Robert Baran

The burden of nail psoriasis: an introduction.

Nail involvement is an extremely common feature of psoriasis and affects approximately 50% of patients. Despite this, it is an often overlooked feature of the disease, and treatment tends to be focused on clearing the cutaneous component of psoriasis. Clinical manifestations of nail psoriasis are pitting, discolouration, onycholysis and subungual hyperkeratosis as well as nail plate crumbling and splinter haemorrhages. Nail psoriasis is associated with discomfort in many patients and leads to significant functional impairment and psychological stress. The often distressing appearance of affected nails impacts the patient tremendously in both work and social activities. Importantly, 80% of patients with psoriatic arthritis have nail psoriasis. This review discusses the incidence of nail psoriasis and the burden on the patient and illustrates when dermatologists are strategically placed to detect the early signs of more severe disease by promptly diagnosing and managing the nail component of psoriasis.

Photoonycholysis induced by the fluoroquinolones pefloxacine and ofloxacine. Report on 2 cases.

Pefloxacine and ofloxacine are 2 new synthetic fluoroquinolones which should be added to the list of drugs inducing photoonycholysis. Two cases are reported.

Frictional Longitudinal Melanonychia: A New Entity

Longitudinal melanonychia of the toes initiated by repeated trauma from the footwear is described as a new entity in a clinical study of 12 patients. Its proper recognition should help to rule out the brown streaks due to malignant melanoma. The nail pigmentation appears over the distal bony phalanx where the deep matrix covered by the proximal nail fold is exposed to friction or pressure of the narrowing portion of the tip of the shoe. Histological studies revealed hyperplasia of the matrix, some melanin granules in the upper dermis with increased pigmentation of the basal cell layer of the epithelium, and marked melanotic pigment in the nail plate.

Nail Biting and Picking as a Possible Cause of Longitudinal Melanonychia

Examination of individuals affected by onychotillomania led us to describe a new cause of longitudinal melanonychia (LM) of the finger-nails. Damage of the finger-nails was caused both manually and by chewing. The nail cuticles were usually pushed back, and biting caused pressure damage of the base of the nail. It is likely that finger-nails respond similarly to toe-nails and the matrix melanocytes can be stimulated by trauma. Such stimulation can apparently persist long after cessation of the trauma. Histological examination of the nail plates demonstrated that the pigment was melanin. In the matrix an increase in melanin content of melanocytes was found without melanocytic proliferation. LM due to onychotillomania should not be overlooked.

Explosive Eruption of Pyogenic Granuloma on the Scalp Due to Topical Combination Therapy of Minoxidil and Retinoic Acid

A 55-year-old patient was treated with a combination of minoxidil and retinoic acid. After 1 month an explosive eruption of pyogenic granuloma appeared on the scalp. Despite redness and itchy reaction, caused only by the test containing both chemicals, histology did not give evidence of contact allergy.

Swelling of the Proximal Nail Fold Caused by Underlying Warts

We report on 2 cases of patients with warts underlying the proximal nail fold which presented as tender erythematous nodules. The remarkable feature in both cases was a significant oedema of the proximal nail fold, resembling a reaction to a foreign body. One patient responded well to mild keratolytic treatment. The second patient was treated surgically with crescentic excision of the distal portion of the proximal nail fold. It is important to recognise this tumour variant in order to avoid unnecessary or excessive intervention.