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Lichen Planus
Published in Nilton Di Chiacchio, Antonella Tosti, Therapies for Nail Disorders, 2020
Bianca Maria Piraccini, Aurora Alessandrini, Michela Starace
Bullous LP of the nails is an uncommon and extreme variant of LP where bullous or ulcerative lesions develop in the matrix and nail bed resulting in complete shedding of the nail plate and nail scarring combine with bullae and erosions on the soles and occasionally on the palms.17 It can affect fingernails or toenails: absence of the nail plates, nail bed erosions, and marked inflammation of the periungual skin lead to total nail loss with anonychia (Figure 11.4).
Nail changes due to systemic drugs
Published in Archana Singal, Shekhar Neema, Piyush Kumar, Nail Disorders, 2019
Some drugs, if taken during pregnancy, may interfere with nail development of the fetus and result in nail abnormalities of newborns. Nail development begins at 8–10 weeks of gestational age and is completed by the fifth month of gestational age; hence, intake of teratogens by mother during the 1st and 2nd trimester of pregnancy adversely affects nail development. The nail abnormalities range from mild hypoplasia to complete absence of the nails, i.e., anonychia. Anonychia secondary to teratogenic drugs commonly occurs with phenytoin and warfarin and has also been reported with valproate, carbamazepine, morphine, and trimethadione (Figure 23.14).4,5
Nail specific conditions
Published in Eckart Haneke, Histopathology of the NailOnychopathology, 2017
Anonychia is the absence of nail. It may be hereditary or acquired. Isolated anonychia has been described as an autosomal dominant as well as a recessive trait.1–4 Sporadic cases occur.5 Often, some nails are lacking and others are hypoplastic or the nails of some fingers, such as the thumb, are absent.6 The association of both nail aplasia and hypoplasia suggests that the development of the nail anlage was arrested at different time points.7 Aplastic anonychia is observed when the distal phalanx is absent.8–10 Here a tiny keratotic spicule may be seen at the tip in prolongation of the finger axis, which may be taken as evidence that the nail development starts at the most distal point and not at the dorsum of the digit.11 Anonychia keratodes is a condition where the nail field does not have a nail plate and only some keratosis is present instead of a nail. Many congenital syndromes are associated with anonychia or hyponychia.12 The onychotic types of ectodermal dysplasias usually have a hypoplastic nail. Progressive loss of the nail is commonly seen in hereditary epidermolysis bullosa, particularly in the dystrophic forms. Acquired anonychia or hyponychia may be due to trauma or drugs.
Atypical skin manifestations in late-onset lupus: challenging diagnosis
Published in Scandinavian Journal of Rheumatology, 2023
S Méndez-Flores, M Saeb-Lima, G Hernández-Molina
Case 1: A 74-year-old woman presented with brown–squamous plaques at the neck, trunk, and extremities, which appeared 8 months ago (Figure 1(A)). In the previous months, she also experienced low-grade fever, weight loss, anorexia, purpuric lesions involving the palms and soles, small non-confluent ulcers on the distal third of the lower extremities, and anonychia of the left toe (Figure 1B). She denied photosensitivity, hair loss, oral aphthaes, and relevant drug use. Computed tomography ruled out solid organ neoplasia and any other relevant findings. Upon hospital admission, she had normocytic normochromic anaemia, leucolymphopenia, high erythrocyte sedimentation rate, positive anti-nuclear antibody (ANA) (1:320 mitochondrial pattern), low C3 and C4, and positive anti-double-stranded DNA (anti-dsDNA) antibody. Cryoglobulins, anti-ribonucleoprotein (anti-RNP), anti-Smith (anti-Sm), anti-Sjögren’s syndrome antigens A and B (anti-Ro/SSA and anti-La/SSB), anti-cardiolipin, anti-β2-glycoprotein I (anti-B2-GPI), lupus anticoagulant, and anti-neutrophil cytoplasmic antibody (ANCA) antibodies tested negative (Table 1).
Treatment of acrodermatitis continua of hallopeau with ixekizumab
Published in Journal of Dermatological Treatment, 2021
Austinn C. Miller, Timothy E. Holland, David J. Cohen
ACH is a very difficult disorder to treat, which is often frustrating for both the patient and treating clinician. Oftentimes patients are trialed with multiple therapies before an effective, or even marginally helpful treatment is found. The natural course of ACH may lead to atrophied skin, onychodystrophy, anonychia, and osteolysis, which all have the potential to be very debilitating for the affected patient (1). Therefore, quick and accurate diagnosis is paramount to effective care.