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Starace M, Cedirian S, Alessandrini A, Bruni F, Piraccini BM, Iorizzo M. Self-induced nail disorders (SINDs): What do we know so far? Ann Dermatol Venereol 2023; 150:253-259. [PMID: 37813711 DOI: 10.1016/j.annder.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/17/2023] [Accepted: 05/09/2023] [Indexed: 10/11/2023]
Abstract
Self-induced nail disorders are a broad group of different clinical manifestations that share the common trait of being caused more or less voluntarily by the patient. These are distinct conditions within the clinical spectrum of onychotillomania. Most patients diagnosed with these disorders have psychiatric co-morbidities, and a multidisciplinary approach is thus highly recommended. The purpose of this review is to describe the most common clinical features encountered during daily nail consultations and to provide useful diagnostic tools and therapeutic tips for the best approach to these conditions.
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Affiliation(s)
- M Starace
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Bologna, Italy
| | - S Cedirian
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Bologna, Italy.
| | - A Alessandrini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Bologna, Italy
| | - F Bruni
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Bologna, Italy
| | - B M Piraccini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Bologna, Italy
| | - M Iorizzo
- Private Dermatology Practice, Lugano/Bellinzona, Switzerland
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2
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Case Study. JOURNAL OF THE DERMATOLOGY NURSES' ASSOCIATION 2023. [DOI: 10.1097/jdn.0000000000000727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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3
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Bonamonte D, Foti C, DE Marco A, Hansel K, Cecchini E, Filoni A, DE Prezzo S, Ambrogio F, Angelini G, Stingeni L. Self-inflicted pathological cutaneous disorders. Part II. Ital J Dermatol Venerol 2022; 157:480-488. [PMID: 36177780 DOI: 10.23736/s2784-8671.22.07376-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Self-inflicted skin disorders are artefact diseases inflicted by the use of multiple different means, for various different purposes. They account for about 2% of dermatology patient visits, and include disorders with a denied or hidden pathological behavior (factitious disorders) and disorders with a non-denied and non-hidden pathological behavior (compulsive disorders). In turn, factitious skin disorders are subdivided into 2 groups: factitious disorders without an external incentive (considered in a preceding work) and factitious disorders with external incentives. In the second eventuality, the simulator is motivated by illicit intent, wishing to evade civil duties or a prison sentence, for instance, or to exploit situations of an occupational nature, and is fully aware of his action and his intention. Apart of the two groups of pathomimic artefacts and malingering, some self-inflicted dermatoses are due to behavioral disorders involving compulsive habits (tics, psychological excoriations). The great majority of subjects suffering from the latter disturbances are quick to confess their urge to self-inflict lesions. The management, including both psychiatric and dermatological assessment, concludes this second part of the work regarding the self-inflicted cutaneous diseases.
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Affiliation(s)
- Domenico Bonamonte
- Section of Dermatology, Department of Biomedical Science and Human Oncology, Aldo Moro University, Bari, Italy -
| | - Caterina Foti
- Section of Dermatology, Department of Biomedical Science and Human Oncology, Aldo Moro University, Bari, Italy
| | - Aurora DE Marco
- Section of Dermatology, Department of Biomedical Science and Human Oncology, Aldo Moro University, Bari, Italy
| | - Katharina Hansel
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Elisa Cecchini
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Angela Filoni
- Section of Dermatology, Perrino Hospital, Brindisi, Italy
| | - Serena DE Prezzo
- Section of Dermatology, Department of Biomedical Science and Human Oncology, Aldo Moro University, Bari, Italy
| | - Francesca Ambrogio
- Section of Dermatology, Department of Biomedical Science and Human Oncology, Aldo Moro University, Bari, Italy
| | - Gianni Angelini
- Section of Dermatology, Department of Biomedical Science and Human Oncology, Aldo Moro University, Bari, Italy
| | - Luca Stingeni
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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4
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Aljhani S. Fluoxetine for the treatment of onychotillomania associated with obsessive–compulsive disorder: a case report. J Med Case Rep 2022; 16:431. [DOI: 10.1186/s13256-022-03652-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/14/2022] [Indexed: 11/21/2022] Open
Abstract
Abstract
Background
Obsessive–compulsive disorder is a condition in which patients experience an obsession and/or a compulsion. It has a high impact on the quality of life, and is associated with an increased prevalence of psychiatric comorbidities in patients. Onychotillomania is an underestimated psychodermatosis caused by repeated self-inflicted damage to the nail unit. In patients, it is characterized by an obsessive or irrepressible impulse to repeatedly damage their own nails, resulting in their destruction. It is a chronic condition that is difficult to manage, largely because of its psychocutaneous character, as well as its high tendency to interact with underlying neuropsychiatric diseases or other behavioral disorders. Only a few studies have reported an association between obsessive–compulsive disorder and onychotillomania, which typically presents with therapeutic challenges. Cognitive behavioral therapy, physical-barrier approaches, and pharmaceutical treatments have been reported to be beneficial in the management of onychotillomania; however, no major clinical studies have investigated the effectiveness of these therapies. Onychotillomania remains a clinical and therapeutic issue owing to the lack of evidence-based treatment techniques.
