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Hepatomegaly
Published in K. Gupta, P. Carmichael, A. Zumla, 100 Short Cases for the MRCP, 2020
K. Gupta, P. Carmichael, A. Zumla
Look for signs of liver disease: - Check for supraclavicular nodes.- Look for spider naevi (upper limbs, face and thorax = drainage of the superior vena cava).- Examine nails for leuconychia.- Examine for Dupuytren's contractures.- Inspect for raised jugular venous pulse.- Look for jaundice.- Look and palpate for gynaecomastia.- Check for testicular atrophy.- Examine for pedal oedema.- Look for absence of secondary sexual hair.
Chemotherapeutic-Induced Nail Reactions
Published in Gabriella Fabbrocini, Mario E. Lacouture, Antonella Tosti, Dermatologic Reactions to Cancer Therapies, 2019
Eric Wong, Maria Carmela Annunziata, Antonella Tosti
Apparent leukonychia present as parallel, white bands that disappear with pressure. As opposed to true leukonychia, apparent leukonychia does not migrate with growth of the nail plate (1). The exact pathogenesis of leukonychia is unknown, but they are believed to be caused by damage to the nail bed vessels leading to variable blood flow (1,18,11). Muehrcke's nails are a typical example of apparent leukonychia due to chemotherapy (Figure 9.4) (8). Apparent leukonychia is a common side effect of combined chemotherapy. It has also been in reported patients on doxorubicin and tyrosine kinase inhibitors (TKIs), including sorafebnib, sunitinib, and imatinib (8,33). Apparent leukonychia typically resolves with discontinuation of medication (18).
Nails in systemic disease
Published in Archana Singal, Shekhar Neema, Piyush Kumar, Nail Disorders, 2019
Leukonychia refers to the white discoloration of the nail plate. It is traditionally classified into three subtypes.1,2True leukonychia – Pathology originates in matrix and emerges in the nail plate. Here nails are porcelain white; this may be due to chronic liver disease, but there are rare inherited forms (Figure 20.12).Apparent leukonychia – Here, the pathology is in the nail bed. On pressure, the leukonychia becomes less apparent and this maneuver differentiates apparent leukonychia from true leukonychia.Pseudo leukonychia – Nail plate pathology is exogenous, for example, onychomycosis.
A new method to treat onychopapilloma with pulsed dye laser irradiation: a 13-case series report
Published in Journal of Dermatological Treatment, 2023
Xing Fan, Tong Li, Xi Zhang, Juan Yang, Jiangbo Cui, Wenjie Dou, Yue Yin, Qing Yang, Ping Xue, Bin Liu, Yang Li
No obvious difference is observed between the effectiveness and the recurrence rate of laser treatment and those of surgical treatment. Recurrence after surgical resection may be linked to incomplete excision (4). In this series of cases, the effective rate is 77% and the recurrence rate is 23% overall. However, the effective rate for erythronychia satisfactorily reaches 88%, with a cure rate of 39%. In contrast, the effective rate of leukonychia or melanonychia is low, without any case of cure. Such differences may result from differences in the pathogenesis of these conditions. For example, melanonychia may be due to oxyhemoglobin formed after nail bed hemorrhage, or due to activation of melanocytes. Dermoscopic examination suggests that the treatment of melanonychia caused by bleeding is satisfactory. Future studies are needed to test whether Q-switched laser, often used to treat pigmented disorders, can be used to treat melanonychia with active melanocytes.
Development of Terry’s nails after a gastrointestinal bleed
Published in Baylor University Medical Center Proceedings, 2021
Christine P. Lin, Mahmud Alkul, Jay M. Truitt, Cloyce L. Stetson
The differential diagnoses for Terry’s nails include Lindsay’s (half and half) nails, Muehrcke’s nails, and true leukonchyia.1 Although both Terry’s nails and Lindsay’s nails are associated with chronic kidney disease and characterized by ground-glass opacities, the proximal nail bed whiteness in Terry’s nails occupies approximately 80% of nail while only about half of the proximal nail bed is opacified in Lindsay’s nails.1,4 In Muehrcke’s nails, transverse white lines run parallel to the lunula and are separated by areas of normal pink nail bed color. They are often seen in association with hypoalbuminemia (e.g., from nephrotic syndrome, liver diseases, malnutrition) and chemotherapy.5 True leukonychia may mimic Terry’s nails, but true leukonychia involves the nail plate instead of the nail bed. Thus, a true leukonychia will grow out with the nail while Terry’s nails retain the proximal nail discoloration as the nail grows out.1
Focussing on the foot in psoriatic arthritis: pathology and management options
Published in Expert Review of Clinical Immunology, 2018
Aimie Patience, Philip S. Helliwell, Heidi J. Siddle
Nail disease in PsA (Figure 1) can be divided into changes arising from the nail matrix and changes involving the nail bed. Typical nail matrix disease includes leukonychia (white discoloration), onychorrhexis (nail ridging), nail pitting, and blood spots on the lunula whereas nail bed disease can present as onycholysis (separation of the nail from the nail bed) (Figure 2), splinter hemorrhages, and subungual hyperkeratosis [9]. There are a number of scoring systems to assess the extent of nail disease including the Nail Psoriasis Severity Index and the Psoriasis Nail Severity Score [14,15] but it is often difficult to differentiate from bacterial and fungal infections which can mimic the presentation of psoriatic nail disease.