DOCSLIB.ORG

Nail Changes Due to Diabetes and Other Endocrinopathies

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Nail Changes Due to Diabetes and Other Endocrinopathies Dermatologic Therapy, Vol. 15, 2002, 107±110 Copyright # Blackwell Publishing, Inc., 2002 Printed in the United States Á All rights reserved DERMATOLOGIC THERAPY ISSN 1396-0296 Nail changes due to diabetes and other endocrinopathies PHOEBE RICH Dermatology Specialists NW, Portland, Oregon ABSTRACT: Most endocrine-associated nail disorders are non-specified but can provide valuable clues for diagnosis of some endocrine disorders. The nail effects of diabetes,thyroid disorders, parathyroid dysfunction,adrenal and ovarian dysfunction are discussed in relation to nail health and pathology. Diabetes mellitus affects many organ systems including skin and nails. The lower extremity consequences of diabetes is related to the poor peripheral circulation,neuropathy,and immunopathy. Sharp brittle nails can puncture the adjacent skin and escape notice due to the lack of sensation in the feet resulting in potential limb-threatening bacterial infections. Thyroid,adrenal, and ovarian hormones affect the nails in many ways,and various endocrine abnormalities with nail manifestations are reviewed. KEYWORDS: nails,endocrine,diabetes mellitus,thyroid,parathyroid,pituitary. Hormones affect many organ systems and body diabetes can have devastating effects on many functions,including the integrity and quality of organ systems including cardiovascular,neurolo- skin,hair,and nails. The various effects of gic,ocular,renal,and cutaneous,with its impact endocrinopathies on skin and hair are well docu- on skin,hair,and nails. mented,but less is known about the hormonal Over time many diabetics develop nails that are impact on nails. This review highlights some of the yellow,thickened,and sometimes fragile,ridged, known and postulated interactions between hor- and brittle (Fig. 1). There is definite overlap with mones and human nails. Diabetes,thyroid dis- some of the physical attributes seen in diabetic orders,parathyroid dysfunction,adrenal hormone nails and those seen due to aging. It is unclear abnormalities,and ovarian dysfunction are dis- whether diabetes exacerbates nail changes asso- cussed in relation to their influence on nail health ciated with aging or vice versa. Periungual and pathology. Most endocrine-associated nail erythema and telangiectasia can be seen in the changes are nonspecific,but can provide clues to nail folds as an early finding of diabetes. Thicken- the diagnosis of some endocrine disorders. ing of the skin of the dorsal hands and feet and proximal nail folds can be seen in up to one-quarter of diabetics (Figs. 2 and 3). The skin becomes Diabetes mellitus effects on nails thickened,rough,and indurated,particularly Diabetes mellitus (DM) affects 16 million Amer- icans and the incidence is increasing in the United States and worldwide. Diabetes is a metabolic disorder caused by the abnormal release of or sensitivity to the hormone insulin, with loss of blood glucose control. Uncontrolled Address correspondence and reprint requests to: Phoebe Rich, Fig. 1. Yellow, thickened Fig. 2. Thickened skin on MD,Dermatology Specialists NW,2222 NW Lovejoy,Suite 419, nails are characteristic of the lower extremities ofa Portland,OR 97210. long-standing diabetes. diabetic. 107 Rich sharp mycotic nail causing traumatic skin lesions that escape notice due to loss of sensation in the lower extremities. These minor breaks in the skin around the nails can become infected,leading to serious limb-threatening bacterial infections in the diabetic (5). Ulceration and cuts of the nail bed and perionychium can result in necrosis and Fig. 3. Onychogryphosis Fig. 4. Vesicles and heal- severe paronychia infections (Figs. 6 and 7). In in diabetics is not uncom- ing erosions occur in the addition,diabetics often have difficulty perform- mon. diabetic with vascularly ing normal nail grooming due to their inability to and neurologically com- promised extremities. bend over and reach their feet. Many diabetics are visually impaired and cannot inspect their feet daily for problems. Fungal and bacterial over the joints on the dorsum of the digits (1). infections of the nail unit in diabetics should be Thickening of the toenails and even onychogry- cultured and treated with the appropriate anti- phosis (Fig. 3) can be related to the microangio- microbial agents. pathic changes of the lower extremities in diabetic Glucogonoma syndrome occurs in patients patients. Vesicles and bulla on the toes are some- with malignant islet cell tumor and hypergluca- times seen in diabetic patients (2). These blisters gonemia. Glucagon along with insulin helps can become infected and pose a threat to the regulate blood glucose levels. There are many integrity of the diabetic foot (Figs. 4 and 5). clinical features of glucagonemia including