Case presentation
We report a case of an 18-year-old, middle-eastern female patient who developed onychotillomania when she was being treated with paroxetine for obsessive–compulsive disorder and was showing partial improvement. The patient developed side effects from paroxetine, and was switched to fluoxetine. Thereafter, improvement in her obsessive–compulsive disorder was observed, which relapsed when treatment was discontinued. However, the onychotillomania symptoms did not reemerge.
Conclusion
Onychotillomania typically presents both diagnostic and therapeutic challenges. Fluoxetine plays an important role in the treatment of onychotillomania and other psychiatric disorders. However, large-scale studies should be conducted before these outcomes can be generalized.
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5
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Nguyen B, Hawash AA, Tosti A. Oral N-acetylcysteine in the Treatment of Onychotillomania. Dermatol Ther 2022; 35:e15605. [PMID: 35620921 DOI: 10.1111/dth.15605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/25/2022] [Accepted: 05/25/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Betty Nguyen
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.,University of California Riverside School of Medicine, Riverside, CA, USA
| | - Ahmed A Hawash
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Antonella Tosti
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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6
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Cohen PR, Kurzrock R. Nailing the Diagnosis: Onychotillomania in Patients With Artificial Nails—An Underrecognized Phenomenon? Cureus 2022; 14:e24737. [PMID: 35686271 PMCID: PMC9170376 DOI: 10.7759/cureus.24737] [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] [Accepted: 05/03/2022] [Indexed: 11/25/2022] Open
Abstract
Artificial nails are an essential component of nail cosmetics. The artificial nails are either preformed and glued onto the existing nail plate or they are custom made by applying a polymerizing mixture to the existing nail plate and overlying the template with a paintbrush that is subsequently allowed to harden into an acrylic nail. Artificial nails require regular maintenance. Onychotillomania is a body-focused repetitive disorder in which the person is usually aware that they are picking at their nail and/or the surrounding soft tissue. A woman with onychotillomania affecting her artificial nails is described; although this may be a relatively common occurrence, additional reports of artificial nail-associated onychotillomania were not able to be retrieved from the medical literature. The woman was not only aware that she picked at her artificial nails, but also realized that the action might result in adverse events to her natural nails and the corresponding digits. She desired no interventions for her nail-associated repetitive behavior and continued to regularly visit the nail salon for the application of new artificial custom acrylic nails. The acronym ANASON is introduced to define the condition of artificial nail-associated onychotillomania.
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Update on Diagnosis and Management of Onychophagia and Onychotillomania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063392. [PMID: 35329078 PMCID: PMC8953487 DOI: 10.3390/ijerph19063392] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 12/16/2022]
Abstract
Onychophagia (nail biting) and onychotillomania (nail picking) are chronic nail conditions categorized as body-focused repetitive behavior (BFRB) disorders. Due to a limited awareness of their clinical presentations, embarrassment on the part of patients, and/or comorbid psychiatric conditions, these conditions are frequently underrecognized and misdiagnosed. This article reviews the prevalence, etiology, diagnostic criteria, historical and physical exam findings, and treatment options for these conditions. The PubMed/MEDLINE database was searched for relevant articles. Onychophagia and onychotillomania are complex disorders necessitating a detailed patient history and physical examination and a multidisciplinary treatment approach for successful diagnosis and management. Due to the dearth of clinical trials for treatment of nail biting and nail picking, large clinical trials are necessary to establish standardized therapies.
