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Published in Ken Addley, MCQs, MEQs and OSPEs in Occupational Medicine, 2023
The following are appropriate and found in patients with psoriasis: Onycholysis: separation of the nail from its bed.Distal nail bed hyperkeratosis: Subungual hyperkeratosis is a disorder characterised by an excessive reproduction of skin cells that accumulate between the nail and the nail bed. Also involves thickening and lifting of the nail.Splinter haemorrhages: A splinter haemorrhage is a longitudinal, red-brown haemorrhage under a nail and looks like a wood splinter.Oil-drop or salmon-patch is a translucent yellow-red discolouration in the nail bed proximal to onycholysis. It reflects inflammation and can be tender.
Onycholysis
Published in Robert Baran, Dimitris Rigopoulos, Chander Grover, Eckart Haneke, Nail Therapies, 2021
Onycholysis is a common disorder with nail plate-nail bed separation leading to a whitish appearance due to the nail transparency (Figure 14.1). The pattern of separation of the plate from the nail bed takes many forms. Sometimes, it closely resembles the damage from a splinter under the nail that is the detachment extending proximally along a convex line, giving the appearance of a half-moon. When the process reaches the matrix, onycholysis becomes complete. Involvement of the lateral edge of the nail alone is less common; in certain cases, the free edge rises up like a hood, or coils open itself like a roll of paper. Onycholysis creates a subungual space that gathers dirt and keratin debris. After a more or less period of onycholysis, the nail bed may epithelialize, leading to a phenomenon that has been sometimes named “disappearing” nail bed (Daniel, Tosti, Iorizzo, and Piraccini 2017) different from that observed with local corticoids, especially in children (see chapter). The grayish-white color, sometimes observed, is due to the presence of air under the nail, but the color may vary from yellow to green or brown, depending on the etiology. In psoriasis, there is usually a red margin visible between the normal pink nail and the separate white onycholytic area (Figure 14.2).
Onycholysis
Published in Nilton Di Chiacchio, Antonella Tosti, Therapies for Nail Disorders, 2020
Shari R. Lipner, Carlton Ralph Daniel
Simple onycholysis is commonly seen in clinical practice, but the true incidence is unknown. Fingernail and toenail onycholysis affect both sexes, but fingernail involvement is much more common in women than men. If the separation is mild, it is typically asymptomatic. However, when moderate-to-severe detachment occurs, patients may experience pain and difficulty performing activities of daily living. Simple onycholysis is most commonly caused by physical trauma. Etiologies of fingernail onycholysis include manicuring, onychophagia, and onychotillomania, while toenail onycholysis is usually due to pressure of the closed shoes on the toes secondary to asymmetric gait.
Pemigatinib in cholangiocarcinoma with a FGFR2 rearrangement or fusion
Published in Expert Review of Anticancer Therapy, 2022
Michael H. Storandt, Zhaohui Jin, Amit Mahipal
With regards to cutaneous adverse effects, including stomatitis, preventative measures, such as oral hygiene and skin moisturizers are recommended, and stomatitis may be managed with dexamethasone, doxycycline and sucralfate oral rinses [39,87]. For intolerable grade 2 or greater toxicity, dermatology consultation should be considered and the FGFR inhibitor may be held for 7 days, and if grade 3 or greater toxicity persists in spite of dose reduction, the medication may require discontinuation [87]. Patients who develop onycholysis should undergo evaluation for onychomycosis [39]. Management of chronic dermatologic and nail toxicities becomes more relevant as patients remain on FGFR inhibitors for longer duration. Early consultation with podiatry can potentially be beneficial in managing the AEs.
Use of in vitro performance models in the assessment of drug delivery across the human nail for nail disorders
Published in Expert Opinion on Drug Delivery, 2018
Marc Brown, Rob Turner, Sean Robert Wevrett
Distal and lateral subungual onychomycosis is the most prevalent form of the nail condition and is commonly believed to take hold in a fissure at the lateral edge of the nail, as often individual nails present the disease while other nails on the same hand or foot will be asymptomatic. The infection then spreads to the underside of the nail and the nail bed, where hyperkeratosis leads to onycholysis. At this stage, the nail may thicken and become friable and then lift away from the nail bed [11,18], which reduces the effectiveness of systemic treatment as the fungus occupies an air space through which a drug cannot permeate. Furthermore, onychomycosis does not spontaneously resolve without treatment and can take up to a year to correct using current topical or systemic treatments [1–3,20,21]. There is also thought to be a 50% rate of recurrence when adhering to the current recommended treatment procedures [22], potentially due to reinfection from fungal spores in the environment, such as within socks.
Dermatological side effects of targeted antineoplastic therapies: a prospective study
Published in Cutaneous and Ocular Toxicology, 2020
Senay Agirgol, Ceyda Çaytemel, Kezban Nur Pilanci
Side effects involving the nail and paronychia and pyogenic granuloma were observed in two patients using trastuzumab and cetuximab. Pyogenic granuloma developed on the nails and teeth and continued throughout the treatment duration. Onycholysis was observed in three patients using trastuzumab. Trichomegaly of the hair shaft abnormalities developed in one subject using sunitinib; madarosis developed in two patients using sunitinib and trastuzumab. Hyperkeratotic hand-foot syndrome developed in three patients, two of whom were using cetuximab and one of whom was using sunitinib. Total alopecia developed in one patient using cetuximab and trastuzumab. The skin side effects of all patients were mild to moderate, and all managed to complete the chemotherapy process.