R L Baran

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..The Psoriasis Area and Severity Index does not take the severity of nail involvement into account...

..However, in a minority of difficult cases, expert dermatological evaluation is needed...

..As onychomycosis is an important medical disorder affecting both patient's health and quality of life, it requires prompt and effective treatment...

..Multielemental characterization of human hair and nails shows that even after sample washing, many elements are enriched in the surface of the nails...

..Altogether, 13 patients with onychomycosis, aged 25-78 years, most with involvement of the matrix region, were treated. A solution of 1% fluconazole and 20% urea in a mixture of ethanol and water was applied once daily, at bedtime...

..None of the current drug regimens have demonstrated reliable efficacy against all cases of onychomycosis. Treatment failures, relapses and reinfections remain stubborn problems in the management of onychomycosis...

..Nail thickening of idiopathic or hereditary aetiology originating in the matrix is difficult to treat. OBJECTIVE; The purpose is to describe an easy surgical technique to reduce the thickness of the nail...

..This article discusses the most common defects associated with the nail unit and its surrounding tissue, as well as the differential diagnosis and treatment of these conditions...

..Tumors in the nail area are relatively frequent. Nail fungal infection may be isolated or associated with conditions such as psoriasis and diabetes. The management of the main nail disorders observed in the elderly are presented...

..Treatment takes many months and therapeutic choices can increase clinical effectiveness, lower toxicity and minimize healthcare costs...

..Nail degloving represents the end result of a variety of insults to the nail apparatus, including trauma, dermatologic diseases, and drug reactions...

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..Among the therapeutic possibilities for onychomycosis, chemicalnail avulsion is a logical approach to the eradication of the pathogen...

..The purpose of this paper will be focused on red nails that can present principally with red lunulae, solitary longitudinal erythronychia and multiple longitudinal erythronychia. Other aspects of this feature will also be raised...

..This article discusses the results obtained by authors who have varied the standard duration of therapy, increased the dosage of the oral antifungal agents, or have used two oral drugs in treating this condition...

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..Photoonycholysis may be seen as a part of Segal's triad, photosensitivity followed by discoloration of the nails and onycholysis. But the latter may also appear, independently, in the absence of photosensitive reaction elsewhere...

..Matricectomy may be indicated for the management of onychauxis, onychogryphosis, congenital nail dystrophies, and chronic painful nail, such as recalcitrant ingrown toenail or split within the medial or lateral one-third of the nail...

..This open randomized study examined the efficacy of a combination of oral terbinafine and topical amorolfine in the treatment of severe dermatophyte toenail onychomycosis with matrix area involvement...

..The clinician will have to choose among three main possibilities: topical therapy with the new nail lacquers, new oral drugs, and removal of the nail plate. A combination of different modalities often provides the best option...

..Histological study showed a myxoid tumour but with, unexpectedly, a diffuse expression of CD34. Differential diagnoses between perineurioma and myxoid soft tissue tumours expressing CD34 are discussed...

..Caution is necessary in interpreting formaldehyde patch testing reactions...

..At the same time a pilot pharmacoeconomic analysis was performed demonstrating a better cost per cure ratio for the patients receiving combination treatment...

..Systemic drugs either in isolation or in combination with topical treatment are mandatory when deep penetration or ventral fungal invasion are observed...

..A new 8% ciclopirox-medicated nail lacquer (P-3051), based on a new technology, revealed superior properties in terms of affinity to keratin, nail permeation, and ease of use...

..We have therefore suggested that the term 'localized, distal, subungual keratosis with multinucleate cells' should be replaced by 'onychopapilloma' (nail-producing papilloma)...

..Long-term management with the nail lacquers applied twice a month should still improve the cure rate and its economic implication...

..Distal digital keratoacanthoma (DKA) is an uncommon tumor difficult to diagnose clinically, and even histologically, with certainty...

..In the matrix an increase in melanin content of melanocytes was found without melanocytic proliferation. LM due to onychotillomania should not be overlooked...

..Endogenous. In this group, the nail plate is altered secondarily by changes occurring in the matrix, proximal nail fold, nail bed, hyponychium or underlying bony phalanx...

..In this commentary the arguments are discussed for a potential role of lymphatic dissemination in the development of proximal white subungual onychomycosis, where invasion of the nail plate by fungi proceeds from the proximal nail fold...

..Most treatment modalities will require long-term use from 3 to 9 months to be most effective, with strategies presented in Part II of this review...

..Combined therapies are shown to increase cure rates. Mechanical interventions are essential in reducing fungal burdens to allow other modalities to penetrate, especially in dermatophytomas and onycholysis...

..We review the main drug combinations that have been tested. Additional measures, such as mechanical intervention, may help improve response rates further...

..The most common adverse events are gastrointestinal upset, headache, and transient skin reaction. There have also been rare reports of hepatitis...

..Its V-shaped expression in epithelium ridges offers early identification of the keratogenous zone of OM, on tumors separated from their nail plates and limited to their fibroepithelial components...

..Topical agents have a favorable adverse events profile. Further studies are required on the treatment of onychomycosis with nail lacquers...

..While many patients with non-dermatophyte mold onychomycosis will respond to oral or topical antifungal therapy, poor or incomplete response might still be expected in some patients...

..However, these agents appear to be effective and safe in this indication...

..Longitudinal erythronychia (LE) is a term for red streaks in the nail. We describe the range of diseases manifested by localized (single or bifid) LE and explain the underlying physical changes...

..The term describes a combination of proximal nail plate ingrowth into the proximal nail fold which is associated with multiple generations of nail plate misaligned beneath the proximal nail...

..Oral therapy can potentially reduce resource utilization and health care system costs, improve drug safety, and enhance patient satisfaction...

..The main clinical implication is that in combined forms, or where the infection emerges from beneath the proximal nailfold, systemic rather than topical antifungal therapy is advised...

..We report 3 cases of transverse melanonychia secondary to total skin electron beam therapy in patients who were treated for mycosis fungoides...

..Myxoid cysts located beneath the nail are very different from those within the nailfold and there is no established literature on their diagnosis and therapy...

..In this article, we will review the management, including diagnosis as well as differential diagnosis of nail pigmentations and propose a new algorithm for the non invasive diagnosis of nail pigmentation...