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8
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Rasul TF, Gulraiz S, Henderson A. Onychotillomania in the Setting of Homelessness. Cureus 2022; 14:e22988. [PMID: 35415028 PMCID: PMC8993992 DOI: 10.7759/cureus.22988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 11/16/2022] Open
Abstract
Onychotillomania is a psychodermatosis that involves repetitive, self-induced trauma to the nail and sometimes the periungual skin. It is generally seen as an overlapping psychiatric and dermatologic disorder, although there have not been any statistically significant associations with psychiatric illness. Some studies have noted an association with obsessive-compulsive disorder (OCD). Due to the relative lack of empirical data on this condition, treatments are often not evidence-based. As a result, there is no standardized method of treating onychotillomania, and patients suffering from this disease are susceptible to relapse. This report presents the case of a 32-year-old male experiencing homelessness and suffering from major depressive disorder and methamphetamine use disorder who developed onychotillomania two months after becoming homeless. He regularly used various instruments such as nail cutters, tweezers, and nail files to constantly pick at his nails, a few of which were noted to be bleeding with signs of infection. He was evaluated jointly by dermatology and psychiatry providers who confirmed the diagnosis. By thorough examination of the patient’s history, he was provided tactile sensory equipment to reduce his repetitive picking behavior. A direct referral for substance use counseling was also provided. At follow-up, he was noted to have a subjective improvement in his picking symptoms, although there was no significant difference in the size of his nails. This case represents the twofold challenge of managing a difficult condition, onychotillomania, in the setting of the severe socio-personal stressor of homelessness.
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9
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Chen Y, Pradhan S, Lyu L, Xue S. Clinical and Dermoscopic Characteristics of Onychophagia and Onychotillomania: A Retrospective Study of 63 Cases. Clin Exp Dermatol 2021; 47:961-963. [PMID: 34905226 DOI: 10.1111/ced.15057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/08/2021] [Accepted: 12/09/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Yusha Chen
- Department of Dermatology, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Sushmita Pradhan
- Department of Dermatology, Sichuan University West China Hospital, Chengdu, Sichuan, China.,Department of Dermatology, Province Hospital, Karnali province, Birendranagar Surkhet, Nepal
| | - Ling Lyu
- Department of Dermatology, Aerospace central hospital, Beijing, China
| | - Siliang Xue
- Department of Dermatology, Sichuan University West China Hospital, Chengdu, Sichuan, China
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10
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Shin JO, Roh D, Son JH, Shin K, Kim HS, Ko HC, Kim BS, Kim MB. Onychophagia: detailed clinical characteristics. Int J Dermatol 2021; 61:331-336. [PMID: 34416026 DOI: 10.1111/ijd.15861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/14/2021] [Accepted: 07/30/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Onychophagia is a common disorder affecting 20% to 30% of the general population. It is defined as habitual nail biting and can cause various changes in the nail units. However, to date, there has been a paucity of data focusing on nail deformities related to onychophagia. This study was performed to investigate the clinical characteristics of onychophagia in Korea. METHODS This study included 53 patients with onychophagia who visited the Pusan National University Hospital (Busan and Yangsan) over a 10-year period (2011-2020). We retrospectively reviewed medical records and clinical and dermoscopic photographs. RESULTS All 10 fingernails were affected in 37.7% of the patients. The left thumbnail was the most predominantly affected site (81.1%). Clinical findings showed that short nails with ragged distal borders were the most common presentation (100.0%), followed by generalized or patchy rough areas (50.9%), linear and pinpoint hemorrhage (32.1%), longitudinal melanonychia (30.2%), transverse groove (28.3%), brittleness (28.3%), macrolunula (24.5%), washboard nail (13.2%), and pterygium (3.8%). Of the patients, 88.7% had periungual complications, such as periungual exfoliation (77.4%), absent or ragged cuticle (52.8%), hyponychial hyperkeratosis (37.7%), and paronychia (15.1%). CONCLUSIONS Although onychophagia is a common disorder, its clinical characteristics have not been reported in the literature. The results of this study may be helpful in managing patients with onychophagia.
