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Congenital Leukonychia

Leukonychia Totalis


Presentation

  • A 66-year-old male patient presented with itchy and scaly lesions over the body of 2 months' duration. Initial skin lesions were noted on the trunk that gradually extended over other parts of the body.[ijdvl.com]
  • Surgery Longitudinal Melanonychia Tumors of the Nail Apparatus Honors & Awards Fulbright Scholar - Hamburg, Germany, United States Department of State, Bureau of Educational and Cultural Affairs National Medical Honor Society, Alpha Omega Alpha (2009-Present[profiles.stanford.edu]
  • Nail and skin changes are present at birth in only 50% of cases, but by 5 years, they are seen in more than 75% of children. By the age of 10 years, pain can be present as a symptom, which greatly impairs quality of life [ 28 ].[karger.com]
  • Genodermatoses are conglomeration of cutaneous and systemic signs and symptoms and some of these disorders present with nail involvement.[ijdvl.com]
  • On clinical examination, the patient presented stature of 170 cm, weight of 63 kg, occipital-frontal-circumference of 54 cm (all within normal range), and no remarkable dysmorphic features.[scielo.br]
Rales
  • Physical examination revealed an elevated jugular venous pressure, an S4 gallop rhythm, bilateral pulmonary rales, peripheral pitting edema, and complete whitening of the nail units of her hands and feet.[nejm.org]
Oral Ulcers
  • There was no history of photosensitivity, oral ulceration or loss of hair. He was a known diabetic and was on metformin therapy. His eruptions were not attributable to metformin.[ijdvl.com]
S4 Gallop
  • Physical examination revealed an elevated jugular venous pressure, an S4 gallop rhythm, bilateral pulmonary rales, peripheral pitting edema, and complete whitening of the nail units of her hands and feet.[nejm.org]
Gallop Rhythm
  • Physical examination revealed an elevated jugular venous pressure, an S4 gallop rhythm, bilateral pulmonary rales, peripheral pitting edema, and complete whitening of the nail units of her hands and feet.[nejm.org]
Brachydactyly
  • Al Gazali Hirschsprung Syndrome Albinism anonychia congenita Basaran Yilmaz Syndrome Brachydactyly Type A5 Nail Dysplasia candidal paronychia chronic mucocutaneous candidiasis Cole Disease Congenital Hereditary Endothelial Dystrophy with Nail Hypoplasia[rgd.mcw.edu]
Leukonychia Punctata
  • Unna classified leukonychia based on distribution of whiteness into the following - leukonychia punctata, leukonychia striata, leukonychia totalis and leukonychia partialis.[ijdvl.com]
  • Leukonychia may involve all of the nail (leukonychia totalis) or only part of the nail (leukonychia partialis), or can appear as one or more transverse bands (leukonychia striata) or white spots (leukonychia punctata).[uniprot.org]
  • punctata [ edit ] Also known as "true" leukonychia, this is the most common form of leukonychia, in which small white spots appear on the nails.[en.wikipedia.org]
  • Leukonychia punctata Leukonychia punctata is also referred to as true leukonychia. This is the most common or frequently recorded leukonychia of all types. This is the condition which causes actual whites spots to appear on nail.[symptomstreatment.org]
  • Leukonychia punctata is a very common phenomenon and appears to result from periodic minor local trauma to the nail matrix. Pathogenesis of leukonychia is not established with certainty.[jamanetwork.com]
Nail Deformity
  • Nail bed damage may result in permanent nail deformity.[merckmanuals.com]
  • The nail dystrophy can be permanent, with anonychia, progressive hyperkeratosis with onychogryphosis, nail thickening, and parrot beak nail deformity in adult life [ 19 ].[karger.com]
Photosensitivity
  • Odontomicronychial Dysplasia Onycholysis pachyonychia congenita Palmoplantar Keratoderma, Spastic Paralysis paronychia Patel Bixler Syndrome Pectus Excavatum, Macrocephaly, Short Stature, Dysplastic Nails Pedal Onychogryposis with Keratosis Plantaris and Coarse Hair Photosensitive[rgd.mcw.edu]
  • There was no history of photosensitivity, oral ulceration or loss of hair. He was a known diabetic and was on metformin therapy. His eruptions were not attributable to metformin.[ijdvl.com]
Lanugo
  • […] morphological disturbances of hair, not elsewhere classified Inclusion term(s): Beaded hair Monilethrix Pili annulati Q84.2 Other congenital malformations of hair Inclusion term(s): Congenital hypertrichosis Congenital malformation of hair NOS Persistent lanugo[icd10coded.com]
  • Accessory skin tags, congenital Congenital scar Epidermolysis bullosa Keratoderma (congenital) Excludes: pilonidal cyst (685.0-685.1) 757.4 Specified anomalies of hair Congenital: alopecia atrichosis beaded hair hypertrichosis monilethrix Persistent lanugo[dhs.state.il.us]
Spastic Paralysis
  • Paralysis paronychia Patel Bixler Syndrome Pectus Excavatum, Macrocephaly, Short Stature, Dysplastic Nails Pedal Onychogryposis with Keratosis Plantaris and Coarse Hair Photosensitive Trichothiodystrophy 1 Raindrop Hypopigmentation Subungual Exostoses[rgd.mcw.edu]

