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Basics of onychopathology
Published in Archana Singal, Shekhar Neema, Piyush Kumar, Nail Disorders, 2019
The histological differential diagnosis comprises parakeratosis pustulosa of Hjorth, pityriasis rubra pilaris, acrokeratosis paraneoplastica of Bazex, crusted (Norwegian) scabies, some drug reactions, and above all onychomycosis, the exact histopathological diagnosis of which requires the demonstration of invasive fungi.
Inflammatory dermatoses affecting the nail
Published in Eckart Haneke, Histopathology of the NailOnychopathology, 2017
Acrokeratosis paraneoplastica of Bazex is a paraneoplastic dermatosis mainly due to cancers of, and metastases to, the upper aero-digestive tract. The skin of the tips of the digits, of the ears, and of the nose develops a violaceous hue and psoriasiform hyperkeratosis.45,46 The nails are the first to show alterations with thinning and fragility.47 Later the nails become flaky, whitened, and develop subungual hyperkeratosis. Finally, the nail may be replaced by epidermis. The histopathological alterations are nonspecific with a lymphocytic perivascular infiltrate in the upper dermis, mild acanthosis, and hyperkeratosis with some parakeratosis.48
Seborrheic dermatitis with massive facial hyperkeratosis resembling acquired ichthyosis
Published in Baylor University Medical Center Proceedings, 2020
Brett A. Austin, Alan Vu, William D. Boothe, Cloyce L. Stetson
Although massive hyperkeratosis is unusual for SD, the diagnosis was supported by the symmetric distribution of hyperkeratotic scale on our patient’s face, the presence of budding yeast on the biopsy, and the near complete resolution with oral fluconazole and topical ketoconazole shampoo treatment. In this patient’s case, ketoconazole shampoo was preferable to cream as it is washed off after 5 min, avoiding messy buildup. Clinically there was minimal erythema and no pruritus, as seen in pityriasis versicolor, another Malassezia dermatosis, though our patient lacked truncal involvement. Differential diagnoses of acquired ichthyosis and acrokeratosis paraneoplastica of Bazex were also considered but were not supported by the lack of additional exam findings; in particular, the patient’s acral skin and legs were unremarkable. This presentation highlights the hyperproliferative processes underlying SD’s pathophysiology and may provide insight into Malassezia’s role in the development of SD.