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Affiliation(s)
- Jun-Oh Shin
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea.,Department of Dermatology, Pusan National University, Yangsan Hospital, Yangsan, Korea
| | - Dongyoung Roh
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea.,Department of Dermatology, Pusan National University, Yangsan Hospital, Yangsan, Korea
| | - Jin-Hwa Son
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea.,Department of Dermatology, Pusan National University, Yangsan Hospital, Yangsan, Korea
| | - Kihyuk Shin
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea.,Department of Dermatology, Pusan National University, Yangsan Hospital, Yangsan, Korea
| | - Hoon-Soo Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
| | - Hyun-Chang Ko
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea.,Department of Dermatology, Pusan National University, Yangsan Hospital, Yangsan, Korea
| | - Byung-Soo Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Moon-Bum Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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11
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Dany M, Fischer AS, Pei S, Rubin AI. Updates on the Pathology and Management of Nail Unit Tumors and Dermatoses. Surg Pathol Clin 2021; 14:327-339. [PMID: 34023109 DOI: 10.1016/j.path.2021.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Nail unit pathology is indispensable to reach an accurate diagnosis of nail tumors as well as inflammatory disorders. This review article provides an update from the most recently published studies on the pathology and management of nail unit tumors and inflammatory disorders. Recent findings of nail clipping histopathology are described first, followed by discussing recent data on the diagnosis and surgical management of several types of nail unit tumors, ending with discussing the recent discoveries in selected nail unit inflammatory disorders.
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Affiliation(s)
- Mohammed Dany
- Department of Dermatology, Hospital of the University of Pennsylvania, University of Pennsylvania, 3600 Spruce Street, 2 Maloney Building, Philadelphia, PA 10104, USA
| | - Andrew S Fischer
- Department of Dermatology, Hospital of the University of Pennsylvania, University of Pennsylvania, 3600 Spruce Street, 2 Maloney Building, Philadelphia, PA 10104, USA
| | - Susan Pei
- Department of Dermatology, Hospital of the University of Pennsylvania, University of Pennsylvania, 3600 Spruce Street, 2 Maloney Building, Philadelphia, PA 10104, USA
| | - Adam I Rubin
- Department of Dermatology, Hospital of the University of Pennsylvania, University of Pennsylvania, 3600 Spruce Street, 2 Maloney Building, Philadelphia, PA 10104, USA; Hospital of the University of Pennsylvania, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, University of Pennsylvania, 3600 Spruce Street, 2 Maloney Building, Philadelphia, PA 10104, USA.
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12
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Abstract
Melanonychia has many causes and can involve one or several fingernails or toenails, and may occur at any age. Dermoscopy is used routinely in the evaluation of a pigmented nail. If pigmentation is caused by melanin produced by nail matrix, identify whether the pigmentation is caused by an activation or proliferation of nail melanocytes. When melanocytic proliferation is suspected, biopsy with histopathologic examination is the gold standard for diagnosis and is recommended when a longitudinal melanonychia occurs in an adult and is localized in a single digit, in the absence of local or systemic causes that may explain its onset.
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Affiliation(s)
- Aurora Alessandrini
- Department of Specialised Experimental and Diagnostic Medicine, Dermatology Alma Mater Studiorum - Università di Bologna, Via Massarenti 1, Bologna 40138, Italy.
