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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

Bowen’s disease beneath the distal nail margin with accumulation of parakeratotic material. (A) Overview. (B) Dermatoscopy of the nail surface and (C) the distal nail edge. In this slightly pigmented keratotic tumor distal onycholysis and subungual hemorrhage are visible. Differentiation from verruca vulgaris is very difficult since a number of characteristic criteria are present (yellowish, rough to verrucous surface with brown-red streaky hemorrhages). (Copyright: ©2014 Haenssle et al.)
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f12-dp0404a02: Bowen’s disease beneath the distal nail margin with accumulation of parakeratotic material. (A) Overview. (B) Dermatoscopy of the nail surface and (C) the distal nail edge. In this slightly pigmented keratotic tumor distal onycholysis and subungual hemorrhage are visible. Differentiation from verruca vulgaris is very difficult since a number of characteristic criteria are present (yellowish, rough to verrucous surface with brown-red streaky hemorrhages). (Copyright: ©2014 Haenssle et al.)

Mentions: In the aging population tumors with increasing incidences (Bowen’s disease, squamous cell carcinoma) may also arise in less common localizations including the nail bed or the skin below the distal nail plate. The clinical presentation of these tumors is often atypical and they are usually non-pigmented; therefore, their diagnosis is often missed or delayed. Moreover, these tumors may be misinterpreted as other benign conditions such as verruca vulgaris, onychomycosis or trauma-induced nail dystrophy [14]. Dermatoscopically, the characteristic pattern of pigmented Bowen’s disease with its typical brownish dots along imaginary lines can frequently be observed (Figure 11A, B) [17]. In contrast, non-pigmented Bowen’s disease or squamous cell carcinoma may often show dot-like to glomerular vessels clustering in groups (up to vascular polymorphism) [18]. The potential risk of misdiagnosing subungual bowenoid squamous cell carcinoma as verruca vulgaris is exemplified in Figure 12 (Figure 12A–C) and 13 (Figure 13A, B).


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)

Bowen’s disease beneath the distal nail margin with accumulation of parakeratotic material. (A) Overview. (B) Dermatoscopy of the nail surface and (C) the distal nail edge. In this slightly pigmented keratotic tumor distal onycholysis and subungual hemorrhage are visible. Differentiation from verruca vulgaris is very difficult since a number of characteristic criteria are present (yellowish, rough to verrucous surface with brown-red streaky hemorrhages). (Copyright: ©2014 Haenssle et al.)
© Copyright Policy
Related In: Results  -  Collection

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

f12-dp0404a02: Bowen’s disease beneath the distal nail margin with accumulation of parakeratotic material. (A) Overview. (B) Dermatoscopy of the nail surface and (C) the distal nail edge. In this slightly pigmented keratotic tumor distal onycholysis and subungual hemorrhage are visible. Differentiation from verruca vulgaris is very difficult since a number of characteristic criteria are present (yellowish, rough to verrucous surface with brown-red streaky hemorrhages). (Copyright: ©2014 Haenssle et al.)
Mentions: In the aging population tumors with increasing incidences (Bowen’s disease, squamous cell carcinoma) may also arise in less common localizations including the nail bed or the skin below the distal nail plate. The clinical presentation of these tumors is often atypical and they are usually non-pigmented; therefore, their diagnosis is often missed or delayed. Moreover, these tumors may be misinterpreted as other benign conditions such as verruca vulgaris, onychomycosis or trauma-induced nail dystrophy [14]. Dermatoscopically, the characteristic pattern of pigmented Bowen’s disease with its typical brownish dots along imaginary lines can frequently be observed (Figure 11A, B) [17]. In contrast, non-pigmented Bowen’s disease or squamous cell carcinoma may often show dot-like to glomerular vessels clustering in groups (up to vascular polymorphism) [18]. The potential risk of misdiagnosing subungual bowenoid squamous cell carcinoma as verruca vulgaris is exemplified in Figure 12 (Figure 12A–C) and 13 (Figure 13A, B).

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