Nail disorders

Nail and skin disorders of the foot

Disorders of the dermis and the nails on the feet are common. Despite the simplicity of the skin and nail disorders of the foot, they can be debilitating and impact the patient's ability to ambulate and perform activities of daily living. Diagnosis in most cases is confirmed on physical examination alone. Diligent care of skin and nail disorders can prevent further pathology involving the deeper structures of the foot and allow the patient to fully participate in their usual activities.

Psoriatic nail disease: quality of life and treatment

Nail psoriasis is common among patients with plaque psoriasis or psoriatic arthritis and has a detrimental effect on quality of life. However, there are currently no standardized therapeutic regimens for nail psoriasis. Traditional treatments for nail psoriasis, which include topical, intralesional, and oral therapies, may be time-consuming, painful, or unsafe when administered long term. Biologic therapies have demonstrated efficacy for plaque psoriasis and psoriatic arthritis; these therapies may be particularly promising for the treatment of nail psoriasis as both groups of patients have an elevated incidence of nail dystrophy. The biologic therapies adalimumab, alefacept, efalizumab, etanercept, and infliximab have demonstrated clinically important nail psoriasis improvements using the Nail Psoriasis Severity Index, a helpful tool that, upon validation, will allow comparison across treatments and trials. Large-scale, long-term trials using standardized outcome measures are needed to further evaluate biologic therapies for the treatment of nail psoriasis.

Nail changes in chronic renal failure patients under haemodialysis

BACKGROUND

Chronic renal failure is known to cause various nail pathologies. They may be directly related to the renal condition itself or its complications or to the therapy.

OBJECTIVE

To compare nail changes in end-stage renal failure patients under haemodialysis with healthy persons and to study the potential relationship with various parameters in the patients.

PATIENTS AND METHODS

The study comprised 100 patients with chronic renal failure under regular haemodialysis as well as 100 healthy control subjects of matched age and sex. Both groups were subjected to full history taking and thorough general and nail examination. Complete blood picture, liver and kidney function tests and fasting blood glucose level were investigated.

RESULTS

Nail disorders were more prevalent in patients (76%) than in control group (30%). The half and half nail was the most common finding (20%) followed by - in descending manner - absent lunula, onycholysis, brittle nail, Beau's lines, clubbing, longitudinal ridging, onychomycosis, subungual hyperkeratosis, koilonychias, total leukonychia, splinter hemorrhage, pitting and pincer nail deformity. There was non-significant correlation between nail changes and age of the patients or duration of haemodialysis. In addition, no evidence of significant relation was found between nail changes and both haemoglobin and albumin levels.

CONCLUSION

Frequent nail changes are observed on systematic nail examination of uraemic patients undergoing haemodialysis; however, the cause of them remains obscure and could not be traced to a particular abnormality in the renal condition, medication or the procedure itself and it needs further investigations.

Finger sucking and onycholysis in an infant

A case of onycholysis in a 6-month-old male infant secondary to chronic finger sucking is reported. He was allowed to suck on his fingers without intervention. The onycholysis resolved after cessation of finger sucking habits when the child was a toddler.