| | - Emi Dika
- Department of Specialised Experimental and Diagnostic Medicine, Dermatology Alma Mater Studiorum - Università di Bologna, Via Massarenti 1, Bologna 40138, Italy
| | - Michela Starace
- Department of Specialised Experimental and Diagnostic Medicine, Dermatology Alma Mater Studiorum - Università di Bologna, Via Massarenti 1, Bologna 40138, Italy
| | - Marco Adriano Chessa
- Department of Specialised Experimental and Diagnostic Medicine, Dermatology Alma Mater Studiorum - Università di Bologna, Via Massarenti 1, Bologna 40138, Italy
| | - Bianca Maria Piraccini
- Department of Specialised Experimental and Diagnostic Medicine, Dermatology Alma Mater Studiorum - Università di Bologna, Via Massarenti 1, Bologna 40138, Italy
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13
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Elmas ÖF, Demirbaş A. Utility of dermatoscopy in the diagnosis of Habit-Tic Nail Deformity. J Cosmet Dermatol 2020; 20:703-704. [PMID: 32542900 DOI: 10.1111/jocd.13551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/15/2020] [Accepted: 06/08/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Ömer Faruk Elmas
- Department of Dermatology, Ahi Evran University, Kırşehir, Turkey
| | - Abdullah Demirbaş
- Department of Dermatology, Konya Numune State Hospital, Konya, Turkey
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14
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Wang X, Suo H, Gao Y, Du H, Fu Y, Sha S, Liu Y, Su X, An X, Guo X, Li Y, Tao J. Correlation between the hemoporfin-mediated photodynamic treatment response and the dermoscopy vascular pattern in patients with a port-wine stain: a prospective study. J Eur Acad Dermatol Venereol 2020; 34:2795-2801. [PMID: 32401355 DOI: 10.1111/jdv.16596] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/20/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Vascular targeted photodynamic therapy (PDT) is a novel and promising therapy for the treatment of port-wine stains (PWS). There has been little prior exploration to our knowledge of how the dermatological vascular pattern may predict the response to PDT. OBJECTIVES To analyse whether the vascular pattern classifications of PWS by dermoscopy can predict the efficacy of PDT. METHODS This prospective cohort study included 163 patients with a clinical diagnosis of PWS who were treated twice with hemoporfin-mediated photodynamic therapy (HMME-PDT) at two-month intervals and followed up for 6 months. The vascular manifestations of dermoscopy with PWS were independently classified into 8 categories by 3 dermatologists. Images of the lesions were taken using VISIA, and the vascular patterns were imaged by dermoscopy by the same investigator. Images were captured before and after each treatment. The efficacy was evaluated with pre- and post-treatment VISIA images, and correlations between efficacy and vascular patterns were analysed by four dermatologists in a blinded and independent manner, between 10 January 2019 and 11 December 2019. RESULTS In the dermoscopy images for the whole cohort, dotted and globular vessels (15.3%), short clubbed vessels (18.4%) and curved vessels (12.9%) were highly associated with cure and beneficial treatment effects. Pale halos surrounding brown dots (8.0%) and arborizing vessels (9.8%) were mainly correlated with skin lesion alleviation. Mixed vessels (12.9%), a grey-whitish veil (11.7%) and reticular patterns (11.0%) were mainly associated with no effect. The differences between each subgroup were statistically significant (P = 0.000). CONCLUSIONS There is a clear correlation between the efficacy of PDT and the dermoscopy pattern in patients with PWS. Dermoscopy may therefore provide very useful clinical information prior to treatment in these cases. In addition, the vascular manifestations of PWS determined by dermoscopy help to predict response to PDT and manage patient expectations.
