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Nail Splinter Hemorrhage

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21. Psoriasis, Nails (Diagnosis)

starts distally and progresses proximally, causing a traumatic uplifting of the distal nail plate. Secondary microbial colonization may occur. Nail plate crumbling Nail plate weakening due to disease of the underlying structures causes this condition. Splinter hemorrhage/dilated tortuous capillaries in the dermal papillae Splinter hemorrhages are longitudinal black lines due to minute foci of capillary hemorrhage between the nail bed and the nail plate. This is analogous to the Auspitz sign (...) or salmon patch of the nail bed This lesion is a translucent, yellow-red discoloration in the nail bed resembling a drop of oil beneath the nail plate. This patch is the most diagnostic sign of nail psoriasis. [ ] Pitting of the proximal nail matrix Pitting is a result of the loss of parakeratotic cells from the surface of the nail plate. Beau lines of the proximal nail matrix These lines are transverse lines in the nails due to intermittent inflammation causing growth arrest lines. Leukonychia

2014 eMedicine.com

22. Psoriasis, Nails (Overview)

starts distally and progresses proximally, causing a traumatic uplifting of the distal nail plate. Secondary microbial colonization may occur. Nail plate crumbling Nail plate weakening due to disease of the underlying structures causes this condition. Splinter hemorrhage/dilated tortuous capillaries in the dermal papillae Splinter hemorrhages are longitudinal black lines due to minute foci of capillary hemorrhage between the nail bed and the nail plate. This is analogous to the Auspitz sign (...) or salmon patch of the nail bed This lesion is a translucent, yellow-red discoloration in the nail bed resembling a drop of oil beneath the nail plate. This patch is the most diagnostic sign of nail psoriasis. [ ] Pitting of the proximal nail matrix Pitting is a result of the loss of parakeratotic cells from the surface of the nail plate. Beau lines of the proximal nail matrix These lines are transverse lines in the nails due to intermittent inflammation causing growth arrest lines. Leukonychia

2014 eMedicine.com

23. Nail Surgery (Treatment)

that are significantly dystrophic appear to respond better to avulsion with urea paste. The benefits of performing nonsurgical nail avulsion with urea ointment include pain relief; a low risk of infection, hemorrhage (ie, bloodless procedure), and other morbidity; a quick improvement after avulsion; and the absence of pain during and after treatment. [ ] Nail avulsion with urea is ideal for the treatment of symptomatic dystrophic nails in patients with diabetic neuropathy, vascular disease, or immunosuppression (...) is indicated in the treatment of this condition to provide pain relief, and it may be performed twice a year for this purpose. Matricectomy The nail matrix is the germinative epithelium that forms the nail plate by means of the continuous differentiation of its basal cells. Matricectomy is the process of surgically, chemically, or electrically ablating or destroying the nail matrix. Complete excision of the viable nail matrix results in loss of the nail plate. Therefore, a new nail plate cannot

2014 eMedicine.com

24. Psoriasis, Nails (Treatment)

starts distally and progresses proximally, causing a traumatic uplifting of the distal nail plate. Secondary microbial colonization may occur. Nail plate crumbling Nail plate weakening due to disease of the underlying structures causes this condition. Splinter hemorrhage/dilated tortuous capillaries in the dermal papillae Splinter hemorrhages are longitudinal black lines due to minute foci of capillary hemorrhage between the nail bed and the nail plate. This is analogous to the Auspitz sign (...) or salmon patch of the nail bed This lesion is a translucent, yellow-red discoloration in the nail bed resembling a drop of oil beneath the nail plate. This patch is the most diagnostic sign of nail psoriasis. [ ] Pitting of the proximal nail matrix Pitting is a result of the loss of parakeratotic cells from the surface of the nail plate. Beau lines of the proximal nail matrix These lines are transverse lines in the nails due to intermittent inflammation causing growth arrest lines. Leukonychia