soft Onychomycosis and its associated complica- and flexible fingernails (6). tions have been reported in diabetic patients (3). Gupta showed that diabetics have a threefold higher risk of developing onychomycosis than Thyroid abnormalities age-matched controls. The risk was not related to the degree of diabetic control or whether the Thyroid hormone deficiency or surplus can diabetic was type 1 or 2 (4). Many of the have effects on the hair,skin,and nails. The abnormalities and adverse reactions that occur nail changes seen with hyperthyroidism are in the lower extremities in diabetics are related to subtle and usually consist of onycholysis begin- four main factors: impaired peripheral circulation ning in the fourth or fifth nail,the so-called due to diabetic angiopathy,loss of sensation of Plummers nails (7). This onycholysis is reversed the lower extremity because of diabetic peripheral when the hyperthyroidism is normalized. Na- neuropathy,impaired wound healing related in katsui reported three patients who presented part to diabetic immunopathies,and unrecog- with onycholysis and were found to be hy- nized trauma resulting in a breach in cutaneous perthyroid; he suggests that patients with integrity. These factors are referred to collectively unexplained onycholysis should be screened as the diabetic foot. for asymptomatic thyroid disease (8). Hyper- The risks of untreated onychomycosis in the thyroidism has been associated with yellow nail high-risk diabetic,that is,diabetics with advanced syndrome,which is characterized by yellow, neuropathy and angiopathy,is related to the slow-growing nails and absent lunulae and mechanical effects of the thickened,brittle or cuticles. Fig. 5. Nail bed erosion in Fig. 6. Acute bacterial in- Fig. 7. Large ulceration of Fig. 8. Thin, ridged, brit- a diabetic. fections in the periungual the lateral nail fold in a tle nails sometimes occur tissue ofa diabetic pa- diabetic patient. in patients with hypothyr- tient. oidism. 108 Endocrine effects on nails There are no pathognomonic changes of showed a significant decrease in capillary blood hypothyroid nails. Changes reported are slow flow in postmenopausal women as compared to growth,hapalonychia (thin nails),longitudinal premenopausal women. HRT resulted in an sulcus,and brittle nails (9). Nails in hypothyroid increased capillary blood flow of 20±30% of initial patients are sometimes described as dry,brittle, values at 6 and 12 months (14). The significance of lusterless,and longitudinally ridged (10) (Fig. 8). the increased blood flow to the nail unit in There are reports of associated endocrinopathies, premenopausal women and women on HRT especially hypothyroidism,and chronic mucocu- therapy is unknown. taneous candidiasis (CMCC),a rare inherited Unfortunately there are no large controlled trials condition characterized by Candida infection of that evaluate the effect of estrogen on nail growth the mucous membranes and nails. Because a high and nail quality. As the ovaries cease estrogen percentage of patients with CMCC develop thyr- production during menopause,many women oid abnormalities,regular monitoring with thyr- complain of changes in the strength,appearance, oid function tests is needed (11). and flexibility of their nails. Some women note that their nails are thinner,softer,and more brittle. Many women note increased brittleness,peeling, Parathyroid disease and softness of their nails. While these changes can be due to a variety of causes,the authors opinion is Several nail changes have been associated with based on clinical observation that many women hypoparathyroidism and hypocalcemia,including experience a decline in the strength and flexibility brittle,thin,and fragile nails affecting the distal of their nails in the postmenopausal period. These half of the nail. In hyperparathyroidism a pseudo- nail changes appear to be postponed in women on racquet nail can be seen. These nails appear HRT. Large-scale controlled studies are necessary broader and shorter than normal because of acro- to scientifically study the effect of menopause and osteolysis of the distal phalanx due to calcium HRT on nail health. mobilization (12) (Fig. 9). Brosche et al. evaluated the integral lipid levels in the nail plates of 70 patients age 20 to 92 years old.Thereappearedtobeanageassociated Estrogen states increase in cholesterol lipids in nails in men but not in women. They propose that this age- During pregnancy the growth rate of nails is dependent decrease in integral lipids in the nail increased and during lactation the nail growth plate in women might explain the increased rate is decreased. It is not known if these growth incidence of brittle nails in women as they age (15). rate changes are related to hormones or to other A case of contraceptive pill-induced
Load more

Recommended publications
  • Nail Anatomy and Physiology for the Clinician 1
