1/14. Global nail dystrophy associated with human papillomavirus type 57 infection.Verrucae vulgares frequently induce nail dystrophy when infection of the nail matrix occurs. Classic periungual warts are easily recognized by the experienced physician. We report a very unusual presentation of human papillomavirus (HPV) infection of the nail matrix and nail bed involving all 20 nails in an otherwise immunocompetent patient. Viral typing by in situ hybridization revealed HPV type 57. To our knowledge, this is the first association between dystrophy of all 20 nails and HPV infection. However, as the ease of HPV typing improves, a variety of previously unrecognized cutaneous lesions is likely to be associated with HPV infection.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/14. The ABC rule for clinical detection of subungual melanoma.BACKGROUND: Subungual melanoma is a relatively rare disease with reported incidence between 0.7% to 3.5% of all melanoma cases in the general population. Unlike the significant improvement in the diagnosis of cutaneous melanoma, the diagnosis of subungual melanoma has shown little, if any, improvement over the years. The widespread adoption of the ABCDs of cutaneous melanoma has helped increase public and physician awareness, and thus helped increase the early detection of cutaneous melanoma; the same criteria cannot be applied to the examination of the nail pigmentation. OBJECTIVE: We reviewed the world literature on subungual melanoma and arranged the available information into a system for the identification of subungual melanoma. This system has to be thorough, easy to remember, and easy to apply by both physician and lay public. A case to illustrate the delayed diagnosis often encountered in the current evaluation of nail melanoma is presented. methods: A thorough review of the world literature on subungual melanoma was undertaken. The important findings of various studies and case reports were compared among themselves and the salient features were summarized. The information was then categorized under the easily recalled letters of the alphabet, ABCD, that have already become associated with melanoma. RESULTS: The most salient features of subungual melanoma can be summarized according to the newly devised criteria that may be categorized under the first letters of the alphabet, namely ABCDEF of subungual melanoma. In this system A stands for a ge (peak incidence being in the 5th to 7th decades of life and african americans, Asians, and native Americans in whom subungual melanoma accounts for up to one third of all melanoma cases. B stands for brown to black b and with breadth of 3 mm or more and variegated borders. C stands for change in the nail band or lack of change in the nail morphology despite, presumably, adequate treatment. D stands for the digit most commonly involved; E stands for extension of the pigment onto the proximal and/or lateral nailfold (ie, Hutchinson's sign); and F stands for family or personal history of dysplastic nevus or melanoma. CONCLUSION: Although each letter of the alphabet of subungual melanoma is important, one must use all the letters together to improve early detection and thus survival of subungual melanoma. Still, as with cutaneous melanoma, the absolute diagnosis of subungual melanoma is made by means of a biopsy.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
3/14. Oral ivermectin treatment in two cases of scabies: effective in crusted scabies induced by corticosteroid but ineffective in nail scabies.We report two cases of scabies treated with oral ivermectin (200 micro g/kg). Case 1, a 72-year-old man, developed crusted scabies with the use of oral corticosteroids due to a misdiagnosis by an earlier physician. The patient was successfully treated with two doses of oral ivermectin at a 7 day interval with concomitant topical use of crotamiton and keratolytic agents. However, the nail scabies in this patient failed to respond to these treatments. Live mites were detected from all his toenails two weeks after the second dose of ivermectin. A complete cure of the nail scabies was achieved by occlusive dressing of 1% gamma-BHC on all toenails for one month. Case 2, a 52-year-old woman, had been treated with oral corticosteroid for mesangial nephritis. She developed common scabies, but a topical scabicide, crotamiton, was not effective. Two weeks after treatment with a single dose of oral ivermectin, eggs were still detected from a burrow on her trunk. Her treatment was completed after a further two doses of oral ivermectin were administered at 7 day intervals. In both patients, the administration of oral ivermectin did not induce any clinical or laboratory side effects. Oral ivermectin is effective for crusted scabies, but not effective for nail scabies. Two doses of oral ivermectin, administered with a one-week interval, is an appropriate treatment regimen.