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Interesting nail cases from Miami
Antonella TostiFredric Brandt Endowed Professor of
Dermatology&Cutaneous Surgery Miller School of Medicine, University of Miami
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Antonella Tosti, MDF091 Interesting nail cases from Miami
DISCLOSURES
Fotofinder :Consultant, Erconia Laser : PI, Springer & Verlag, Taylor&Francis: Author-Royalties , Karger : Editor in chief
DISCLOSURE OF RELATIONSHIPS WITH INDUSTRY
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65 year old woman
Diabetes and chronic kidneydisease in dialysis
Nail “infection” since a few months, recently worsened
Complains of paresthesia of the fingertips
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Carpal tunnel syndrome
Treatment: nitroglycerin transdermal patch
Nerve conduction study
Patient referred to hand surgeon
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Carpal tunnel syndrome
After 2 weeks of treatment with nitroglycerin transdermal patch
Diagnosis confirmed by nerve conduction study
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Carpal tunnel syndromeDiagnostic clues
Nail abnormalitiesrestricted to theanatomical distributionof the median nerve
Neurological symptoms
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Take Home MessageThink of carpal tunnel syndrome in patients with nail abnormalities involving first three fingers.Fingertip paresthesia is typically associated. Depending on the severity of nerve damage, nail changes vary from Beau’s lines to onychomadesis and necrosis. Neurological examination and electromyography confirm the diagnosis. Treatment : nail lesions are cured by surgery in most cases
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62 -year old lady
Bending of her 3°, 4° and 5° fingernails
No evidence of pulp atrophy, sclerosis or digital ulceration.
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Parrot beak nails
The nails straighten whenimmersed in water for 30 min
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Parrot beak nails
Primary as in this case
Secondary to conditions causingfinger pulp atrophy
Scleroderma
Cocaine abuse
Desai T, Magdum A, Patel T, Loghdey S. Parrot-beak nails. Clin Exp Dermatol.2011 Mar;36(2):208-9.
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74 year oldwoman
nail discolorationsince 2 years
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Convex proximalborder
Superficial scaling
Exogeneous nail discoloration
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Exogeneous nail discoloration
Patient was regularlyapplying a self tanninglotion to her legs
Herskovitz I, Nolan BV, Tosti A. Orange chromonychia due to dihydroxyacetone. Dermatitis. 2014 Jan-Feb;25(1):43-4.
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74 year old womanNail discoloration of all fingernails for 5 years
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Endogeneous nail discoloration
Concave proximal border
More marked around lunula
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Daily intake of colloidal silver to treat occasional sore throats for twenty years
No skin or mucosal pigmentation
Argyria
Fox J, D, Baker J, A, Tosti A, Chromonychia in an Asymptomatic Vitamin Consumer. Skin Appendage Disord 2015;1:131-133
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There are no known chelating agents or other treatments for argyria.
1064-nm Q-switched Nd:YAG laser has been used in cutaneous argyria.
Argyria
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Nail discoloration : look at the shape of proximal border!
Exogenous : convex proximal border Endogenous : concave proximal border
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61 year-old man
Milia and hemorrhagic bullaeon the dorsum of the hands
Nail abnormalities
Progressive alopecia
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Thinning
Longitudinalridging
Onychorrexis
Nail abnormalities
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Longitudinal incisional nail biopsy demonstrating striking amorphous pink deposits (arrowheads) in the nail matrix, dermis and vessels.
Systemic amyloidosis
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Systemic amyloidosis
A bone marrow biopsy revealed multiple myeloma
The patient underwent four rounds of chemotherapy with cyclophosphamide-bortezomib-dexamethasone (CyBorD) before undergoing an autologous stem cell transplant, followed by maintenance bortezomibtherapy
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Systemic amyloidosisPatient was cured and is still symptom free after 3 years, his skin and nail changes resolved 1 year after treatment
First case showing resolution of nail amyloidosis after successful bone marrow transplantation
Oberlin KE, Wei EX, Cho-Vega JH, Tosti A. Resolution of Nail Changes of Systemic Amyloidosis After Bone-Marrow Transplantation in a Patient With Multiple Myeloma. JAMA Dermatol. 2016 Dec 1;152(12):1395-1396