Nadine Lateur

Two Hundred Ninety‐Six Cases of Onychomycosis in Children and Teenagers: A 10‐Year Laboratory Survey

Abstract: There is still little data available about the epidemiology of childhood onychomycosis. Looking at our laboratory figures over a 10‐year period provided us with some useful information. Nail keratin samples were taken by dermatologists from 21,557 patients with nail conditions, mainly in the Brussels region. The specimens were examined by direct microscopy and/or histology, and cultured on Sabouraud medium agar. Only patients less than 17 years of age were considered as children. Clinical information was gathered about age, sex, and the location of the infected nail. Nine hundred sixty‐three of the samples were from children, and 296 of those children had proven onychomycosis. More than three‐fourths of the cases were found in children more than 6 years old, and boys were more frequently affected than girls. Toenails were the predominant location of infection. Trichophyton rubrum was the main pathogen, followed by Candida spp. and Trichophyton interdigitale. One case was caused by Scopulariopsis spp. As in adults, onychomycosis is probably the main nail disease in children. After the age of 6 years, the presentation is very similar to that in adults: toenails are mostly involved, and T. rubrum, the main pathogen, is responsible for distal and lateral subungual onychomycosis.

Immunohistochemical study of 40 cases of longitudinal melanonychia.

The etiology of longitudinal melanonychia (LM) is difficult to establish by clinical and dermoscopic examinations alone. Microscopic examination of the nail matrix remains crucial. Two groups of LM may be identified: melanocytic activation (melanic pigmentation of the matrix epithelium without any increase in the density of melanocytes) and melanocytic proliferation (lentigo, nevus, or melanoma). The histological examination is challenging, and immunohistochemical investigations can be helpful. The objective of this study was to analyze the immunohistochemical findings with routinely used markers in melanocytic tumors-S-100 protein, HMB-45, and Melan-A-in LM. A series of 40 cases were analyzed: 10 activations, 4 lentigines, 7 nevi, 12 in situ melanomas, and 7 invasive melanomas. The sensitivity of S-100 protein is weak in benign and malignant intraepithelial melanocytes of the nail matrix, and if this marker is performed alone, it may be wrongly reassuring. However, the use of S-100 protein is essential to differentiate invasive melanoma, lacking an intraepithelial component, and particularly desmoplastic melanoma, from epithelial and mesenchymal tumors. HMB-45 and Melan-A are more sensitive than S-100 protein for the evaluation of intraepithelial melanocytic proliferation of the nail apparatus, with HMB-45 being the most intense marker. In the dermal component, HMB-45 and Melan-A were less sensitive than S-100 protein. In conclusion, we recommend that the panel of antibodies used for histological evaluation of LM should include HMB-45 and/or Melan-A and S-100 protein only if an invasive melanoma is suspected.

Tinea capitis in Brussels: epidemiology and new management strategy.

Background: We found pre-established directives inadequate to cope with the current increase in anthropophilic tinea capitis in Brussels. Objectives: To study new epidemiological profiles and to define new strategies for management and prevention. Patients and Methods: A total of 122 children affected by tinea capitis were followed in our department from October 1, 2001, until September 30, 2002. The results were assessed retrospectively. Results: Anthropophilic tinea capitis represented 89.34% of the cases. The implicated anthropophilic dermatophytes were by decreasing frequency: Microsporum langeronii (39.34%), Trichophyton soudanense (28.69%), Trichophyton violaceum (18.03%) and Trichophyton tonsurans (3.28%). Conclusion: The responsible pathogens reflect immigration flows originating mostly from Black and North Africa. Precise recommendations for each visit are detailed.

Melanonychia: diagnosis and treatment

Melanonychia should be a term restricted to the presence of melanin in the nail unit. To be able to understand the process of melanin deposition in the nail plate, the nail apparatus and its melanocyte system are described. The different causes responsible for a black nail are reviewed, enabling the clinician to pick out those cases that are highly suspicious of being a malignant condition. Their differential diagnosis is also considered, with special attention to Hutchinsons sign. The second part of the article deals with the management of longitudinal melanonychia, including history, clinical examination, nail plate sampling, and when and how to perform a biopsy. Finally, pathology and subungual melanoma treatment are briefly reviewed.

New Tools in Nail Disorders

Tumors of the nail unit may be difficult to diagnose because of the screening effect of the nail plate. In longitudinal melanonychia, several new promising techniques assist with early diagnosis of melanoma (in vivo matrix dermoscopy and immunohistochemistry) as well as sparing as much of the healthy tissues as is possible (shave biopsy technique). Diagnosing nail disorders is in some instances difficult both for the clinician and the pathologist. New tools such as polymerase chain reaction have been proposed for onychomycosis, which accounts for more than half of nail conditions, will allow quick and accurate diagnosis. However, polymerase chain reaction analysis remains expensive and is not routinely used by clinicians. Scoring nail dystrophy by clinical observation remains very subjective; therefore, severity indexes have been proposed. Another emerging noninvasive technique is forensic analysis of nail clippings for detection of drug intake and abuse, as well as exposure to environmental pollution.

An Unusual Case of Squamous Cell Carcinoma of the Nose

A 49-year-old man presented with a tumoral lesion of the tip of the nose which had been manifest for 2 months. Within a few weeks, the tumour increased in size and became infiltrated. The biopsy showed a squamous cell carcinoma. Treatment consisted of a radical surgical excision.

Onychomycosis: beyond cosmetic distress.

Onychomycosis, or fungal infection of the nail, is the most common nail disease affecting children (although to a lesser extent) as well as adults. The distress it provokes is not only of a cosmetic kind; it may impair the quality of life.

FLUCONAZOLE ORAL SOLUTION AS FIRST CHOICE TREATMENT FOR TINEA CAPITIS IN SMALL CHILDREN

the effects of the used drugs. For this purpose we have investigated several drugs which were produced from natural sources. The fungicidal as well as the inhibitory effects were examined. The tests were done on human pathogenic yeast such as Candida albicans, Candida krusei, Candida glabrata and others. The fungicidal effects were tested by determining the decrease of CFU (Colony Forming Units) in time and concentrations in water solution. The development of the colonies were tested in Sabouraud glucose agar in Petri dishes. In the case of oils (eg. tea-plant oil, etc.) or volatile oil (e.g. thymol) first an alcoholic mixture was made which was diluted by water or physiological NaCI. The end-concentration of the natural agencies were 5 0 0 0 ~ or 5 0 0 ~ . In these experiments the product which was a composition of natural plant volatile oils used in foraging and veterinary medicine showed a very high fungicidal effect. In further examinations grapefruit-seed extract, lavender-oil, tea-plant-oil, geranium-oil, rosemary-oil, orange-peel extract were tested. Three of them: tea-plantoil, geranium-oil and orange-peel extract showed fungicidal effect, others had no effect on fungi. The fungistatic effects were also tested by the reduced growing of the species in growing media containing acid/alcalic indicators. The effects were visualised by colour changing depending on the produced amounts of acid(s) by yeast species. According to the in vitro results some natural drugs may be a helpful supplement in certain cases.