Nail Disorder

Acrodermatitis Continua of Hallopeau

June 14, 2012 by Dr.Deepak Leave a Comment

Acrodermatitis continua Hallopeau (ACH) also called as Dermatitis Repens is considered as a rare and severe variant of localized form of palmoplantar pustular psoriasis. This usually is resistant or unresponsive to treatment and may relapse time to time.

Acrodermatitis continua Hallopeau is most commonly seen in middle aged women but may be seen at any age. This may be followed by injury or trauma to the nails, fingers or toes. It is often characterized by eruption of pustules on red scaly base and usually involves the distal phalanges of fingers and toes with frequent involvement of the nail beds. This often results in scarring of skin, degeneration of nail and bone on the affected area.

Initially, it may involve a distal one or two digits. Further, when disease progress it may be generalized over hands, forearm and foot. The skin over the lesion may be red and scaly and multiple pustules may develop. The lesion can be very painful and disabling. Involvement of nail bed and nail matrix often leads to nail dystrophy.

Although it is considered as a variant of pustular psoriasis, as it shares similar histologic features, it doesn’t respond to normal anti-psoriatic medications. Treatment of Acrodermatitis Continua of Hallopeau is very difficult. Although, systemic acitretin is considered as the first-line treatment, results may still vary. As the disease is rare and there are no large scale studies on the treatment approach, specific treatment with successful results is still lacking. Several other treatment modalities have been tried with mixed results. Some of these are; corticosteroids, calcipotriol, adalimumab,[1-3] tretinoin cream, fluorouracil cream, phototherapy (PUVA and UVB), topical tacrolimus and thalidomide. Combination therapy with etanercept and acitretin followed by corticosetroids and acitretin have also been described.[4]

References:
[1] Jennifer A. Sopkovich, Georgann Anetakis Poulos, Henry K. Wong. Acrodermatitis Continua of Hallopeau Successfully Treated with Adalimumab. J Clin Aesthet Dermatol. 2012 February; 5(2): 60–62.
[2] A.M. Tobin, B. Kirby. Successful treatment of recalcitrant acrodermatitis continua of Hallopeau with adalimumab and acitretin. British Journal of Dermatology,Volume 153, Issue 2, pages 445–446, August 2005.
[3] Rodica Olteanu,Catalina Iuganu.Successful treatment of acrodermatitis continua of Hallopeau with adalimumab.JAAD,Volume 66, Issue 4, Supplement 1, April 2012, Pages AB203.
[4] Silpa-archa N, Wongpraparut C.A recalcitrant acrodermatitis continua of Hallopeau successfully treated with etanercept.J Med Assoc Thai. 2011 Sep;94(9):1154-7.

Toenail Fungus Home Remedies

June 9, 2012 by Dr.Deepak 1 Comment

Toenail fungus, medically known as onychomycosis is common fungal infection of the nail. It is estimated that more than 50% of the world population will have their toenail fungus by the time they reach 70 years. Toenail fungus is most commonly seen in people who wear tight fitting shoes (athletes are prone to infection).In this article, we will try to research the most effective toenail fungus home remedies that work to alleviate the symptoms of the nail condition.

Signs and Symptoms of toenail fungus

The nail that has been affected becomes thick, discolored (yellow, brown or dark colored), foul smelling, brittle and sometimes gets infected and be separated from nail bed (medically termed as onycholysis) and may eventually fall off. When it gets infected, you may feel pain in your toes which may prevent from wearing shoes or moving.

There are other conditions that make look like toenail fungus, so be sure to visit a dermatologist to confirm the case and to exclude other diseases. It is very important because treatment options may vary.

Toenail Fungus Treatment

Toenail fungus is often difficult to treat as most of the topical anti-fungal medications will not work and you may need oral anti-fungal medications. Taking oral medication along with topical anti-fungal have good result and may eliminate the toenail fungus. However, one should remember that it may take as long as 4-6 months to completely eliminate the infection.

Toenail Fungus Pictures:

Toenail Fungus Home Remedies

Many individuals doesn’t want to visit a dermatologist for mild cases of toenail fungus, as mild cases of nail fungal infection may not affect ones daily life. This has led to increase in trends of using some home remedies for toenail fungal infection. There are several home remedies for toenail fungal infection with mixed results. Some of the common remedies are discussed below.

Vinegar: Although there is no any direct evidence that Vinegar can cure toenail fungus, many people finds it useful in treating the condition. Mix 1 part of vinegar with 2 parts of water and sock your feet in it for around 20 minutes than wash off your feet and pat dry. If you think it irritates your feet, you may use it less often and try other remedies.