    Nail Anatomy and Physiology for the Clinician 1 The nails have several important uses, which are as they are produced and remain stored during easily appreciable when the nails are absent or growth. they lose their function. The most evident use of It is therefore important to know how the fi ngernails is to be an ornament of the hand, but healthy nail appears and how it is formed, in we must not underestimate other important func- order to detect signs of pathology and understand tions, such as the protective value of the nail plate their pathogenesis. against trauma to the underlying distal phalanx, its counterpressure effect to the pulp important for walking and for tactile sensation, the scratch- 1.1 Nail Anatomy ing function, and the importance of fi ngernails and Physiology for manipulation of small objects. The nails can also provide information about What we call “nail” is the nail plate, the fi nal part the person’s work, habits, and health status, as of the activity of 4 epithelia that proliferate and several well-known nail features are a clue to sys- differentiate in a specifi c manner, in order to form temic diseases. Abnormal nails due to biting or and protect a healthy nail plate [1 ]. The “nail onychotillomania give clues to the person’s emo- unit” (Fig. 1.1 ) is composed by: tional/psychiatric status. Nail samples are uti- • Nail matrix: responsible for nail plate production lized for forensic and toxicology analysis, as • Nail folds: responsible for protection of the several substances are deposited in the nail plate nail matrix Proximal nail fold Nail plate Fig.
    [Show full text]
  • Clinical Management of Cutaneous Adverse Events in Patients on Chemotherapy 449
    Actas Dermosifiliogr. 2019;110(6):448---459 CONSENSUS DOCUMENT Clinical Management of Cutaneous Adverse Events in Patients on Chemotherapy: A National Consensus Statement by the Spanish Academy of Dermatology and Venereology and the Spanish Society of Medical Oncologyଝ a b c d e f O. Sanmartín, C. Beato, H. Jin Suh-Oh, I. Aragón, A. Espana,˜ M. Majem, g h i,∗ j S. Segura, A. Gúrpide, R. Botella, C. Grávalos a Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, Espana˜ b Departamento de Oncología Médica, Hospital Universitario Virgen Macarena, Sevilla, Espana˜ c Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Espana˜ d Departamento de Oncología Médica, Complejo Hospitalario Universitario de Huelva, Huelva, Espana˜ e Servicio de Dermatología, Clínica Universitaria de Navarra, Pamplona, Espana˜ f Departamento de Oncología Médica, Hospital de la Santa Creu i Sant Pau, Barcelona, Espana˜ g Servicio de Dermatología, Hospital del Mar, Barcelona, Espana˜ h Departamento de Oncología Médica, Clínica Universitaria de Navarra, Pamplona, Espana˜ i Servicio de Dermatología, Hospital Universitario La Fe, Facultad de Medicina, Universidad de Valencia, Valencia, Espana˜ j Servicio de Oncología Médica, Hospital Universitario Doce de Octubre, Madrid, Espana˜ KEYWORDS Abstract Although the arrival of new chemotherapy drugs and combinations has brought Chemotherapy; progress in terms of cancer patient survival, they entail many adverse effects that can Photosensitivity; compromise treatment, and hence
    [Show full text]
  • Study Guide Medical Terminology by Thea Liza Batan About the Author
    Study Guide Medical Terminology By Thea Liza Batan About the Author Thea Liza Batan earned a Master of Science in Nursing Administration in 2007 from Xavier University in Cincinnati, Ohio. She has worked as a staff nurse, nurse instructor, and level department head. She currently works as a simulation coordinator and a free- lance writer specializing in nursing and healthcare. All terms mentioned in this text that are known to be trademarks or service marks have been appropriately capitalized. Use of a term in this text shouldn’t be regarded as affecting the validity of any trademark or service mark. Copyright © 2017 by Penn Foster, Inc. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner. Requests for permission to make copies of any part of the work should be mailed to Copyright Permissions, Penn Foster, 925 Oak Street, Scranton, Pennsylvania 18515. Printed in the United States of America CONTENTS INSTRUCTIONS 1 READING ASSIGNMENTS 3 LESSON 1: THE FUNDAMENTALS OF MEDICAL TERMINOLOGY 5 LESSON 2: DIAGNOSIS, INTERVENTION, AND HUMAN BODY TERMS 28 LESSON 3: MUSCULOSKELETAL, CIRCULATORY, AND RESPIRATORY SYSTEM TERMS 44 LESSON 4: DIGESTIVE, URINARY, AND REPRODUCTIVE SYSTEM TERMS 69 LESSON 5: INTEGUMENTARY, NERVOUS, AND ENDOCRINE S YSTEM TERMS 96 SELF-CHECK ANSWERS 134 © PENN FOSTER, INC. 2017 MEDICAL TERMINOLOGY PAGE III Contents INSTRUCTIONS INTRODUCTION Welcome to your course on medical terminology. You’re taking this course because you’re most likely interested in pursuing a health and science career, which entails ­proficiency­in­communicating­with­healthcare­professionals­such­as­physicians,­nurses,­ or dentists.
