Nail Matrix Arrest during the Course of Hand, Foot, and Mouth Disease: Evaluation of Onychomadesis Cases
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Hand-foot-and-mouth disease
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Patients with partially destroyed fingernails tend to hide them, and such patients often do not find help because fingernails are considered of little functional value. To improve the aesthetic appearance of such nails, a simple excision of the destroyed nail matrix can stimulate the growth of the residual healthy matrix and regenerate the nail. Prerequisite is a healthy nail residue of at least the lunula. An excision of an en bloc, crescent-shaped, full-thickness scar, 5 mm at its greatest width and extending from one lateral nail fold to the other, increases the length of the nail plate. Together with the matrix, the nail will grow about 4 mm distally. A second crescent-shaped excision 1 to 2 months later will further lengthen the nail until it has gained full length. Normal nail growth was achieved in 11 patients who had partially scarred nail beds after mycosis or trauma. (Plast. Reconstr. Surg. 111: 167, 2003.)
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Histologic studies of melanocytes of nail matrices with or without nail pigmentation were made in 15 specimens taken from 12 Japanese subjects. The following results were obtained: (1) Melanin granules were present in the normal nail matrix, (2) dopa-positive melanocytes were also present in the lower two to four layers of normal nail matrix, but few or none in the lowest layer, (3) histological findings of the nail matrix, corresponding to pigmented bands, revealed an increase in activity and number of dopa-positive melanocytes, (4) of five patients with pigmented band on nail, none was found to be nevoid in character.
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BACKGROUND The authors made use of echograms for the observation of the nail matrix. OBJECTIVE To inspect the nail matrix and identify what causes nail plate deformities. METHODS A 30-MHz frequency high-resolution B-mode was applied to normal and damaged nails. RESULTS Clear shadows of underlying nail plates were observed beneath the proximal nail fold. Some cases with nail plate deformities showed damaged sub-proximal fold nail plates, which would indicate nail matrix deformities. CONCLUSION The echograms had diagnostic value to nail plate deformities. If a normal echogram is obtained at the proximal nail fold, the nail bed will be the place at which the nail deformities occur. If the echogram indicates any sub-proximal fold nail plate changes, the damaged nail matrix may be attributable to the nail deformities. Echograms also gave clear echoic shadows of subungual tumors. That contributed to identifying the infiltrating border of subungual malignant melanomas around the nail matrix noninvasively.
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Nail-matrix kinetics were studied in 21 patients (19 with onychomycosis, two with tinea corporis) as soon as taking itraconazole (Sporanox) 100 mg daily for up to 7 months. Itraconazole was detected in the distal nail as soon as 1 month after the start of therapy (42 ng/g in fingernails and 16 ng/g in toenails). During the course of treatment, this concentration rose and reached a mean of 160 ng/g in fingernail clippings and 197 ng/g in toenail clippings. Moreover, in fingernails of 12 out of 21 patients and in toenails of six out of 20 patients, itraconazole was detected in the distal nail clippings before full outgrowth of the fastest-growing nail. In most patients, itraconazole was detected in the distal nail clippings earlier than would be expected if the drug were incorporated only via the nail matrix, indicating that in addition to the nail matrix, a second route of penetration into the nail exists, i.e. the nail bed.
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Patients with partially destroyed fingernails tend to hide them, and such patients often do not find help because fingernails are considered of little functional value. To improve the aesthetic appearance of such nails, a simple excision of the destroyed nail matrix can stimulate the growth of the residual healthy matrix and regenerate the nail. Prerequisite is a healthy nail residue of at least the lunula. An excision of an en bloc, crescent-shaped, full-thickness scar, 5 mm at its greatest width and extending from one lateral nail fold to the other, increases the length of the nail plate. Together with the matrix, the nail will grow about 4 mm distally. A second crescent-shaped excision 1 to 2 months later will further lengthen the nail until it has gained full length. Normal nail growth was achieved in 11 patients who had partially scarred nail beds after mycosis or trauma.
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Journal Article PATHOLOGY OF THE FINGER NAIL IN PSORIASIS: A CLINICOPATHOLOGICAL STUDY Get access KLAUS LEWIN, KLAUS LEWIN Department of Pathology and Dermatology, Stanford University School of Medicine, California 94305, U.S.A Search for other works by this author on: Oxford Academic Google Scholar SHARON DEWIT, SHARON DEWIT Department of Pathology and Dermatology, Stanford University School of Medicine, California 94305, U.S.A Search for other works by this author on: Oxford Academic Google Scholar RICHARD A. FERRINGTON RICHARD A. FERRINGTON Department of Pathology and Dermatology, Stanford University School of Medicine, California 94305, U.S.A Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 86, Issue 6, 1 June 1972, Pages 555–563, https://doi.org/10.1111/j.1365-2133.1972.tb05069.x Published: 01 June 1972 Article history Accepted: 25 January 1972 Published: 01 June 1972
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