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Diseases of the Nails
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Definition: This tumor of the distal matrix and nail bed is usually benign. It shows a monodactylous longitudinal streak beneath the nail plate as an erythronychia or sometimes a leukonychia but rarely as melanonychia.
Hematomas
Published in Nilton Di Chiacchio, Antonella Tosti, Therapies for Nail Disorders, 2020
Nail hematoma has a broad differential diagnosis and includes etiologies of melanonychia. Recognition of characteristic features from the history and physical examination are helpful in ruling in/out other nail disorders. For example, a history of significant wet work, onycholysis, and green-black discoloration of the nail plate may be a sign of green nail syndrome due to Pseudomonas aeruginosa nail infection. An expanding black band involving the hallux, with pigment involving the proximal nail fold (Hutchinson's sign) warrants a nail matrix biopsy to rule out subungual melanoma.3Table 8.1 summarizes the differential diagnosis of subungual hematoma.
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
Melanonychia is a black or brown longitudinal or transverse pigmentation of the nail plate due to production of melanin pigment from activated melanocytes in nail matrix (Figure 9.4) (1,3,18,19). Drug-induced melanonychia usually affects several or all nails and presents as soon as 3–8 weeks after starting a medication (Figure 9.5). It can be associated with other skin and mucosal pigmentation, and with other nail abnormalities due to chemotherapy (8). This discoloration can be reversible once the drug is stopped, however, this may take weeks to months to allow the nail to grow out (11). Chemotherapeutic agents most commonly reported in causing melanonychia include hydroxyurea (hydroxycarbamide), methotrexate, bleomycin, cyclophosphamide, anthracyclines (daunorubicin), and 5-fluorouracil (18,21).
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.
Onychopapilloma: a rare cause of longitudinal melanonychia. Usually benign (but not always). A case report
Published in Case Reports in Plastic Surgery and Hand Surgery, 2021
Stuart H. Kuschner, Bonnie Balzer, Ryan DellaMaggiora
A definitive diagnosis is made via biopsy. When to biopsy and when to observe a longitudinal chromonychia can be influenced by several factors. A painful lesion merits the discovery of an underlying cause. Much longitudinal chromonychia is painless however, Jellinek, in a discussion of localized (single digit) longitudinal erythronychia, stated that biopsy ‘should be considered’ for any ‘evolving’ or ‘changing’ or new band [13]. Good advice regardless of the color of the lesion and especially so for a brown or black band (melanonychia) where there is a risk of melanoma. If a biopsy of the lesion or surgical excision is deferred, then careful documentation of findings, including photographs, with regular follow-up is advised [13]. Peri-ungual extension of pigment from a longitudinal melanonychia onto the proximal or lateral nail folds – Hutchinson sign – can indicate melanoma and would warrant a biopsy.
Laugier-Hunziker syndrome: complete clearance of mucosal lentigines with a single session of Q-Switched Nd:YAG laser
Published in Journal of Cosmetic and Laser Therapy, 2019
Pigmented spots in the oral mucosa are a common problem for which patients present to dermatologists, ENT specialists, and dentists. Laugier-Hunziker syndrome (LH syndrome) is a condition characterized by mucosal lentigines in the oral cavity with or without lentigines on acral parts of the body and longitudinal melanonychia. Laugier and Hunziker first described this condition in 1970 as a condition characterized by adult-onset oral pigmentation and sometimes similar genital lesions(1). Longitudinal melanonychia was added to the description of the syndrome a decade later(2). Clinically the condition mimics Puetz-Jeghers syndrome but it does not have a familial predisposition or malignant potential(3). Its etiology is still unknown.