2014 eMedicine.com

25. Nail Surgery (Overview)

the extravasation of blood into the potential space between the nail plate and the nail bed after capillaries are disrupted. They develop in the long axis of the nail bed, which conforms to the orientation of the dermal ridges and the subungual vessels. Other etiologic factors are associated with the formation of splinter hemorrhages in the nail bed; the hemorrhages may clinically occur in such conditions as , vasculitis, , arterial embolism, lupus, , cirrhosis, , , and . [ , , ] Certain drugs (eg, tetracycline (...) extend to involve the underlying bone. The connective tissue of the dermis, the dermal collagen, contains a balanced mixture of lymphatics, blood vessels, and elastic fibers. The dermis also has a wealth of glomus bodies and a rich capillary network longitudinally oriented with the parallel ridges. Splinter hemorrhages of the nail plate form when a small amount of blood leaks from the capillary bed into one of these folds and becomes trapped by the nail plate. [ ] Melanocytes are not found

2014 eMedicine.com

26. Psoriasis, Nails (Follow-up)

starts distally and progresses proximally, causing a traumatic uplifting of the distal nail plate. Secondary microbial colonization may occur. Nail plate crumbling Nail plate weakening due to disease of the underlying structures causes this condition. Splinter hemorrhage/dilated tortuous capillaries in the dermal papillae Splinter hemorrhages are longitudinal black lines due to minute foci of capillary hemorrhage between the nail bed and the nail plate. This is analogous to the Auspitz sign (...) or salmon patch of the nail bed This lesion is a translucent, yellow-red discoloration in the nail bed resembling a drop of oil beneath the nail plate. This patch is the most diagnostic sign of nail psoriasis. [ ] Pitting of the proximal nail matrix Pitting is a result of the loss of parakeratotic cells from the surface of the nail plate. Beau lines of the proximal nail matrix These lines are transverse lines in the nails due to intermittent inflammation causing growth arrest lines. Leukonychia

2014 eMedicine.com

27. Nail Surgery (Follow-up)

that are significantly dystrophic appear to respond better to avulsion with urea paste. The benefits of performing nonsurgical nail avulsion with urea ointment include pain relief; a low risk of infection, hemorrhage (ie, bloodless procedure), and other morbidity; a quick improvement after avulsion; and the absence of pain during and after treatment. [ ] Nail avulsion with urea is ideal for the treatment of symptomatic dystrophic nails in patients with diabetic neuropathy, vascular disease, or immunosuppression (...) is indicated in the treatment of this condition to provide pain relief, and it may be performed twice a year for this purpose. Matricectomy The nail matrix is the germinative epithelium that forms the nail plate by means of the continuous differentiation of its basal cells. Matricectomy is the process of surgically, chemically, or electrically ablating or destroying the nail matrix. Complete excision of the viable nail matrix results in loss of the nail plate. Therefore, a new nail plate cannot

2014 eMedicine.com

28. Dermatoscopy of nail lichen planus. (Abstract)

in 50.63%, splinter hemorrhage in 35.44%, onycholysis in 27.85%, and subungual keratosis in 7.59%. Concerning anomalies that involved nail matrix, bed, and perionychial region altogether, there were longitudinal streaks in 82.28% and anonychia in 1.27%. Paronychia was present in 31.65% of the cases.Considering that nail lichen planus is an underdiagnosed disease with severe consequences, early diagnosis is essential. This descriptive study of dermatoscopic characteristics of nail lichen planus would (...) Dermatoscopy of nail lichen planus. Nail lichen planus affects 10% of all patients with lichen planus. It is a severe disease that may lead to destruction of the nail plate. It affects fingernails more than toenails. Early diagnosis is important due to its aggressive behavior. Histopathology should be carried out, but in many occasions it is not enough to come to a conclusive diagnosis. Dermatoscopy, a complementary tool, has proven to be useful in its diagnosis, management, and prognosis