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Affiliation(s)
- X Wang
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China.,Hubei Engineering Research Center for Skin Repair and Theranostics, Wuhan, China
| | - H Suo
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China.,Hubei Engineering Research Center for Skin Repair and Theranostics, Wuhan, China
| | - Y Gao
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China.,Hubei Engineering Research Center for Skin Repair and Theranostics, Wuhan, China
| | - H Du
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China.,Hubei Engineering Research Center for Skin Repair and Theranostics, Wuhan, China
| | - Y Fu
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China.,Hubei Engineering Research Center for Skin Repair and Theranostics, Wuhan, China
| | - S Sha
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China.,Hubei Engineering Research Center for Skin Repair and Theranostics, Wuhan, China
| | - Y Liu
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China.,Hubei Engineering Research Center for Skin Repair and Theranostics, Wuhan, China
| | - X Su
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China.,Hubei Engineering Research Center for Skin Repair and Theranostics, Wuhan, China
| | - X An
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China.,Hubei Engineering Research Center for Skin Repair and Theranostics, Wuhan, China
| | - X Guo
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China.,Hubei Engineering Research Center for Skin Repair and Theranostics, Wuhan, China
| | - Y Li
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China.,Hubei Engineering Research Center for Skin Repair and Theranostics, Wuhan, China
| | - J Tao
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China.,Hubei Engineering Research Center for Skin Repair and Theranostics, Wuhan, China
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15
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Dika E, Starace M, Lambertini M, Patrizi A, Veronesi G, Alessandrini A, Piraccini BM. Oral and nail pigmentations: a useful parallelism for the clinician. J Dtsch Dermatol Ges 2020; 18:7-14. [PMID: 31951106 DOI: 10.1111/ddg.14023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/21/2019] [Indexed: 12/20/2022]
Abstract
Oral (OP) and nail (NP) pigmentations may occur simultaneously in physiological or pathological conditions, and may be a sign of underlying syndromic conditions that necessitate further investigation and treatment. Interestingly, the nail unit and oral cavity show a clinical parallelism that may help the clinician to conduct a correct examination and reach a prompt diagnosis. Both OP and NP can manifest clinically with focal or diffuse involvement and are due to external factors (exogenous pigmentation, drug-induced pigmentation) or endogenous factors (racial pigmentation, post-inflammatory pigmentation, nevi, genetic conditions and other disorders). The most concerning differential diagnosis is melanoma. Here we report the pathogenetic basis of OP and NP, together with the description of similar clinical features. To the best of our knowledge this is the first paper to summarize and describe the causes of pigmentation of both the oral cavity and the nail unit.
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Affiliation(s)
- Emi Dika
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Michela Starace
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Martina Lambertini
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Giulia Veronesi
- 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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Dika E, Starace M, Lambertini M, Patrizi A, Veronesi G, Alessandrini A, Piraccini BM. Orale und Nagelpigmentierungen: eine für den Kliniker nützliche Parallelität. J Dtsch Dermatol Ges 2020; 18:7-16. [DOI: 10.1111/ddg.14023_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/21/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Emi Dika
- DermatologyDepartment of ExperimentalDiagnostic and Specialty MedicineUniversity of Bologna Bologna Italy
| | - Michela Starace
- DermatologyDepartment of ExperimentalDiagnostic and Specialty MedicineUniversity of Bologna Bologna Italy
| | - Martina Lambertini
- DermatologyDepartment of ExperimentalDiagnostic and Specialty MedicineUniversity of Bologna Bologna Italy
| | - Annalisa Patrizi
- DermatologyDepartment of ExperimentalDiagnostic and Specialty MedicineUniversity of Bologna Bologna Italy
| | - Giulia Veronesi
- DermatologyDepartment of ExperimentalDiagnostic and Specialty MedicineUniversity of Bologna Bologna Italy
| | - Aurora Alessandrini
- DermatologyDepartment of ExperimentalDiagnostic and Specialty MedicineUniversity of Bologna Bologna Italy
| | - Bianca Maria Piraccini
- DermatologyDepartment of ExperimentalDiagnostic and Specialty MedicineUniversity of Bologna Bologna Italy
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18
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Abstract
Various advancements in the diagnosis and management of nail diseases have transpired in recent years. To provide the best care for patients with nail complaints, it is essential that physicians be updated on new diagnostic and treatment modalities. The purpose of this article is to discuss new and oncoming diagnostic and management options for nail disorders, including nail psoriasis, retronychia, brittle nails, onychotillomania, trauma, trachyonychia, and pyogenic granulomas.
