improve the drug transungual penetration. To avoid permanent alterations
of the nail structure due to the use of chemical compounds or organic solvent-based formulation, researchers have
developed novel formulations focusing on the use of new natural-based compounds. The purpose of this review is
to provide information on the outcoming of natural ingredients-based formulations that have been developed in
the last years as potential alternative to chemical-based formulations.
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Affiliation(s)
| | | | | | | | | | - Daniela Monti
- Department of Pharmacy, University of Pisa, Pisa, Italy
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Chessa MA, Iorizzo M, Richert B, López-Estebaranz JL, Rigopoulos D, Tosti A, Gupta AK, Di Chiacchio N, Di Chiacchio NG, Rubin AI, Baran R, Lipner SR, Daniel R, Chiheb S, Grover C, Starace M, Piraccini BM. Pathogenesis, Clinical Signs and Treatment Recommendations in Brittle Nails: A Review. Dermatol Ther (Heidelb) 2020; 10:15-27. [PMID: 31749091 PMCID: PMC6994568 DOI: 10.1007/s13555-019-00338-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Indexed: 02/06/2023] Open
Abstract
Nail plate brittleness (or fragility) is a common complaint affecting up to 20% of the population, especially women over 50 years of age, with fingernail fragility being more prevalent than toenail fragility. Nail brittleness is characterized by nails that split, flake and crumble, become soft and lose elasticity. The main clinical presentations are: onychoschizia, onychorrhexis, superficial granulation of keratin and worn-down nails. According to causative factors, we can distinguish 2 forms of nail fragility (NF): a primary "idiopathic or brittle nail syndrome" form and NF secondary to different causes such as inflammatory nail disorders, infections, systemic diseases and general conditions, traumas and alteration of the nail hydration. Optimal management requires treatment of the primary cause of brittle nails, when possible. In idiopathic NF oral supplementation, vitamins (especially biotin, also known as vitamin B7), trace elements and amino acids (especially cysteine) have been reported to be useful. In addition, several products, such as topical moisturizers and lacquers could be considered to restructure the affected nail plate and to reduce psychological impacts of this common problem.
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Affiliation(s)
- Marco A Chessa
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
| | - Matilde Iorizzo
- Private Dermatology Practice, Bellinzona/Lugano, Switzerland
| | - Bertrand Richert
- Saint Pierre - Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Dimitrios Rigopoulos
- Department of Dermatology, National and Kapodistrian University of Athens, "A. Sygros" Hospital, Athens, Greece
| | - Antonella Tosti
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Aditya K Gupta
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Canada and Mediprobe Research Inc., London, ON, Canada
| | - Nilton Di Chiacchio
- Dermatology Clinic - Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil
| | - Nilton G Di Chiacchio
- Dermatology Clinic - Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil
- Dermatology Discipline - Faculade de Medicina do ABC, Santo André, Brazil
| | - Adam I Rubin
- Department of Dermatology, Hospital of the University of Pennsylvania, and Section of Dermatology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
| | - Ralph Daniel
- University of Mississippi, Medical Center, University of Alabama, Birmingham, AL, USA
| | - Soumya Chiheb
- Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco
| | - Chander Grover
- University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Michela Starace
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Bianca M Piraccini
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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