Tea Tree Oil: Tea tree oil has been used in many skin conditions including acne, dermatitis, psoriasis, scalp conditions and many other skin diseases with good results. You may apply few drops of tea tree oil to the affected part and massage or mix with olive oil, lavender oil and thyme oil and apply the mixture on the affected area everyday. Gently scrubbing the area may help to slough off the fungus out of the area.

Listerine Mouthwash: Although there is no scientific evidence that Listerine mouthwash cure nail fungus, some people find this useful. You may sock your feet in the Listerine mouthwash for 15 minutes and wash off. You also add vinegar or lemon juice to it for better effect.

Diet: Diet also plays an important role indirectly by boosting your immune system to fight the nail fungus. Take well maintained diet, reduce intake of sugar and dairy products.

Vicks VapoRub: Vicks VapoRub is another option for nail fungus. Although its effectiveness has not been proved, some people find it useful. You may give it a try.

Herbs: Several herbs are also being suggested in toenail fungus home remedies. Some available herbs are aloe-vera, thyme, burdock, turmeric and Echinacea, oregano seeds, cat’s claw, fenugreek and pokeroot.

Treatment either with prescription or home remedies will not work until you maintain your feet hygiene. Always wash feet after sports or any other activities that may involve wearing shoes for longer time. Be sure to wash and change your socks on regular basis and clean your shoes. It is better to throw away the old shoes and get a new one or wash the old shoes and don’t wear it for at-least 3-4 months. This will further avoid recurrence in future.

Remember: You may try this home remedies for mild cases of nail fungal infection, but will not work for severe cases. If you think your fungus has advanced and is severe, always seek help from your physician or dermatologist. Don’t try to treat it by yourself at home in order to save money, your nail infection might get complicated and you may need to spend thousands of dollars.

Nail fungal Infection

June 6, 2012 by Avinav Leave a Comment

Nail fungal infections, also called as onychomycosis (onycho means nail and mycosis means fungal growth) are due to overgrowth of fungus in your nails. Common fungi that can cause this nail infection are called as dermatophytes. Nail fungal infections is very common and may involve both the nails of hands and foot. But most commonly is seen in foot nails because of humidity while wearing shoes and socks. Toe nail is most susceptible to this infection. It can lead to nail deformity and it is difficult to treat.

Risk factors for Nail Fungal Infection
Following are the major risk factors that can favor this fungal infection.

Excessive heat
Humidity
Low immunity like in AIDS
Diabetic person
Trauma to nail
Poor hygiene
excessive shoes wearing
Microangiopathies
Old age

Sign and Symptoms of Fungal nail Infection
Your nails look pale, yellow or black but yellowish discoloration is most common presentation. Nails may be thick, rough and brittle. Nail may be deformed like humped or broken, there may be local discharge. Nail may be separated from its bed. Dull looking nail with streaks, laxity in nail bed is common. Systemic symptoms and sign may also be presented in some patients. Nail may be tough, with or without pain and may be associated with foul smelling.

Usually your doctor will diagnose it just by direct examination, and may perform fungal scraping to see the fungus under microscope and confirm the case.

Prevention and Treatment

Prevention is better than cure so following points must be kept in mind if you really want to avoid fungal infections.

Always maintain good hygiene
Take care of your foot and nails
Degrade long nails proper nail cutting with sterilized cutter.
Don’t go bear footed in dirty places
Proper care of foot and nail wounds
Temperature regulation
Care in old age
Take proper control of your diabetes if you have it, because diabetes predisposes to infection.

Medical Treatment
Treatment of nail fungal infection is long term usually requiring 3 months or more. Most commonly used drugs are those of azoles family and some other antifungal agents like Itraconazole, fluconazole and terbinafine. Other drug like griseofulvin is also used with success. These drugs are for oral use only. NSAIDs used as symptomatic treatment as it slow down deformity process and reduce pain and discharge. During treatment, history of patient about drug allergy and other hepatic diseases is very important. Because these drugs have side effects like hepatotoxicity and renal problem and some have bad effect on heart pump action.

There is also topical treatment for this disease. Antifungal nail polish and topical creams can be used, these have low efficacy due to less absorption. But these can be used for mild to moderate infection.

Surgical Treatment:
Nail can be surgically removed with excision of nail while preserving nail bed. And in some severe conditions onychectomy removal of nail with nail bed is performed.

Acrodermatitis continua of Hallopeau

March 10, 2011 by Dr.Deepak 1 Comment

Acrodermatitis continua of Hallopeau, which is also known as “pustular acrodermatitis”, “Acrodermatitis perstans”,or “Dermatitis repens” is a rare, chronic, recurrent pustular eruption involving the fingers and toes.

The cause of Acrodermatitis continua of Hallopeau is still unknown. As it resembles the similar histologic features as pustular psoriasis, many consider it as a variant of pustular palmoplantar psoriasis. It is most common in middle-aged women and usually starts after localized infection or trauma on finger or toe. Later it may extend into generalized form during the chronic course of disease.