    [Show full text]
  • Pedicure: Nail Enhancements
    All Hair Services Include Shampoo All Services Based on Student Availability Long Hair is Extra & Senior Price Available Hair Cuts: Color: (Does Not Include Cut & Style) Hair Cut (Hood dryer) $6.50 Retouch/Tint/PM Shine $14.50 With Blowdry $13.50 Additional Application $8.00 With Blowdry & Flat Iron $21.50 Color (All over color) $20.00 Foils Each $4.00 Hair Styles: Hair Length to Collar $38.00 Shampoo/Set $6.75 Hair Length to Shoulder $48.00 Spiral Rod Set $20.00 Hair Length past Shoulder $58.00 Shampoo/ Blowdry $9.00 Frosting with Cap $17.50 With Thermal Iron $13.00 Men’s Comb Highlight with Cut $15.00 With Flat Iron $15.00 With Press & Curl $18.00 Perms & Relaxers: (Includes Cut & Style) Wrap Only $6.50 Regular or Normal Hair $20.95 Wrap with Roller Set $10.50 Resistant or Tinted Hair $26.00 Fingerwaves with Style $17.50 Spiral or Piggyback $36.00 Twists $3.00 Relaxer $35.00 Straight Back $20.00 Curled $15.00 Other Hair Services: Spiral $20.00 Shampoo Only $2.00 French Braids with Blowdry $15.00 Line-up $3.00 Under 10 Braids $20.00 Deep Condition $5.00 Over 10 Braids $25.00 Keratin Treatment $15.00 Braid Removal $15.00 Updo or French Roll $20.00 Manicure: Spa Manicure $9.50 Waxing: French Manicure $8.00 Brow $6.00 Manicure $6.42 Lip $5.00 Chin $5.00 Pedicure: Full Face $15.00 Spa Pedicure $20.00 Half Leg $15.00 French Pedicure $17.00 Full Leg $30.00 Pedicure $15.00 Underarm $15.00 Half Arm $10.00 Nail Enhancements: Full Arm $15.00 Shellac (French $2) $15.00 Mid Back & Up $15.00 Overlay (Natural Nail) $12.00 Full Back $25.00 Acrylic Full Set $16.50 Bikini $25.00 Gel Full Set $18.00 Fill-in Gel & Acrylic $12.00 Massages: Nail Repair( Per Nail) $2.00 Relaxation $15.00 Soak Off $3.00 Deep Tissue $19.95 Nail Art (Per Nail) $1.00 Other Nail Services: Nails & Waxing Services Taxable Polish Change $4.00 Nails Clipped $5.00 Paraffin Dip Wax $5.00 .
    [Show full text]
  • NAIL DISEASES and NAIL HEALTH Your Nails Can Tell You a Lot About Your Health
    Dermatology Patient Education NAIL DISEASES AND NAIL HEALTH Your nails can tell you a lot about your health. Nail diseases and warning signs of other health problems appear on the nails. Your nails also reveal whether you are taking good care them. Good nail care is important because it can help prevent many common nail problems. NAIL DISEASES The skin around our nails and the tissue beneath are susceptible to many diseases. If you see any of the following, promptly see a dermatologist. Early diagnosis and proper treatment offer the best outcome. If allowed to progress, nail disease can be challenging to treat. Melanoma under the nail • Dark spot or streak Melanoma (skin cancer): Nail streaks are common in people of color. While many nail streaks are harmless, it is important to know that about 30% to 40% of melanomas that occur in people of color develop under a nail. While melanoma under the nail is more common in people of color, anyone can get melanoma under a nail. If your nail has a dark streak or spot and you do not remember injuring the nail, promptly see a dermatologist. When caught early, melanoma can be cured. • Growth Skin cancer: Many different types of skin cancer, including melanoma and Squamous cell carcinoma, can form under or around a nail. If you see a growth under or around your nail, promptly see a dermatologist. Your dermatologist can tell you whether the growth should be removed. Wart: A growth on the skin surrounding a nail is often a wart. Warts are common on the hands and feet.