2013 International Journal of Dermatology

29. A Study to Evaluate the Safety and Efficacy of Adalimumab in Subjects With Chronic Plaque Psoriasis and Nail Psoriasis

for psoriasis with mNAPSI, and the scores of all 10 fingernails were combined. Investigators assessed each nail abnormality for each of a participant's nails by grading 3 features or groups of features (pitting, onycholysis and oil-drop dyschromia, and crumbling) and noting the presence or absence of 4 features (leukonychia, splinter hemorrhages, hyperkeratosis, and red spots in the lunula). The range of possible scores was 0 to 130, with a score of 0 indicating absence of nail psoriasis and a score of 130 (...) A Study to Evaluate the Safety and Efficacy of Adalimumab in Subjects With Chronic Plaque Psoriasis and Nail Psoriasis A Study to Evaluate the Safety and Efficacy of Adalimumab in Subjects With Chronic Plaque Psoriasis and Nail Psoriasis - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum

2013 Clinical Trials

30. Comparison of Efficacy of Intralesional Triamcinolone Injection and Clobetasol Propionate Ointment for Psoriatic Nails

, discoloration, splinter hemorrhage and subungual hyperkeratosis. The main treatment of psoriatic nails is using topical high- potent steroids however topical steroids are limited their ability to penetrate deep nail matrix or nail bed which are the main pathology. Use of such a treatment can lead to skin atrophy and report in the case of "Disappearing digits". Previous studies of steroid injection in the treatment of psoriatic nails show satisfactory results without any serious permanent adverse effects (...) disorder. The nails involvement has been reported up to 40% of psoriatic patients. Psoriatic nails can significantly affect a quality of life of patients. Psoriasis affects both nail matrix and nail bed. Pitting, leukonychia and red spots in lunula indicate a defect in the nail matrix. Psoriasis can change the nail bed as the results in onycholysis, discoloration, splinter hemorrhage and subungual hyperkeratosis. The main treatment of psoriatic nails is using topical high- potent steroids however

2012 Clinical Trials

31. Nail psoriasis: a review. (Abstract)

Nail psoriasis: a review. Nail psoriasis is common, occurring in up to half of patients with psoriasis and in 90% of patients with psoriatic arthritis. Left untreated, it may progress to debilitating nail disease, which leads to significant functional impairment. The most common clinical signs of nail psoriasis are nail plate pitting and onycholysis. Other classical signs include oil drop discoloration, subungual hyperkeratosis, and splinter hemorrhages. The modified Nail Psoriasis Severity (...) Index (mNAPSI) can be used to grade the severity of nail psoriasis, while the Nail Psoriasis Quality of Life Scale (NPQ10) is a questionnaire that evaluates the impact of nail psoriasis on the patient's functional status and quality of life. Treatment of nail psoriasis should be individualized according to the patient's preferences, severity of nail changes, and presence of skin and/or joint involvement. Both topical and intralesional therapies are safe and effective treatment modalities for nail

2012 American journal of clinical dermatology

32. Comparative prospective study of proximal femoral nail and dynamic hip screw in treatment of intertrochanteric fracture femur Full Text available with Trip Pro

of the patient was 62.3 years. Most common mechanism of fracture was domestic fall. Twenty percent four percent had stable, 58% unstable and 18% reverse oblique pattern of fracture. The unstable pattern was more common in old aged patients with higher grade of osteoporosis. The average blood loss was 100 and 250 ml in PFN and DHS group respectively. In PFN there were more no. of radiation exposure intraoperatively. The average operating time for the patients treated with PFN was 55 min as compared to 87 min (...) Comparative prospective study of proximal femoral nail and dynamic hip screw in treatment of intertrochanteric fracture femur The aim of this study was to compare the outcome of intertrochanteric fractures treated with Dynamic Hip Screw and Proximal Femoral nail.This study was conducted on 50 cases of Intertrochanteric fractures of femur treated by a dynamic hip screw and proximal femoral nail. Patients were operated on standard fracture table under image intensifier control.The average age

