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When all you have is a dermatoscope- start looking at the nails.

Haenssle HA, Blum A, Hofmann-Wellenhof R, Kreusch J, Stolz W, Argenziano G, Zalaudek I, Brehmer F - Dermatol Pract Concept (2014)

Bottom Line: The formation of continuous, longitudinal pigmented streaks (longitudinal melanonychia) may either be caused by a benign activation of matrix melanocytes (e.g., as a result of trauma, inflammation, or adverse drug reactions) or by a true melanocytic proliferation (e.g., in a nevus or melanoma).Important and common differential diagnoses in these cases are subungual hemorrhage or onychomycosis.Benign or malignant neoplasms that may also affect the nail unit include glomus tumor, Bowen's disease, squamous cell carcinoma, and rare collision tumors.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany ; Department of Dermatology, Venereology and Allergology, University Medical Center Heidelberg, Heidelberg, Germany.

ABSTRACT
Pigmented and non-pigmented nail alterations are a frequent challenge for dermatologists. A profound knowledge of clinical and dermatoscopic features of nail disorders is crucial because a range of differential diagnoses and even potentially life-threatening diseases are possible underlying causes. Nail matrix melanocytes of unaffected individuals are in a dormant state, and, therefore, fingernails and toenails physiologically are non-pigmented. The formation of continuous, longitudinal pigmented streaks (longitudinal melanonychia) may either be caused by a benign activation of matrix melanocytes (e.g., as a result of trauma, inflammation, or adverse drug reactions) or by a true melanocytic proliferation (e.g., in a nevus or melanoma). In general, non-continuous nail alterations, affecting only limited parts of the nail apparatus, are most frequently of non-melanocytic origin. Important and common differential diagnoses in these cases are subungual hemorrhage or onychomycosis. In addition, foreign bodies, bacterial infections, traumatic injuries, or artificial discolorations of the nail unit may less frequently cause non-continuous nail alterations. Many systemic diseases that may also show involvement of the nails (e.g., psoriasis, atopic dermatitis, lichen planus, alopecia areata) tend to induce alterations in numerous if not all nails of the hands and feet. A similar extensive and generalized alteration of nails has been reported after treatment with a number of systemic drugs, especially antibiotics and cytostatics. Benign or malignant neoplasms that may also affect the nail unit include glomus tumor, Bowen's disease, squamous cell carcinoma, and rare collision tumors. This review aims to assist clinicians in correctly evaluating and diagnosing nail disorders with the help of dermatoscopy.

No MeSH data available.


Related in: MedlinePlus

(A) Algorithm for the dermatoscopic evaluation on the nail unit. In a first step, a differentiation between melanocytic and non-melanocytic alterations is made. In a second step, the alterations of melanocytic origin, that normally present as longitudinal melanonychia, need to be separated into benign (activation or proliferation) or malignant lesions. (B) The icons depict the most common dermatoscopic criteria of six frequent nail alterations in a much simplified manner. (Copyright: ©2014 Haenssle et al.; first published in Der Hautarzt, 2014, 65(4):301–11.)
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f1-dp0404a02: (A) Algorithm for the dermatoscopic evaluation on the nail unit. In a first step, a differentiation between melanocytic and non-melanocytic alterations is made. In a second step, the alterations of melanocytic origin, that normally present as longitudinal melanonychia, need to be separated into benign (activation or proliferation) or malignant lesions. (B) The icons depict the most common dermatoscopic criteria of six frequent nail alterations in a much simplified manner. (Copyright: ©2014 Haenssle et al.; first published in Der Hautarzt, 2014, 65(4):301–11.)

Mentions: The clinical and dermatoscopic evaluation of nail alterations is often a diagnostic challenge for dermatologists in their daily practice. Regarding the variety of different patterns, it is helpful to follow a standardized diagnostic algorithm (Figure 1A) and to memorize the dermatoscopic features of the most frequent nail disorders as depicted by the schematic icons in Figure 1B [1]. In agreement with the evaluation of pigmented lesions elsewhere on the skin, a multi-step diagnostic procedure has proven to be successful [2]. A first step is dedicated to the differentiation of a melanocytic origin (longitudinal melanonychia) from a non-melanocytic origin of the nail pigmentation (non-continuous discoloration).