Workup

  • No, this boy has congenital leukonychia totalis; a workup for underlying disease is unnecessary.[consultant360.com]
T Wave Inversion
  • Electrocardiography revealed deep T-wave inversions in leads V 1 through V 3 .[nejm.org]

Treatment

  • "Leukonychia – Symptoms, Causes, Treatment, Pictures" . byebyedoctor.com . Retrieved 2017-05-18 . Maino KL, Stashower ME. "Traumatic Transverse Leukonychia" . Medscape. Baran, Robert et al.[en.wikipedia.org]
  • Treatment: Increasing the quantity of grains, vegetables and nuts and even taking a zinc supplement (as zinc deficiency is a cause of leukonychia) is a good preventative and treatment, as is keeping affected nails out of harms way when using chemicals[medigoo.com]
  • Treatment of white spots on nails If you suspect that the white spot on nails is due to leukonychia, then you should adopt treatment to eradicate the issue. Unfortunately, there is no specific treatment for this condition.[symptomstreatment.org]
  • Frequent clipping of the nail increases the response to treatment.[merckmanuals.com]

Prognosis

  • Prognosis The prognosis of patients with lichen striatum is excellent. Recovery is complete. In a year lesions regress spontaneously. Relapses may occur but are rare. Hyper and hypopigmentation postinflamatorie may require up to 30 months to deliver.[medicaldb.blogspot.com]
  • Nail biopsy is not recommended for diagnosis, due to the benignity of the disease and a good prognosis. TND can affect one nail or all nails (Fig. 14 ).[karger.com]

Etiology

  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10coded.com]
  • Review of mycotic melanonychia and its relationship with the various etiological agents . CrossRef PubMed Google Scholar 31. Urán ME, Cano LE.[link.springer.com]
  • The etiology of lichen striatum is unknown. The most accepted hypothesis is one that involves a combination of predisposing factors and environmental factors genetigi. Atopy may be a predisposing factor.[medicaldb.blogspot.com]
  • Sudanese Longitudinal erythronychia Onychopapilloma (MC etiology) Other malignant and non-malignant neoplasms Inflammatory - Darier's, lichen planus, etc[quizlet.com]
  • Pruritus prevalence among HD patients ranged from 19% to 90% in the prior studies. 16,19 The etiology of pruritus in CRF is unknown; however, it has been associated with the degree of renal insufficiency (urine output of 500 mL), 20 dry skin, 21 retention[woundsresearch.com]

Epidemiology

  • Certification: Dermatology, American Board of Dermatology (2014) Medical Education:University of Michigan Medical School (2010) MI Internship:Oakwood Hospital and Medical CenterMI Masters in Public Health, Boston University School of Public Health, Epidemiology[profiles.stanford.edu]
  • White superficial onychomycosis: epidemiological, clinical, and pathological study of 79 patients. Arch Dermatol. 2004;140:696–701. CrossRef PubMed Google Scholar 18. Oyeka CA, Gugnani HC.[link.springer.com]
  • However, only a small amount of epidemiological data extracted from a few studies is currently available for the pediatric population [ 5 ].[karger.com]
Sex distribution
Age distribution

Pathophysiology

  • What struck me as interesting in this man was the following: i had never seen this pattern before; i could not and still can not imagine a pathophysiological process leading to such an unusual symmetrical pattern of feathered chevrons that were non-continuous[vgrd.blogspot.com]
  • One common explanation is zinc deficiency. [4] Pathophysiology Associated Conditions Kidney disease Liver disease Causes Causes In Alphabetical Order Anemia Arsenic poisoning Calcium deficiency Cardiac Diseases Cirrhosis Congenital isolated nail dysplasia[wikidoc.org]
  • The pathophysiology seems to be some sort of distal subungual telangiectasia. The causes of this sign are as follows: Cirrhosis CCF NIDDM Just straight-out old age. Eponymous nail lines: Muehrcke's lines This is known as "leukonychia striata".[derangedphysiology.com]
  • Walker J, Baran R, Vélez N, Jellinek N: Koilonychia: an update on pathophysiology, differential diagnosis and clinical relevance. J Eur Acad Dermatol Venereol 2016; 30: 1985–1991. Richert B, André J: Nail disorders in children.[karger.com]

Prevention

  • Treatment and Prevention of Leukonychia There is no treatment for leuconychia as such. The white marks will dissapear on their own, when the nails will grow outwards. Reducing minor injury to the nails may prevent the white marks.[thebeautytips.com]
  • So it is advised to use the products in moderation.An individual can prevent it by taking better care of the nails and prevent them from being mistreated by stopping hitting, rubbing or biting them.If there has not been any improvement in these white[medigoo.com]
  • An individual can prevent leukonychia by taking better care of the nails and prevent them from being mistreated by stopping hitting, rubbing or biting them.[byebyedoctor.com]
  • To prevent and reduce complications and morbidity can be given corticosteroids. They have anti-inflammatory effects and alter the body's response to different stimuli.[medicaldb.blogspot.com]

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