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/14. A non-healing ulcerated fingertip following injury.A man went to his primary care physician 3 months after slamming his right thumb in a car door. The nail had turned black and sloughed off several weeks later, leaving a red, draining wound on the tip of his thumb. The wound drained continuously for the next 2 months and showed little progress in healing. His physician started him on antibiotics, but the wound still showed no progress in healing over the next 6 weeks. Cultures were obtained that grew out staphylococcus and streptococcus spp. Another course of antibiotics was given, but the patient's condition failed to improve. At this point the patient was referred to a surgeon. He missed several appointments before finally presenting to the surgery clinic nearly 6 months after his original office visit. He was diagnosed clinically as having a giant pyogenic granuloma and was given antibiotics as well as silver nitrate sticks to cauterize the wound daily. After missing several more follow-up appointments, the patient returned with a spongy, weeping soft-tissue wound over the dorsum of his right thumb [that] doubled in size over the past 3 months. Radiographs obtained at that time were normal, but a bone scan revealed late uptake, cause for concern that this was osteomyelitis. What is the differential diagnosis, and what tests are necessary?- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
5/14. The spectrum of malignant melanoma of the nail apparatus.Unlike most morphological types of malignant melanoma, that of the nail apparatus is relatively rare--only 2% to 3% of one series. Although in the case of blacks and orientals, the incidence of malignant melanoma of the nail apparatus is proportionately more common. However, it is a serious disease with poor 5-year survival figures in the published series--21% to 50%. This poor prognosis may be an intrinsic function of the site and of other parts of the body, but the lateness of diagnosis in many of the published cases is of far more significance. In malignant melanoma at other body sites, late diagnosis usually relates to the patient not presenting early in the course of the disease; this may also apply to nail malignant melanoma. However, the frequency of failure of the first line physician or surgeon to recognize the clinical signs or to perform a biopsy from the correct site to obtain an accurate diagnosis is far more important.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/14. Pigmented nail streak associated with bowen's disease of the nail matrix.We described a 59-year-old male physician with bowen's disease occurring on the nail matrix of his right 5th finger. The rapid growth of the pigmented nail streak accompanied by nail deformity led us to consider the possibility of subungual melanoma clinically. Histologic features, however, were compatible with those of bowen's disease accompanied by melanocytes with melanin-rich long dendrites in the nail matrix. We speculate that his occupational exposure to x-rays for 25 years played an important role in the pathomechanism of the present case.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/14. tetracycline photo-onycholysis.Photo-onycholysis is a rare complication of tetracycline therapy. Its occurrence is probably greater than the few reported cases indicate. It is hoped that this case report will alert physicians to its occurrence.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/14. pseudomonas infections associated with hot tubs and other environments.Infections due to pseudomonas aeruginosa are not confined to the hospital intensive care unit. This paper examines the association of P. aeruginosa and several community-acquired infections. Hot tub folliculitis is a recently described disorder occurring in outbreaks among persons who unknowingly immerse themselves in contaminated whirlpools, spas, or swimming pools. The green nail syndrome and other dermatoses are also reviewed. Infective endocarditis, invasive external otitis, and puncture would osteomyelitis are serious infections that carry high risks for the patient and challenge the physician's most potent therapies.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/14. Nail, skin, and scleral pigmentation induced by minocycline.minocycline-induced cutaneous and nail bed discoloration, although uncommon, should be closely watched for during treatment. The initial changes may be subtle and may mimic other processes that may deceive both patient and physician. patients should be counseled about the remote possibility of pigmentation with the understanding that any such changes should resolve upon discontinuation of the drug. The time required for resolution depends upon the degree of pigmentation and may take longer than a year in extensive cases.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/14. Subungual malignant melanoma.An early accurate diagnosis of subungual melanoma depends upon an alert podiatric physician. Clinically, the lesion is often easily misdiagnosed and mistreated because of its resemblance to benign nail conditions. This paper discusses the incidence, histology, clinical findings, diagnosis, and treatment of this malignant lesion. An illustrative case report is presented.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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