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Nakamura T, Yamauchi M, Sonoda S, Aharen D, Ikemura M, Kohagura K, Kusunose K. Green Nails, Red Alert: An Unusual Exit site infection Presentation. Perit Dial Int 2024:8968608241234529. [PMID: 38445494 DOI: 10.1177/08968608241234529] [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: 03/07/2024] Open
Abstract
Green nail syndrome is an infectious nail disorder caused most commonly by Pseudomonas aeruginosa. We report a rare case of peritoneal dialysis (PD) exit site infection (ESI) accompanied by P. aeruginosa-associated green nail syndrome. The patient was treated with oral and topical antibiotics without the need for PD catheter removal. We aim to emphasise the importance of nail assessment for ESI in patients undergoing PD.
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Affiliation(s)
- Takuto Nakamura
- Department of Internal Medicine, Nishizaki Hospital, Okinawa, Japan
| | - Marino Yamauchi
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Shinichiro Sonoda
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Daigo Aharen
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Masaki Ikemura
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kentaro Kohagura
- Department of Nephrology, Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan
| | - Kenya Kusunose
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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Forouzan P, Cohen PR. Fungal Viridionychia: Onychomycosis-Induced Chloronychia Caused by Candida parapsilosis-Associated Green Nail Discoloration. Cureus 2021; 13:e20335. [PMID: 35036181 PMCID: PMC8752341 DOI: 10.7759/cureus.20335] [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: 12/10/2021] [Indexed: 11/05/2022] Open
Abstract
Green nail syndrome is a form of chromonychia, discoloration of the nail plate, that describes fingernails or toenails that are green in appearance. Bacterial-associated green nail syndrome, referred to as chloronychia, is most common; however, fungal and polymicrobial etiologies have been reported. Two 70-year-old women presented with green discoloration of their nails for over five months; both women had prior unsuccessful treatments and were referred for further evaluation and treatment. The affected nails were biopsied and cultured. Bacterial cultures did not yield any organisms; however, fungal cultures grew Candida parapsilosis after four weeks. Both women were treated with a topical alcohol-based solution and ketoconazole cream with improvement in their nail discoloration after two months. We introduce a term that specifically describes fungal etiology-associated green nail syndrome: viridionychia.
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Bakos RM, Leite LL, Reinehr C, Escobar GF. Dermoscopy of skin infestations and infections (entomodermoscopy) - Part II: viral, fungal and other infections. An Bras Dermatol 2021; 96:746-758. [PMID: 34620527 PMCID: PMC8790190 DOI: 10.1016/j.abd.2021.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/31/2021] [Accepted: 04/17/2021] [Indexed: 02/03/2023] Open
Abstract
In addition to the infestations and bacterial infections reported in part I, the study of entomodermoscopy also involves descriptions of dermoscopic findings of a growing number of viral and fungal infections, among others. In this article, the main clinical situations in viral infections where dermoscopy can be useful will be described, that is in the evaluation of viral warts, molluscum contagiosum, and even in recent scenarios such as the COVID-19 pandemic. As for fungal infections, dermoscopy is particularly important, not only in the evaluation of the skin surface, but also of skin annexes, such as hairs and nails. The differential diagnosis with skin tumors, especially melanomas, can be facilitated by dermoscopy, especially in the evaluation of cases of verruca plantaris, onychomycosis and tinea nigra.