Treatment of Acrodermatitis continua is often difficult and there is no established treatment regimen. Because of its histopathologic similarity to pustular psoriasis, several psoriasis treatment modalities (topical and systemic ) have been tried. Topical treatment options include topical corticosteroids, tar, 5-fluorouracil, calcipotriol, racrolimus and dithranol. Systemic treatment options include oral retinoids, corticosteroids and other immunomodulating and immunosupressing drugs like cyclosporine, methotrexate, colchine, infliximab, dapsone, sulphasalazine, and PUVA photochemotherapy.

If you have any questions regarding Acrodermatitis continua of Hallopeau, ask us at our Psoriasis forum

Efficacy of Acitretin Therapy for Nail Psoriasis

March 20, 2009 by Dr.Deepak 2 Comments

Treatment of isolated nail psoriasis is difficult and often unsatisfactory. Information about the efficacy of systemic treatments on nail psoriasis is scarce because most studies on skin psoriasis do not focus on the nail changes. Nail involvement occurs in up to 78% of patients with psoriasis, is more common in patients with psoriatic arthritis, and may be the only sign of psoriasis. Nail psoriasis usually involves several nails, and both fingernails and toenails may be affected.

This open study involved 36 patients with moderate to severe psoriasis limited to the nails treated with low-dose acitretin from January 2005 through January 2007. The study was approved by the ethical committee of the Istituto Fisioterapici Ospitalieri, in Rome, Italy. The patients included 27 men and 9 women ranging in age from 28 to 67 years (mean age, 41 years).

Main Outcome Measures: Clinical evaluation, and Nail Psoriasis Severity Index (NAPSI) and modified NAPSI scores before therapy, every 2 months during therapy, and 6 months after treatment.

Results: The mean percentage of reduction of the NAPSI score after treatment was 41%; the mean percentage of reduction of the modified NAPSI score of the target nail was 50%. Clinical evaluation at 6 months showed complete or almost complete clearing of the nail lesions in 9 patients (25%), moderate improvement in 9 (25%), mild improvement in 12 (33%), and no improvement in 6 (11%).

Conclusion: Results from low-dose acitretin therapy show NAPSI score reductions comparable with those studies evaluating biologic drugs for nail psoriasis and suggest that low-dose systemic acitretin should be considered in the treatment of nail psoriasis.

Source: http://archderm.ama-assn.org/cgi/content/full/145/3/269

Treatment For Nail Psoriasis

January 28, 2009 by Dr.Deepak Leave a Comment

Psoriasis is a chronic proliferative epidermal disease that affects 1-3% of world total population. Although it may develop at any time and any age, but usually seen in people at their late thirties. It is estimated that about 50% of patients with psoriasis will have some degree of nail involvement. The characteristic yellow-brown discoloration is seen in nail matrix or nail bed in most of the patients.

There is no consistently effective therapy for nail psoriasis. The goal of treatment is to improve the function and appearance of your nails. The nail will often improve coincidentally with remission of cutaneous lesion and will almost improve after systemic antimetabolite or immunomodulator therapy. Removal of subungual debris and application of corticosteriods under occlusion may be beneficial.

Small amount of triamcinolone injection into the nail bed at 2-3 weeks interval have shown about 75% improvement in patients with psoriasis. But this method is painful and there might be around 50% recurrence rate when treatment is stopped. For hypertrophic or dystrophic nails urea 40% ointment showed some beneficial effects. It has been reported that 1% 5-flurouracil solution ( fluroplex ) applied twice daily to nail might decrease the severity of involvement by 75% in two-third of patients within 3 to 6 months.

Sometimes in more than 25% of psoriatic patients there is associated fungal infection, so, antifungal medications might help improve the overall conditions.

How To Prevent your Nails From Damage

January 3, 2009 by Zenisha 1 Comment

Many women suffer from the problem of cracked and chipped nails which can often be quite difficult to avoid due to the toll taken on them by housework, incorret diet and incorrect filing. However, chipped nails are inclined to spoil the appearance. To maintain the good health and apperance of your nails, try the following :

To lessen the possibility of chipping try keeping the nails squarish or rounded and do not weaken the base by filing too much at the edges.
Warm olive oil massaged into the nails thrice a week helps to strength them.
Lemon peels rubbed into nails daily helps reduce the yellowish shade which most people want to avoid and also makes them smooth.
Another easy remedy for strengthening is to consume a teaspoon of gelatine with half a glass of water daily.
Calcium products helps to strengthen the nail-consume, plenty of dairy products like milk,cheese, butter, curd, etc. for the welfare of your nails since they are a rich source of calcium.