    [Show full text]
  • A RARE PRESENTATION of INGROWN TOE NAIL *Alagar Samy R
    CIBTech Journal of Surgery ISSN: 2319-3875 (Online) An Open Access, Online International Journal Available at http://www.cibtech.org/cjs.htm 2015 Vol. 4 (1) January-April, pp.24-27/Samy Case Report A RARE PRESENTATION OF INGROWN TOE NAIL *Alagar Samy R. ESIC Medical College and Hospital, Coimbatore, Tamilnadu, India *Author for Correspondence ABSTRACT Onychocryptosis or ingrown toenail is a very common pathology of the toenail unit, chiefly affecting adolescents and young adults. The ingrown toenail is responsible for disabling complaints like pain and difficulty in walking. It is associated with significant morbidity, hampering the quality of life as it interferes with sporting activities, school, or work. It principally occurs in the hallux. It is ascribed to poor trimming of the nails in combination with local pressure due to ill-fitting footwear, hyperhidrosis, poor foot hygiene and nail abnormalities. Pain, swelling and discharge are the main clinical features. Four stages of the condition have been described. Diagnosis is usually evident, but it should be differentiated from subungual exostosis and tumors of the nail bed (James et al., 2006). I report a case of in grown toe nail involving right great toe with a swelling in the same toe with occasional pain. There was no history of trauma or any co morbid illness. Hence the right great toe nail with a swelling excised intoto. The Histopathological examination revealed only chronic inflammation. The post operative period was uneventful and discharged on third post operative period. It is being presented for its rarity. Keywords: Onychocryptosis, Hallux, Ingrown, Avulsion INTRODUCTION Onychocryptosis or ingrown toenail is a very common pathology of the toenail unit, chiefly affecting adolescents and young adults.
    [Show full text]
  • Tasmanian Hardwood Strip Flooring on Joists Guide for Installing
    TASMANIAN HARDWOOD STRIP FLOORING ON JOISTS installation guide These instructions apply to quality Tasmanian strip flooring fixed over joists in residential applications. STRIP FLOOR ON JOISTS TOP NAILED SECRET NAILED END MATCHED TOOLS Simple tools are adequate in most applications. Necessary tools are: Tool Requirement Checklist Pencil, tape measure and square Hammer, punch and nail bag Stringline, spirit level and straight edge Hand saw and jig saw Safety glasses, dust mask and knee pads Spacers (about 100mm long and 2 mm thick) Rubber mallet, broom and vacuum cleaner Framing chisel For specialist applications, a drop saw, an air power staple gun, a power actuated fastener system and a cramping system may be useful. MATERIALS Use quality boards of the correct thickness. Grade descriptions for strip flooring are set out in the Australian Standard AS 2796 and are available at: www.tastimber.tas.gov.au. Boards at least 19 mm thick are needed to span 450 mm. Board width - Only secret nail boards up to 85 mm cover width. Secret nailed flooring is fixed through the tongue of specially profiled boards. Since they are only secured with one fastener per joist or batten, their width is limited to 85 mm cover. Board over 85 cover must be top nailed with two fasteners per joist. Use the correct nails for the job. The nail sizes required by Australian Standard 1684 are: Nail sizes for T & G flooring to joists* Nail sizes for T & G flooring to plywood substrate* Nailing Softwood Hardware & Strip flooring Rec. nailing (min.15mm substrate) joists cypress joists thicknes (mm) Hand 65 x 2.8 mm 50 x 2.8 mm 38 x 16 guage chisel point staples or driven bullet head bullet head 19 or 20 38 x 2.2 mm nails at 300mm spacing 32 x 16 guage chisel point staples or Machine 12,19 or 20 driven 65 x 2.5 mm 50 x 2.5 mm 30 x 2.2 mm nails at 200mm spacing *Alternative fasteners can be used for substrates types not listed subject to manufacturers’ recommendation.
