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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

Benign congenital nevus involving plantar acral skin and the nail of the right second toe in a 4-year-old girl. (A) Overview. (B) Dermatoscopy reveals a double dotted parallel furrow pattern in acral skin and a homogeneous brown pigmented band continuously affecting half of the nail width (longitudinal melanonychia). (Copyright: ©2014 Haenssle et al.)
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f18-dp0404a02: Benign congenital nevus involving plantar acral skin and the nail of the right second toe in a 4-year-old girl. (A) Overview. (B) Dermatoscopy reveals a double dotted parallel furrow pattern in acral skin and a homogeneous brown pigmented band continuously affecting half of the nail width (longitudinal melanonychia). (Copyright: ©2014 Haenssle et al.)

Mentions: Characteristics for subungual benign nevi are their appearance in children and young adults and their regular pattern of the longitudinal lines. The width of the pigmented band of subungual nevi is rather low (normally ≤3 mm) and regular in thickness and spacing of striation. The color of different subungual nevi varies from light brown to dark brown to black [3]. The pigmentation within one lesion is mostly homogeneous or is composed of evenly distributed thinner lines of the same color (Figure 17A, B). Congenital acral nevi may also involve an increased melanocytic pigmentation of the nail unit (Figure 18A, B). Many congenital nevi at acral sites may clinically look suspicious at first sight and should thoroughly be inspected by using dermatoscopy. The double dotted parallel furrow pattern depicted in Figure 18 was described as a typical acral volar skin pattern in younger individuals [27]. Over the course of time when examined by sequential digital dermatoscopy the degree of pigmentation of the longitudinal line may increase or decrease depending on the UV exposure, whereas the width of the lesion should remain unchanged (Figure 19A, B) [28].


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)

Benign congenital nevus involving plantar acral skin and the nail of the right second toe in a 4-year-old girl. (A) Overview. (B) Dermatoscopy reveals a double dotted parallel furrow pattern in acral skin and a homogeneous brown pigmented band continuously affecting half of the nail width (longitudinal melanonychia). (Copyright: ©2014 Haenssle et al.)
© Copyright Policy
Related In: Results  -  Collection

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

f18-dp0404a02: Benign congenital nevus involving plantar acral skin and the nail of the right second toe in a 4-year-old girl. (A) Overview. (B) Dermatoscopy reveals a double dotted parallel furrow pattern in acral skin and a homogeneous brown pigmented band continuously affecting half of the nail width (longitudinal melanonychia). (Copyright: ©2014 Haenssle et al.)
Mentions: Characteristics for subungual benign nevi are their appearance in children and young adults and their regular pattern of the longitudinal lines. The width of the pigmented band of subungual nevi is rather low (normally ≤3 mm) and regular in thickness and spacing of striation. The color of different subungual nevi varies from light brown to dark brown to black [3]. The pigmentation within one lesion is mostly homogeneous or is composed of evenly distributed thinner lines of the same color (Figure 17A, B). Congenital acral nevi may also involve an increased melanocytic pigmentation of the nail unit (Figure 18A, B). Many congenital nevi at acral sites may clinically look suspicious at first sight and should thoroughly be inspected by using dermatoscopy. The double dotted parallel furrow pattern depicted in Figure 18 was described as a typical acral volar skin pattern in younger individuals [27]. Over the course of time when examined by sequential digital dermatoscopy the degree of pigmentation of the longitudinal line may increase or decrease depending on the UV exposure, whereas the width of the lesion should remain unchanged (Figure 19A, B) [28].

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