When all you have is a dermatoscope- start looking at the nails.

Haenssle HA, Blum A, Hofmann-Wellenhof R, Kreusch J, Stolz W, Argenziano G, Zalaudek I, Brehmer F - Dermatol Pract Concept (2014)

(A) Algorithm for the dermatoscopic evaluation on the nail unit. In a first step, a differentiation between melanocytic and non-melanocytic alterations is made. In a second step, the alterations of melanocytic origin, that normally present as longitudinal melanonychia, need to be separated into benign (activation or proliferation) or malignant lesions. (B) The icons depict the most common dermatoscopic criteria of six frequent nail alterations in a much simplified manner. (Copyright: ©2014 Haenssle et al.; first published in Der Hautarzt, 2014, 65(4):301–11.)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4230252&req=5

f1-dp0404a02: (A) Algorithm for the dermatoscopic evaluation on the nail unit. In a first step, a differentiation between melanocytic and non-melanocytic alterations is made. In a second step, the alterations of melanocytic origin, that normally present as longitudinal melanonychia, need to be separated into benign (activation or proliferation) or malignant lesions. (B) The icons depict the most common dermatoscopic criteria of six frequent nail alterations in a much simplified manner. (Copyright: ©2014 Haenssle et al.; first published in Der Hautarzt, 2014, 65(4):301–11.)
Mentions: The clinical and dermatoscopic evaluation of nail alterations is often a diagnostic challenge for dermatologists in their daily practice. Regarding the variety of different patterns, it is helpful to follow a standardized diagnostic algorithm (Figure 1A) and to memorize the dermatoscopic features of the most frequent nail disorders as depicted by the schematic icons in Figure 1B [1]. In agreement with the evaluation of pigmented lesions elsewhere on the skin, a multi-step diagnostic procedure has proven to be successful [2]. A first step is dedicated to the differentiation of a melanocytic origin (longitudinal melanonychia) from a non-melanocytic origin of the nail pigmentation (non-continuous discoloration).

Bottom Line: The formation of continuous, longitudinal pigmented streaks (longitudinal melanonychia) may either be caused by a benign activation of matrix melanocytes (e.g., as a result of trauma, inflammation, or adverse drug reactions) or by a true melanocytic proliferation (e.g., in a nevus or melanoma).Important and common differential diagnoses in these cases are subungual hemorrhage or onychomycosis.Benign or malignant neoplasms that may also affect the nail unit include glomus tumor, Bowen's disease, squamous cell carcinoma, and rare collision tumors.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany ; Department of Dermatology, Venereology and Allergology, University Medical Center Heidelberg, Heidelberg, Germany.

ABSTRACT
Pigmented and non-pigmented nail alterations are a frequent challenge for dermatologists. A profound knowledge of clinical and dermatoscopic features of nail disorders is crucial because a range of differential diagnoses and even potentially life-threatening diseases are possible underlying causes. Nail matrix melanocytes of unaffected individuals are in a dormant state, and, therefore, fingernails and toenails physiologically are non-pigmented. The formation of continuous, longitudinal pigmented streaks (longitudinal melanonychia) may either be caused by a benign activation of matrix melanocytes (e.g., as a result of trauma, inflammation, or adverse drug reactions) or by a true melanocytic proliferation (e.g., in a nevus or melanoma). In general, non-continuous nail alterations, affecting only limited parts of the nail apparatus, are most frequently of non-melanocytic origin. Important and common differential diagnoses in these cases are subungual hemorrhage or onychomycosis. In addition, foreign bodies, bacterial infections, traumatic injuries, or artificial discolorations of the nail unit may less frequently cause non-continuous nail alterations. Many systemic diseases that may also show involvement of the nails (e.g., psoriasis, atopic dermatitis, lichen planus, alopecia areata) tend to induce alterations in numerous if not all nails of the hands and feet. A similar extensive and generalized alteration of nails has been reported after treatment with a number of systemic drugs, especially antibiotics and cytostatics. Benign or malignant neoplasms that may also affect the nail unit include glomus tumor, Bowen's disease, squamous cell carcinoma, and rare collision tumors. This review aims to assist clinicians in correctly evaluating and diagnosing nail disorders with the help of dermatoscopy.

No MeSH data available.


Related in: MedlinePlus