Aurora Alessandrini

Drug-related nail disease

Drug-induced nail abnormalities can present with a wide variety of clinical manifestations that are often dose-related and that disappear after drug withdrawal. Some nail changes are asymptomatic and only cause cosmetic problems, whereas others cause pain and discomfort and impair manual activities or deambulation. New side effects have been recently observed with different groups of anticancer agents. These include painful onycholysis and subungual abscesses caused by taxanes and anthracyclines (eg, doxorubicin) in addition to ingrown nails, paronychia, and pyogenic granuloma associated with the use of tyrosine kinase inhibitors of the epidermal growth factor receptor (eg, erlotinib, gefitinib).

Onychomycosis: A Review

Onychomycosis is the most common nail infective disorder. It is caused mainly by anthropophilic dermatophytes, in particular by Trichophyton rubrum and T. mentagrophytes var. interdigitale. Yeasts, like Candida albicans and C. parapsilosis, and molds, like Aspergillus spp., represent the second cause of onychomycosis. The clinical suspect of onychomycosis should be confirmed my mycology. Onychoscopy is a new method that can help the physician, as in onychomycosis, it shows a typical fringed proximal margin. Treatment is chosen depending on the modality of nail invasion, fungus species and the number of affected nails. Oral treatments are often limited by drug interactions, while topical antifungal lacquers have less efficacy. A combination of both oral and systemic treatment is often the best choice.

Erosive pustular dermatosis of the scalp: Clinical, trichoscopic, and histopathologic features of 20 cases

Background Erosive pustular dermatosis of the scalp is a chronic eruption that leads to scarring alopecia. Objective The clinical, dermoscopic, and histopathological features and the course of the disease in 20 patients were reviewed and compared with the reports in the literature. Methods Gender, age at diagnosis, age at onset, duration, topography, predisposing factors, concomitant diseases, trichoscopy, histology, treatment, and outcome were taken into consideration. Results The mean age was 59.4 years. Androgenetic alopecia was present in 12 patients, 6 of whom showed actinic damage. Trauma was reported in 9 patients. Four patients were affected by autoimmune disorders. The vertex was the most common location. In all 20 patients trichoscopy showed an absence of follicular ostia with skin atrophy. Histopathology revealed 3 different features, depending on the disease duration. A reduction of inflammatory signs was observed in 14 patients treated with topical steroids and in all 3 patients treated with topical tacrolimus 0.1%. Limitations The rarity of this disease is a limitation. Conclusions The relatively high number of patients allowed us to identify a better diagnostic approach, using trichoscopy, and a more effective therapeutic strategy, with high‐potency steroids or tacrolimus, which should be considered as first‐line treatment.

Topical propranolol 1% cream for pyogenic granulomas of the nail: open-label study in 10 patients.

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Dermoscopy in the Evaluation of Nail Disorders

Nail dermoscopy was initially used only in the assessment of nail pigmentation, but now it is widely utilized for the evaluation of many nail disorders. In daily practice, dermoscopy may confirm clinical diagnoses and guides in the management of nail diseases and treatments, permitting a better visualization of symptoms. Dry dermoscopy is required for evaluation of the nail plate surface, while gel as an interface is necessary for assessment of nail pigmentation and onycholysis, as well as for the evaluation of the distal nail margin. In this review, we describe the dermoscopic features of the most important nail disorders, looking at the different areas of the nail. Dermatoscopic changes that usually accompany specific nail diseases are also reviewed.

Interdigital Psoriasis of the Feet (Psoriasis Alba): Not a Distinct Form of Psoriasis

Background: Interdigital psoriasis (IP) of the feet is often missed and is commonly mistaken for interdigital fungal infection. Objective: To assess the characteristics and the clinical presentation of IP, in order to better understand if IP should be considered a distinct form of psoriasis or not. Methods: We performed a 1-year observational study on 164 psoriatic patients, affected by moderate to severe cutaneous psoriasis and undergoing systemic therapy, examining each patient between the digits of both feet. In every suspected case of IP, differential diagnosis with interdigital fungal infection was excluded by direct microscopic examination of skin scrapings, by culture and by skin biopsy. Results: We suspected IP in 7 of the 164 patients. IP was confirmed in 6 patients and in the other one a diagnosis of tinea pedis was made. Conclusion: IP proved to be not rare or atypical since IP localized between the toes usually presents as characteristic whitish and sodden plaques or patches. Such a diagnosis should be considered in all patients presenting characteristic lesions especially if these have a negative fungal culture, are resistant to antimycotic treatment and involve patients with a history of psoriasis.

Nail apparatus melanoma: dermoscopic and histopathologic correlations on a series of 23 patients from a single centre

Nail apparatus melanoma (NAM) is an uncommon tumour, and there are few studies focused on its dermoscopic features.

Acute periungueal dermatitis induced by application of urea-containing cream under occlusion.

BACKGROUND Urea containing topical products are extensively marked for treatment of nail diseases. Side effects are rare and mainly include irritation of the periungual skin, when topicals with high urea concentration are applied too widely on the digit, or covered by tape. MAIN OBSERVATION We report a case of a 84-year-old man with an erosive-bullous eruption of the 1st and the 2nd left toes due to application of an urea-containing cream, that he had regularly applied every night covering the digit with a plastic bandage. Suspecting an allergic contact dermatitis, we performed patch test with the Italian Standard series called SIDAPA and the product (Xérial 50 Extrême cream®) itself. Patch test readings showed a positive reaction to colophony contained in the plastic band and to the cream. CONCLUSION Our case is the first report of allergic contact dermatitis to a cream containing a high concentration urea utilized for treatment of nail thickening under occlusion.

Dermoscopy of Subungual Exostosis: A Retrospective Study of 10 Patients.

Introduction: Subungual exostosis (SE), the most common nail tumor of young adults, is a benign bony proliferation of the distal phalanx occurring beneath the nail. Misdiagnosis or late diagnosis frequently occurs and no dermoscopy features of this tumor were previously outlined. Material and Methods: To describe the dermoscopic appearance of SE, 10 patients with radiologically and histologically confirmed SE were retrospectively retrieved from our tertiary referral centers. Data regarding age, gender, time to diagnosis, clinical presentation, dermoscopic features, involved nail and history of trauma were recorded for each patient. Results: In our patients, clinical findings were similar to previous reports. Among the dermoscopic features, vascular ectasia was the most common finding (70%), followed by hyperkeratosis (60%), onycholysis (40%), and ulceration (30%). Conclusion: Dermoscopy could be a useful technique aimed at creating diagnostic suspicion of this benign nail condition, although X-ray examination and histopathology are mandatory for the diagnosis.

Diffuse Hair Loss in a Young Female

We present the case of a 21 year-old woman who came to our attention complaining an acute and diffuse hair loss, lasting from about 5 months. She also observed an important hair thinning. The patient was healthy and denied events like psychological stress, significant fever or fast weight loss in the previous months. She had no nutritional deficiency or thyroid disorders. The personal history revealed polycystic ovary syndrome, with normal hormones levels. Her familiar history was positive for male androgenetic alopecia. Clinical examination of the scalp revealed moderate hair density (Figure 1). Eyebrows, eyelashes and body hair were normal, as well as nails.