    [Show full text]
  • Regional Handwashing Policy
    SOUTHERN CALIFORNIA GRADUATE MEDICAL EDUCATION POLICY AND PROCEDURE POLICY INFECTION PREVENTION AND CONTROL POLICIES EFFECTIVE DATE: SECTION: AND PROCEDURES 7/1/2014 TITLE: Hand Health & Hygiene Page: 1 of 8 BACKGROUND Studies have shown that handwashing causes a reduction in the carriage of potential pathogens on the hands. Microorganisms proliferate on the hands within the moist environment of gloves. Handwashing results in the reduction of patient morbidity and mortality from health care associated infections. The Centers for Disease Control and Prevention states that handwashing is the single most important procedure for preventing health-care associated infections. Artificial nails are more likely than natural nails to harbor pathogens that can lead to health care associated infections. There are four types of hand washing (see body of policy for detailed instructions): TYPE PURPOSE METHOD Routine Handwashing To remove soil and transient Wash hands with soap and microorganisms. water for at least 15 seconds. Hand antisepsis To remove soil and remove or Wash hands with antimicrobial destroy transient soap and water for at least 15 microorganisms. seconds. Hand rub/degerming To destroy transient and Rub alcohol-based hand resident microorganisms on degermer into hands vigorously UNSOILED hands. until dry. Surgical hand scrub To remove or destroy transient Wash hands and forearms with microorganisms and reduce antimicrobial soap and water resident flora. with brush to achieve friction. Or alcohol-based preparation rubbed vigorously
    [Show full text]
  • White Nail As a Static Physical Finding: Revitalization of Physical Examination
    Case Report White Nail as a Static Physical Finding: Revitalization of Physical Examination Ryuichi Ohta 1,* and Chiaki Sano 2 1 Community Care, Unnan City Hospital, 699-1221 96-1 Iida, Daito-cho, Unnan 699-1221, Shimane Prefecture, Japan 2 Department of Community Medicine Management, Faculty of Medicine, Shimane University, 89-1 Enya cho, Izumo 693-8501, Shimane Prefecture, Japan; [email protected] * Correspondence: [email protected]; Tel.: +81-9050605330 Abstract: Physical examinations are critical for diagnosis and should be differentiated into static and dynamic categories. One of the static findings is white nail, such as Terry’s and Lindsay’s nails. Here, we report the cases of two older patients with acute diseases who had nail changes that aided evaluation of their clinical course. Two elderly women who presented with acute conditions were initially thought to have normal serum albumin levels. They were found to have white nail with differences in nail involvement of the first finger, which subsequently revealed their hypoalbuminemia. The clinical courses were different following the distribution of nail whitening. Our findings show that examination of a white nail could indicate the previous clinical status more clearly than laboratory data. It can be useful for evaluating preclinical conditions in patients with acute diseases. Further evaluation is needed to establish the relationship between clinical outcomes and the presence of white nail in acute conditions among older patients. Citation: Ohta, R.; Sano, C. White Keywords: Lindsay’s nail; nail findings; nutritional assessment; physical examination; Terry’s nail; Nail as a Static Physical Finding: white nail Revitalization of Physical Examination.
    [Show full text]
  • 2016 Essentials of Dermatopathology Slide Library Handout Book
    2016 Essentials of Dermatopathology Slide Library Handout Book April 8-10, 2016 JW Marriott Houston Downtown Houston, TX USA CASE #01 -- SLIDE #01 Diagnosis: Nodular fasciitis Case Summary: 12 year old male with a rapidly growing temple mass. Present for 4 weeks. Nodular fasciitis is a self-limited pseudosarcomatous proliferation that may cause clinical alarm due to its rapid growth. It is most common in young adults but occurs across a wide age range. This lesion is typically 3-5 cm and composed of bland fibroblasts and myofibroblasts without significant cytologic atypia arranged in a loose storiform pattern with areas of extravasated red blood cells. Mitoses may be numerous, but atypical mitotic figures are absent. Nodular fasciitis is a benign process, and recurrence is very rare (1%). Recent work has shown that the MYH9-USP6 gene fusion is present in approximately 90% of cases, and molecular techniques to show USP6 gene rearrangement may be a helpful ancillary tool in difficult cases or on small biopsy samples. Weiss SW, Goldblum JR. Enzinger and Weiss’s Soft Tissue Tumors, 5th edition. Mosby Elsevier. 2008. Erickson-Johnson MR, Chou MM, Evers BR, Roth CW, Seys AR, Jin L, Ye Y, Lau AW, Wang X, Oliveira AM. Nodular fasciitis: a novel model of transient neoplasia induced by MYH9-USP6 gene fusion. Lab Invest. 2011 Oct;91(10):1427-33. Amary MF, Ye H, Berisha F, Tirabosco R, Presneau N, Flanagan AM. Detection of USP6 gene rearrangement in nodular fasciitis: an important diagnostic tool. Virchows Arch. 2013 Jul;463(1):97-8. CONTRIBUTED BY KAREN FRITCHIE, MD 1 CASE #02 -- SLIDE #02 Diagnosis: Cellular fibrous histiocytoma Case Summary: 12 year old female with wrist mass.