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Affiliation(s)
| | - Leandro Linhares Leite
- Dermatology Service, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Clarissa Reinehr
- Postgraduation in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Lee H, Mun JH, Cho S, Park H. Clinical analysis of Pseudomonas aeruginosa-positive and -negative green nail syndrome cases: A single center retrospective analysis. J Dermatol 2021; 48:1073-1076. [PMID: 33890306 DOI: 10.1111/1346-8138.15832] [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: 12/22/2020] [Revised: 02/09/2021] [Accepted: 02/12/2021] [Indexed: 11/29/2022]
Abstract
Green nail syndrome (GNS) is a paronychial infection mainly due to Pseudomonas aeruginosa, characterized by green discoloration of the nail plate. Although the diagnosis of GNS may be straightforward with its distinctive color change, the clinical management of the disease can be sometimes confusing, especially when the bacterial culture result is inconsistent. There is, however, a paucity of comprehensive reviews regarding the treatment of GNS in the actual clinical setting. In this retrospective review of 34 patients, we found that GNS mostly occurs on a single digit (79.4%) on the big toe or thumb (85.3%) with frequent concurrent fungal infection (67.6%). The prevalence of inconsistent bacterial culture result with no evidence of P. aeruginosa was unexpectedly high (n = 22, 64.7%), in which case coagulase-negative staphylococci were most frequently detected. The P. aeruginosa-negative group did not demonstrate any statistically significant differences compared with the P. aeruginosa-positive group, and it still responded well to the typical topical and/or oral fluoroquinolone treatment. GNS without the evidence of P. aeruginosa may be a more common occurrence than reported in the literature, and it can be managed successfully with the same strategy employed to treat P. aeruginosa-positive cases. It may result from the low detection rate of P. aeruginosa due to the limited sensitivity of the test, or inadequate amount and/or contamination of the sample, warranting close scrutiny by clinicians.
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Affiliation(s)
- Hanjae Lee
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Je-Ho Mun
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Soyun Cho
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Hyunsun Park
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
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Ohn J, Hur K, Park H, Cho S, Mun JH. Dermoscopic patterns of green nail syndrome. J Eur Acad Dermatol Venereol 2021; 35:e464-e466. [PMID: 33724580 DOI: 10.1111/jdv.17224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/09/2021] [Accepted: 03/10/2021] [Indexed: 01/01/2023]
Affiliation(s)
- J Ohn
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Human-Environment Interface Biology, Seoul National University, Seoul, Korea
| | - K Hur
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Human-Environment Interface Biology, Seoul National University, Seoul, Korea
| | - H Park
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Human-Environment Interface Biology, Seoul National University, Seoul, Korea.,Department of Dermatology, Seoul Metropolitan Government - Seoul National University Borame Medical Center, Seoul, Korea
| | - S Cho
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Human-Environment Interface Biology, Seoul National University, Seoul, Korea.,Department of Dermatology, Seoul Metropolitan Government - Seoul National University Borame Medical Center, Seoul, Korea
| | - J-H Mun
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Human-Environment Interface Biology, Seoul National University, Seoul, Korea
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Schwartz RA, Kapila R. The Goldman-Fox syndrome: Treating and preventing green pseudomonas nails in the era of COVID-19. Dermatol Ther 2020; 34:e14624. [PMID: 33274584 PMCID: PMC7744894 DOI: 10.1111/dth.14624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 11/28/2020] [Accepted: 11/30/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Robert A Schwartz
- Dermatology, Infectious Diseases, and Pathology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Rajendra Kapila
- Dermatology, Infectious Diseases, and Pathology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Retrospective Case Series on Risk Factors, Diagnosis and Treatment of Pseudomonas aeruginosa Nail Infections. Am J Clin Dermatol 2020; 21:297-302. [PMID: 31595433 DOI: 10.1007/s40257-019-00476-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Pseudomonas aeruginosa is the most common pathogen causing bacterial nail infections, producing a classic blue-green pigment, known as chloronychia. Clinical examination and dermoscopic findings, as well as diagnosis and treatment, have not been well characterized. OBJECTIVE The aim was to characterize the clinical and dermoscopic findings of P. aeruginosa infection of the nails and assess treatment efficacy. METHODS This is a retrospective study of patients with P. aeruginosa nail infection diagnosed between January 27, 2017 and May 28, 2019. Demographics, history, clinical and dermoscopic findings, diagnostics tests, and treatment were documented and analyzed. RESULTS Twenty-six patients with P. aeruginosa nail infections were analyzed, with 21 patients completing treatment, two lost to follow-up, and three still undergoing treatment. Clinical examination findings were notable for onycholysis in 76.9% of patients. Green discoloration was seen in 38.5% of patients and green-brown discoloration in 30.8%. A majority of the patients had only one nail involved (73.1%). Dermoscopic findings were significant for greenish pigmentation in 37.5% of patients and 88.9% of cases presenting with a fading border. Wound cultures of nail plates were more sensitive (40%) than dermatopathology (16.7%), but the difference was not statistically significant (p value = 0.1596). All patients were treated with ophthalmic 0.3% gentamicin topical solution nightly for a 3-month period and those who completed therapy had complete resolution of their infection. LIMITATIONS The limitations of the study were the retrospective design and the small cohort size. CONCLUSION Clinical examination findings of onycholysis coupled with a green or green-brown discoloration involving one or more digits and dermoscopic findings of greenish discoloration with a fading border are consistent with a diagnosis of Pseudomonas nail infection. Gentamicin topical solution is an effective, inexpensive, easy-to-use treatment for this condition. Larger randomized clinical trials are necessary to compare efficacy with other therapeutic options.