2012 Journal of clinical orthopaedics and trauma

33. Longitudinal erythronychia: individual or multiple linear red bands of the nail plate: a review of clinical features and associated conditions. (Abstract)

band), type Ib (monodactylous - bifid bands), type IIa (polydactylous - single band), and type IIb (polydactylous - multiple bands). Associated morphologic findings that can be present at the distal tip of the nail with longitudinal erythronychia include fragility, onycholysis, splinter hemorrhage, splitting, subungual keratosis, thinning, and V-shaped nick. Some patients with longitudinal erythronychia seek medical evaluation because of pain in the associated distal digit; however, the linear red (...) Longitudinal erythronychia: individual or multiple linear red bands of the nail plate: a review of clinical features and associated conditions. Longitudinal erythronychia is a linear red band on the nail plate that originates at the proximal nail fold, traverses the lunula, and extends to the free edge of the nail plate. Longitudinal erythronychia is classified based upon the number of nails affected and the number of red streaks present on each nail as follows: type Ia (monodactylous - single

2011 American journal of clinical dermatology

34. Prevention, Diagnosis & Management of infective endocarditis

> Immunocompromised patients • Fever is usually very high in acute IE • Anaemia • In subacute cases this may be anaemia of chronic disease or microcytic anaemia Peripheral • Splinter haemorrhagesNail beds of the fingers or toes • Examine all digits of upper and lower limbs • Exclude workplace trauma • Osler’s nodes > Painful subcutaneous nodules (red-purple, slightly raised, tender lumps and with a pale centre) • Pulps of the fingers or toes • Pain precedes the development of the visible lesion by up to 24 (...) Enterococcus species 88 4.2.2.5 HACEK microorganisms 91 4.2.2.6 Candida 92 4.2.2.7 Non-HACEK Gram-negative microorganisms 93 4.2.2.8 Other microorganisms 94 4.2.3 Empirical therapy 95 4.2.4 Outpatient parenteral antimicrobial therapy for infective endocarditis 99 5.0 SURGICAL INTERVENTION 100 5.1 Indications 100 5.2 Timing of surgery 102 5.2.1 Preventing systemic embolism 103 5.3 Sur gery in specific conditions 104 5.3.1 Cerebral infarction or haemorrhage 104 5.3.2 Right-sided endocarditis 105 5.3.3

2017 Ministry of Health, Malaysia

35. CRACKCast E083 – Infective Endocarditis and Valvular Disease

of infective endocarditis Clinical Features: intermittent fever Osler nodes / roth spots / rheumatoid factor Malaise, chills, anorexia non specific : weakness, myalgias, back pain, dyspnea, chest pain, cough, h/a murmur usually absent in EARLY disease present in < 30% 4) Give three examples of vascular sequelae of infective endocarditis Osler nodes Splinter hemorrhages Janeway lesions Roth spots Splenomegaly watch for stroke like symptoms and fever Can have emboli anywhere! CRAO Pneumonia MI Intestinal (...) spots (these were described in the pre-antibiotic era). Osler nodes Tender subcutaneous violaceous nodules usually on the pads of fingers and toes. (papulopustules) Splinter hemorrhages Non-blanching, linear, reddish brown lesions under the nail beds Roth Spots Exudative, edematous hemorrhagic lesions of the retina with pale centres. 2) What are the HACEK organisms, and what is their significance in patients with IE? HACEK haemophilus, actinobacillus, cardiobacterium, eikenella, kingella

2017 CandiEM

36. Effectiveness of Adalimumab (HUMIRA®) in the Treatment of Scalp and Nail Affection in Patients With Moderate to Severe Plaque Psoriasis in Routine Clinical Practice

(NAPSI) [ Time Frame: Baseline and Months 3, 6, 9, and 12 ] NAPSI grades nails for both nail matrix psoriasis and nail bed psoriasis. The sum of these two scores is the total score for that nail. Nail matrix psoriasis consists of any of the following: pitting, leukonychia, red spots in the lunula, or nail plate crumbling. Nail bed psoriasis is the presence or absence of onycholysis, splinter hemorrhages, oil drop (salmon patch) discoloration or nail bed hyperkeratosis. Scoring for each is based (...) , and 12 ] Good clinical response on nails is defined as ≥ 50% improvement from Baseline in total NAPSI score. The NAPSI grades nails for both nail matrix psoriasis and nail bed psoriasis. The sum of these two scores is the total score for that nail. Nail matrix psoriasis consists of any of the following: pitting, leukonychia, red spots in the lunula, or nail plate crumbling. Nail bed psoriasis is the presence or absence of onycholysis, splinter hemorrhages, oil drop (salmon patch) discoloration