    [Show full text]
  • Nail Involvement in Alopecia Areata
    212 CLINICAL REPORT Nail Involvement in Alopecia Areata: A Questionnaire-based Survey on DV Clinical Signs, Impact on Quality of Life and Review of the Literature 1 2 2 1 cta Yvonne B. M. ROEST , Henriët VAN MIDDENDORP , Andrea W. M. EVERS , Peter C. M. VAN DE KERKHOF and Marcel C. PASCH1 1 2 A Department of Dermatology, Radboud University Nijmegen Medical Center, Nijmegen, and Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands Alopecia areata (AA) is an immune-mediated disease at any age, but as many as 60% of patients with AA will causing temporary or permanent hair loss. Up to 46% present with their first patch before 20 years of age (4), and of patients with AA also have nail involvement. The prevalence peaks between the 2nd and 4th decades of life (1). aim of this study was to determine the presence, ty- AA is a lymphocyte cell-mediated inflammatory form pes, and clinical implications of nail changes in pa- of hair loss in which a complex interplay between genetic enereologica tients with AA. This questionnaire-based survey eva- factors and underlying autoimmune aetiopathogenesis V luated 256 patients with AA. General demographic is suggested, although the exact aetiological pathway is variables, specific nail changes, nail-related quality of unknown (5). Some studies have shown association with life (QoL), and treatment history and need were evalu- other auto-immune diseases, including asthma, atopic ated. Prevalence of nail involvement in AA was 64.1%. dermatitis, and vitiligo (6). ermato- The specific nail signs reported most frequently were Many patients with AA also have nail involvement, D pitting (29.7%, p = 0.008) and trachyonychia (18.0%).
    [Show full text]
  • NAIL CHANGES in RECENT and OLD LEPROSY PATIENTS José M
    NAIL CHANGES IN RECENT AND OLD LEPROSY PATIENTS José M. Ramos,1 Francisco Reyes,2 Isabel Belinchón3 1. Department of Internal Medicine, Hospital General Universitario de Alicante, Alicante, Spain; Associate Professor, Department of Medicine, Miguel Hernández University, Spain; Medical-coordinator, Gambo General Rural Hospital, Ethiopia 2. Medical Director, Gambo General Rural Hospital, Ethiopia 3. Department of Dermatology, Hospital General Universitario de Alicante, Alicante, Spain; Associate Professor, Department of Medicine, Miguel Hernández University, Spain Disclosure: No potential conflict of interest. Received: 27.09.13 Accepted: 21.10.13 Citation: EMJ Dermatol. 2013;1:44-52. ABSTRACT Nails are elements of skin that can often be omitted from the dermatological assessment of leprosy. However, there are common nail conditions that require special management. This article considers nail presentations in leprosy patients. General and specific conditions will be discussed. It also considers the common nail conditions seen in leprosy patients and provides a guide to diagnosis and management. Keywords: Leprosy, nails, neuropathy, multibacillary leprosy, paucibacillary leprosy, acro-osteolysis, bone atrophy, type 2 lepra reaction, anonychia, clofazimine, dapsone. INTRODUCTION Leprosy can cause damage to the nails, generally indirectly. There are few reviews about the Leprosy is a chronic granulomatous infection affectation of the nails due to leprosy. Nails are caused by Mycobacterium leprae, known keratin-based elements of the skin structure that since ancient times and with great historical are often omitted from the dermatological connotations.1 This infection is not fatal but affects assessment of leprosy. However, there are the skin and peripheral nerves. The disease causes common nail conditions that require diagnosis cutaneous lesions, skin lesions, and neuropathy, and management.
    [Show full text]