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Green nail syndrome: Analysis of the association with onychomycosis. J Am Acad Dermatol 2020; 83:940-942. [PMID: 32004651 DOI: 10.1016/j.jaad.2020.01.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 01/10/2020] [Accepted: 01/18/2020] [Indexed: 11/24/2022]
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Jayasree P, Ashique KT, Kaliyadan F. Numbered dots technique to standardise onychoscopy imaging. Australas J Dermatol 2020; 61:259-260. [PMID: 31970747 DOI: 10.1111/ajd.13242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 12/27/2019] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Feroze Kaliyadan
- Faculty of Dermatology, College of medicine, King Faisal University, Al Ahsa, Saudi Arabia
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Schwartz RA, Reynoso-Vasquez N, Kapila R. Chloronychia: The Goldman-Fox Syndrome - Implications for Patients and Healthcare Workers. Indian J Dermatol 2020; 65:1-4. [PMID: 32029931 PMCID: PMC6986112 DOI: 10.4103/ijd.ijd_277_19] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Nail coloration has many causes and may reflect systemic disease. White nails (leukonychia) are common; rubronychia is rare, whereas green (chloronychia) is occasionally evident. Chloronychia, the Fox-Goldman syndrome, is caused by infection of an often damaged nail plate by Pseudomonas aeruginosa. P. aeruginosa is an opportunistic pathogen known for localized and systemic infections. It can spread cryptically in a variety of ways, whether from an infected nail to a wound either autologously or to a patient as a surgical site infection, and many represent a threat to elderly, neonatal, or immunocompromised patients who are at increased risk of disseminated pseudomonas infection. We will review the Goldman-Fox syndrome as an occupational disorder of homemakers, nurses, plumbers, and others often with wet hands. At a time when hand washing is being stressed, especially in healthcare settings, examination of nails should be emphasized too, recalling the possibility of surgical site infection even with a properly washed and gloved medical care provider. Pseudomonas may be a community-acquired infection or a hospital or medical care setting-acquired one, a difference with therapeutic implications. Since healthcare workers represent a threat of nosocomial infections, possible guidelines are suggested.
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Affiliation(s)
- Robert A Schwartz
- Department of Dermatology, Infectious Diseases, and Pathology, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Nicole Reynoso-Vasquez
- Department of Dermatology, Infectious Diseases, and Pathology, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Rajendra Kapila
- Department of Dermatology, Infectious Diseases, and Pathology, Rutgers New Jersey Medical School, Newark, New Jersey
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Piccolo V. Update on Dermoscopy and Infectious Skin Diseases. Dermatol Pract Concept 2019; 10:e2020003. [PMID: 31921490 DOI: 10.5826/dpc.1001a03] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2019] [Indexed: 12/29/2022] Open
Abstract
Nowadays, dermoscopy is a global worldwide diffuse diagnostic tool supporting clinicians in their daily hard task of correct orientation among dermatological diseases. Born to be an instrument for early diagnosis of skin cancer, the dermatoscope is now considered the dermatologist's stethoscope, as it can be routinely used to support diagnosis in general dermatology, so spreading its utility in cutaneous inflammatory and infectious diseases, as adjuvant and not substitute to histology and potassium hydroxide examination. As concerns the latter, plenty of papers have been published since the first description of dermoscopic findings of scabies. The aim of this review is to give the clinician a practical approach to dermoscopic parameters of cutaneous infectious diseases with a focus on the latest updates in this topic.
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Affiliation(s)
- Vincenzo Piccolo
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
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