2010 Clinical Trials

37. The burden of nail psoriasis: an introduction. (Abstract)

The burden of nail psoriasis: an introduction. Nail involvement is an extremely common feature of psoriasis and affects approximately 50% of patients. Despite this, it is an often overlooked feature of the disease, and treatment tends to be focused on clearing the cutaneous component of psoriasis. Clinical manifestations of nail psoriasis are pitting, discolouration, onycholysis and subungual hyperkeratosis as well as nail plate crumbling and splinter haemorrhages. Nail psoriasis is associated (...) with discomfort in many patients and leads to significant functional impairment and psychological stress. The often distressing appearance of affected nails impacts the patient tremendously in both work and social activities. Importantly, 80% of patients with psoriatic arthritis have nail psoriasis. This review discusses the incidence of nail psoriasis and the burden on the patient and illustrates when dermatologists are strategically placed to detect the early signs of more severe disease by promptly

2010 Dermatology

38. Onychomatricoma: Genome-wide analyses of a rare nail matrix tumor. (Abstract)

Onychomatricoma: Genome-wide analyses of a rare nail matrix tumor. Onychomatricoma (OM) is a rare benign tumor of the nail matrix in which genome-wide analyses have never been performed. It is clinically characterized by an increased transversal curvature of the nail plate, a longitudinal yellowish discoloration, and splinter hemorrhages. Once the nail plate has been removed, fingerlike fibrokeratogenous projections appear through the proximal nailfold. Histologically, it is a fibroepithelial (...) testing of OM showed 34 genomic alterations, with most of the genomic losses being on chromosome 11. Array-based comparative genomic hybridization showed the deletion of 11p15.4, which harbors STIM-1, 11q14.2 (RP-11 292E14), which harbors the Cathepsin C gene, 11q14 (RP11-281F10-RP11-265F24), and 11q21 (RP11-203F8 and RP11 183A22).This work is an initial approach to a genome-wide study of this tumor. Further studies (with more cases) must be conducted to pinpoint possible candidate genes

2010 Journal of American Academy of Dermatology

39. Addyi - Flibanserin

were assessed only up to 4 hours post-dose, at which time full recovery from the CNS depression had not occurred. Therefore, the time course for full recovery from the ethanol/flibanserin interaction remains unknown. Study SPR-12-03 also assessed for orthostatic vital signs (defined by an increase of = 20 beats per minute, bpm, in pulse rate or a decrease of = 20 mmHg in blood pressure from sitting to standing position). Orthostatic hypotension was observed with flibanserin alone and when (...) flibanserin was co-administered with both ethanol concentrations. The hypotensive effect of the interaction can be profound – in four male subjects (17%, 4/23) receiving low dose ethanol, the magnitude of the systolic blood pressure reductions ranged from about 28 to 54 mmHg and the magnitude of the diastolic blood pressure reductions ranged from about 24 to 46 mmHg. All four subjects received medical intervention. One of these subjects also experienced syncope; his blood pressure at the time of the event

2015 FDA - Drug Approval Package

40. Leg ulcer - venous

investigations, such as: Full blood count — presence of anaemia may delay healing; high white blood cell count and platelet count may indicate infection. Erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) — markers for inflammation and infection. Urea and creatinine — high urea levels may indicate dehydration, which may impair healing. Albumin — low albumin may be associated with protein loss and malnutrition, which may delay healing. HbA1c — to assess for diabetes mellitus. Other (...) to arterial disease often appear well demarcated and have a 'punched out' appearance. There may be signs of arterial compromise, such as pallor, loss of hair, nail dystrophy, coldness, and diminished capillary refill. A history of intermittent claudication, cardiovascular disease, or stroke may indicate the presence of arterial disease. See the CKS topic on for more information. Rheumatoid arthritis — rheumatoid ulcers may be venous, arterial, or vasculitic. Vasculitic ulcers can occur on the calf

2019 NICE Clinical Knowledge Summaries

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