Patients with nail psoriasis can develop a wide variety of nail ch. Evaluation for fungal infection Clinical features of nail psoriasis overlap with onychomycosis, and in some cases it can be difficult to distinguish between these disorders clinically. Nail bed and nail matrix biopsies are performed in very select circumstances where the diagnosis is uncertain. Other manifestations, such as nail pitting, oil drop discoloration, and onycholysis, are more common in nail psoriasis than in onychomycosis. The commonly cited reasons are the complexity of the procedure, risk of scarring and the reluctance of the patient. However, in cases with isolated nail psoriasis, isolated nail lichen planus, onychomycosis not confirmed on direct microscopy and culture, or longitudinal melanonychia, the treating dermatologist is left with no choice but to resort to this procedure. Nail bed biopsy (NBB) is generally performed to distinguish between two or more conditions with a similar clinical pattern, like onycholysis or subungual hyperkeratosis, cases with discoloration of the nail bed, or any painful nail bed lesion. Several specific indications for performing biopsy on the nail unit exist. Biopsy of the nail plate and the hyponychium is performed to help diagnose mycotic nail dystrophies, such as onychomycosis and other dermatoses affecting the nail plate. This biopsy technique has the added benefit of helping differentiate between hemosiderin versus melanic pigment in cases in which the nail has black or brown discoloration. A standard punch biopsy of the nail bed is one of the most commonly performed surgical procedures on the nail unit.
Nail avulsion is the most common surgical procedure performed on the nail unit. 13, 51, 52 Other indications for performing nail avulsion are to treat recalcitrant onychocryptosis; to excise tumors of the nail unit; to allow full examination and exploration of the nail bed, the nail matrix, the PNF and the LNF, and the nail grooves for the presence of pathology; or to use as a preliminary step before performing biopsy on the nail bed and the nail matrix. The use of urea ointment to debride and avulse dystrophic nails has been applied in the treatment of onychomycosis, onychogryphosis, psoriasis, and candidal and bacterial infections. One difference between the 2 procedures is the required use of a tourniquet for hemostasis in phenol matricectomy. The most common indication to perform a nail biopsy was to differentiate between nail psoriasis and onychomycosis. A well-timed biopsy can prevent serious outcomes in potentially harmful nail conditions (e. Psoriatic nail disease occurs in about 50 of patients with psoriasis. Psoriatic nail disease occurs in about 50 of patients with psoriasis and is more common in patients who have psoriatic arthritis. Nail biopsy is not usually performed due to its complexity and patient reluctance but it may be inevitable in cases where only one nail is affected. However, one study found moderate benefit with treatment using methotrexate or ciclosporin and there were no significant differences in efficacy between the two treatments.
Fungal Nail Infections are caused by keratin becoming infected with fungi. The most common result is a poor cosmetic appearance of the affected nail(s); CMC or as a secondary infection due to other causes of nail disease – eg, psoriasis. In PSO, use a scalpel blade to scrape away material from the proximal nail fold or perform punch biopsy to include material from nail bed. Several different nail disorders were discovered or confirmed by nail biopsy. The list may include psoriasis, lichen planus, twenty nail syndrome, lichen sclerosis et atrophicus, eczema, Darier s disease and also tumors like melanocytic nevi, Bowen’s disease, melanoma, and others. Nail bed cells do not have any independent movement, and it is yet to be clearly demonstrated whether they are incorporated into an overlying nail plate as it grows distally. Nail biopsy (NB) is an investigation that is not routinely resorted to by most of the dermatologists. The commonly cited reasons are the complexity of the procedure, risk of scarring and the reluctance of the patient. However, in cases with isolated nail psoriasis, isolated nail lichen planus, onychomycosis not confirmed on direct microscopy and culture, or longitudinal melanonychia, the treating dermatologist is left with no choice but to resort to this procedure. Hence, a practical knowledge of the indications, appropriate patient selection, procedural details and histopathological interpretation of a NB is a must-have for any practicing dermatologist.
Nail Surgery Treatment & Management: Surgical Therapy, Preoperative Details, Postoperative Details
Primary dermatologic disorders present a broad spectrum of nail changes. Aetna considers laser treatment experimental and investigational for the following indications because of insufficient evidence in the peer-reviewed literature (not an all-inclusive list):. In this article, we review some of the artifacts commonly observed in biopsies and the methods used to prevent their appearance. It is useful to remember that nail biopsy is the most sensitive diagnostic tool in onychomycosis, as the hyphae will be visible in the sample even in cases where cultures have repeatedly given negative results. Skin diseases do not always cause marked differences in tissue appearance or histologic presentation (pigmentation changes and drug reactions) and some dermatoses may even mimic others (bullous diseases, contact dermatitis, nummular eczema, dyshidrosis, autoeczematization or Id reaction, and eczemas in general).