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Braun TL, Patel V, DeBord LC, Rosen T. A review of N-acetylcysteine in the treatment of grooming disorders. Int J Dermatol 2019; 58:502-510. [PMID: 30667049 DOI: 10.1111/ijd.14371] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 11/24/2018] [Accepted: 12/05/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pathologic grooming disorders can lead to clinically significant distress and functional impairment. Studies on treatment of these disorders with selective serotonin reuptake inhibitors (SSRIs) and anticonvulsants have led to inconsistent findings. N-acetylcysteine (NAC) has shown promise in treatment of obsessive-compulsive and related disorders. The objective of this article is to perform an updated review of NAC in the treatment of grooming disorders. METHODS PubMed was searched from inception to October 2017 to identify literature on the use of NAC in the management of trichotillomania, onychophagia, and pathological skin picking. Case reports, case series, and randomized controlled trials were included. Data on study design, dosing regimens, comorbidities, concurrent treatment, and side effects were extracted from the included articles. RESULTS Fifteen articles were included in this review, which consisted of 10 case reports, one case series, and four randomized controlled trials. Dosing of oral NAC ranged from 450 to 2,400 mg per day, and treatment periods lasted from 1 to 8 months. Side effects were uncommon, mild, and usually gastrointestinal in nature, with severe aggression reported in one child. CONCLUSIONS While there are multiple reports of the safety and efficacy of NAC in the treatment of grooming disorders, there are currently few randomized controlled trials on this topic, and more research is needed to develop a formal treatment algorithm. While current data should be considered very preliminary, case reports have demonstrated mostly positive results and a lack of significant side effects. A trial of NAC may be a viable option for pathologic grooming disorders, especially in patients who have failed prior psychologic or pharmacologic treatment.
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Affiliation(s)
- Tara L Braun
- Department of Dermatology, Baylor College of Medicine, Houston, TX, USA
| | - Viraat Patel
- Department of Dermatology, Baylor College of Medicine, Houston, TX, USA
| | - Logan C DeBord
- Department of Dermatology, Baylor College of Medicine, Houston, TX, USA
| | - Theodore Rosen
- Department of Dermatology, Baylor College of Medicine, Houston, TX, USA
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Sidiropoulou P, Sgouros D, Theodoropoulos K, Katoulis A, Rigopoulos D. Onychotillomania: A Chameleon-Like Disorder: Case Report and Review of Literature. Skin Appendage Disord 2018; 5:104-107. [PMID: 30815444 DOI: 10.1159/000489941] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/08/2018] [Indexed: 11/19/2022] Open
Abstract
Onychotillomania, or nail-picking disorder, is an uncommon and misdiagnosed behavioral pattern focused on the nail apparatus. It is demarcated by the compulsive or irresistible urge in patients to constantly injure their own nails, with the fingers or tools, inflicting noticeable or even irreversible self-destruction of the nail unit. Despite its rarity, this self-injurious coercion often poses a diagnostic and therapeutic challenge. Not only do many patients deny nail manipulation, but also the disorder has long been recognized to present itself with a wide range of clinical features, which hampers early and indisputable diagnosis. Furthermore, onychotillomania constitutes a persistent and hardly manageable problem, mostly because of its psychocutaneous nature as well as its high propensity to coexist with underlying neuropsychiatric illnesses or other behavioral disorders. However, the medical literature concerning obsessive nail picking still remains relatively scarce. Herein, we present an extraordinary, yet very intriguing case of a Caucasian patient with onychotillomania and onychophagia coexistence masquerading a weird inflammation-like lesion.
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Affiliation(s)
- Polytimi Sidiropoulou
- 1st Department of Dermatology-Venereology, National Kapodistrian University of Athens, Medical School, "A. Sygros" Hospital, Athens, Greece
| | - Dimitrios Sgouros
- 1st Department of Dermatology-Venereology, National Kapodistrian University of Athens, Medical School, "A. Sygros" Hospital, Athens, Greece
| | - Konstantinos Theodoropoulos
- 2nd Department of Dermatology-Venereology, National Kapodistrian University of Athens, Medical School, ATTIKON University Hospital, Athens, Greece
| | - Alexander Katoulis
- 2nd Department of Dermatology-Venereology, National Kapodistrian University of Athens, Medical School, ATTIKON University Hospital, Athens, Greece
| | - Dimitrios Rigopoulos
- 1st Department of Dermatology-Venereology, National Kapodistrian University of Athens, Medical School, "A. Sygros" Hospital, Athens, Greece
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