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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

Subungual hematoma after trauma. (A) Overview. (B–C) Dermatoscopy. The characteristic red-blue to blue-black homogeneous color, numerous satellite droplets towards the distal nail edge and the jagged margins are depicted. (Copyright: ©2014 Haenssle et al.)
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f4-dp0404a02: Subungual hematoma after trauma. (A) Overview. (B–C) Dermatoscopy. The characteristic red-blue to blue-black homogeneous color, numerous satellite droplets towards the distal nail edge and the jagged margins are depicted. (Copyright: ©2014 Haenssle et al.)

Mentions: In addition to the subcorneal hemorrhage, the subungual hemorrhage (also called subungual hematoma) is one of the most frequent differential diagnoses of acral pigmented lesions. A detailed documentation of the lesion history should give first evidences for the causes of the subungual hemorrhage (e.g., trauma, anticoagulation). It usually appears as a reddish-blue to blue-black pigmentation that does not longitudinally involve the whole nail. The characteristic dermatoscopic findings of subungual hemorrhage are homogeneous or globular patterns, streaks, peripheral fading and also periungual hemorrhages of adjacent skin [10]. Moreover, small, globular blood dots directed towards the distal end of the nail plate are a highly characteristic dermatoscopic feature that often leads to the correct diagnosis (Figure 4A-C). Importantly, a proximal subungual hematoma may be visible through the widely transparent cuticula; this should not be confused with the (micro-) Hutchinson sign characterizing a subungual melanoma. Subungual hemorrhage will continuously be transferred towards the distal edge of the nail at the speed of the nail growth. Sequential digital dermatoscopy follow-up may confidently be used to document the progressive “growing-out” of a subungual hemorrhage. Any subungual hemorrhage that persists and eventually forms a longitudinal pigmentation involving the complete nail apparatus requires further diagnostic procedures including biopsy.


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)

Subungual hematoma after trauma. (A) Overview. (B–C) Dermatoscopy. The characteristic red-blue to blue-black homogeneous color, numerous satellite droplets towards the distal nail edge and the jagged margins are depicted. (Copyright: ©2014 Haenssle et al.)
© Copyright Policy
Related In: Results  -  Collection

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

f4-dp0404a02: Subungual hematoma after trauma. (A) Overview. (B–C) Dermatoscopy. The characteristic red-blue to blue-black homogeneous color, numerous satellite droplets towards the distal nail edge and the jagged margins are depicted. (Copyright: ©2014 Haenssle et al.)
Mentions: In addition to the subcorneal hemorrhage, the subungual hemorrhage (also called subungual hematoma) is one of the most frequent differential diagnoses of acral pigmented lesions. A detailed documentation of the lesion history should give first evidences for the causes of the subungual hemorrhage (e.g., trauma, anticoagulation). It usually appears as a reddish-blue to blue-black pigmentation that does not longitudinally involve the whole nail. The characteristic dermatoscopic findings of subungual hemorrhage are homogeneous or globular patterns, streaks, peripheral fading and also periungual hemorrhages of adjacent skin [10]. Moreover, small, globular blood dots directed towards the distal end of the nail plate are a highly characteristic dermatoscopic feature that often leads to the correct diagnosis (Figure 4A-C). Importantly, a proximal subungual hematoma may be visible through the widely transparent cuticula; this should not be confused with the (micro-) Hutchinson sign characterizing a subungual melanoma. Subungual hemorrhage will continuously be transferred towards the distal edge of the nail at the speed of the nail growth. Sequential digital dermatoscopy follow-up may confidently be used to document the progressive “growing-out” of a subungual hemorrhage. Any subungual hemorrhage that persists and eventually forms a longitudinal pigmentation involving the complete nail apparatus requires further diagnostic procedures including biopsy.

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