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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

Nail alteration after chemotherapy with docetaxel. (A) Overview. (B) Dermatoscopy. The dermatoscopic view reveals a diffuse yellow-red discoloration of multiple nails indicative of an increased vascularization of the nail matrix and a diffuse transient extravasation of erythrocytes. -shaped hemorrhages (distal nail edge) are a further marker of toxic changes of the nail unit. (Copyright: ©2014 Haenssle et al.; first published in Der Hautarzt, 2014, 65(4):301–11.)
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f15-dp0404a02: Nail alteration after chemotherapy with docetaxel. (A) Overview. (B) Dermatoscopy. The dermatoscopic view reveals a diffuse yellow-red discoloration of multiple nails indicative of an increased vascularization of the nail matrix and a diffuse transient extravasation of erythrocytes. -shaped hemorrhages (distal nail edge) are a further marker of toxic changes of the nail unit. (Copyright: ©2014 Haenssle et al.; first published in Der Hautarzt, 2014, 65(4):301–11.)

Mentions: A range of drugs has been associated with the formation of nail alterations. However, only a few drugs are regularly responsible for toxic effects on the nail matrix, the nail bed or the periungual skin [23]. These drugs predominantly include retinoids and chemotherapeutics like docetaxel (taxotere) (Figure 15A, B) [24]. Besides diffuse dark pigmentations of all nails and Beau’s lines (lines appearing as horizontal and deep grooves of all fingernails), subungual hemorrhage, orange discolorations, acute painful paronychias, onycholysis, subungual hyper-keratosis and transverse loss of the nail plate are described for docetaxel, in which the type of nail alteration is related to the number of administered cycles. Additionally, minocycline was repeatedly associated with gray-blue longitudinal melanonychias that are clinically very similar to ethnic subungual lentigo [25,26]. Pigmentations usually occur after prolonged minocycline treatment, however, not always in a dose-dependent manner and mostly after treatment intervals of more than a few years, and may coincide with other pigmented sites.


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)

Nail alteration after chemotherapy with docetaxel. (A) Overview. (B) Dermatoscopy. The dermatoscopic view reveals a diffuse yellow-red discoloration of multiple nails indicative of an increased vascularization of the nail matrix and a diffuse transient extravasation of erythrocytes. -shaped hemorrhages (distal nail edge) are a further marker of toxic changes of the nail unit. (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

f15-dp0404a02: Nail alteration after chemotherapy with docetaxel. (A) Overview. (B) Dermatoscopy. The dermatoscopic view reveals a diffuse yellow-red discoloration of multiple nails indicative of an increased vascularization of the nail matrix and a diffuse transient extravasation of erythrocytes. -shaped hemorrhages (distal nail edge) are a further marker of toxic changes of the nail unit. (Copyright: ©2014 Haenssle et al.; first published in Der Hautarzt, 2014, 65(4):301–11.)
Mentions: A range of drugs has been associated with the formation of nail alterations. However, only a few drugs are regularly responsible for toxic effects on the nail matrix, the nail bed or the periungual skin [23]. These drugs predominantly include retinoids and chemotherapeutics like docetaxel (taxotere) (Figure 15A, B) [24]. Besides diffuse dark pigmentations of all nails and Beau’s lines (lines appearing as horizontal and deep grooves of all fingernails), subungual hemorrhage, orange discolorations, acute painful paronychias, onycholysis, subungual hyper-keratosis and transverse loss of the nail plate are described for docetaxel, in which the type of nail alteration is related to the number of administered cycles. Additionally, minocycline was repeatedly associated with gray-blue longitudinal melanonychias that are clinically very similar to ethnic subungual lentigo [25,26]. Pigmentations usually occur after prolonged minocycline treatment, however, not always in a dose-dependent manner and mostly after treatment intervals of more than a few years, and may coincide with other pigmented sites.

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