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Nail Splinter Hemorrhage

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41. Etanercept and Methotrexate in Combination or as Monotherapy in Psoriatic Arthritis

) splinter hemorrhages (0 = absent, 1 = present) In participants with fingernails involved with psoriasis, each fingernail was scored at baseline to determine the worst fingernail (ie, the fingernail with the highest mNAPSI score). This fingernail was followed for the remainder of the study. mNAPSI scores range from 0-13 where higher scores represent worse nail disease. Percentage of Participants With Clear mNAPSI at Week 24 [ Time Frame: Baseline and week 24 ] The modified NAPSI scale is a grading (...) system for nail psoriasis that incorporates the following 7 clinical features: pitting (scores 0-3, depending on the number of pits) nail plate crumbling (scores 0-3, depending on the % of nail involvement) onycholysis and oil drop dyschromia (scores 0-3, depending on the % of nail involvement) leukonychia (0 = absent, 1 = present) red spots in lunula (0 = absent, 1 = present) nail bed hyperkeratosis (0 = absent, 1 = present) splinter hemorrhages (0 = absent, 1 = present) In participants

2015 Clinical Trials

42. Dermoscopic Features of Onychomatricoma: A Study of 34 Cases. (PubMed)

were studied. In detail, 6 observers evaluated 12 clinical and 12 dermoscopical criteria as present or absent.For clinical criteria, the highest mean values were leuconychia (3.21), splinter hemorrhages (3.45), and thickening of the plate (3.0). Dermoscopical criteria were more often found present, such as longitudinal parallel white lines (4.33), parallel lesion edges (4.61), splinter hemorrhages (4.48), dark dots (3.96), free-edge nail pitting (4.5), and thickening of the free edge (5.27 (...) Dermoscopic Features of Onychomatricoma: A Study of 34 Cases. Onychomatricoma is a benign tumor of the nail matrix with a precise histopathological definition but many different clinical features and differential diagnoses.The diagnosis of onychomatricoma is based on the pathological examination of a surgical specimen. The objective of this study was to define preoperative diagnostic criteria using noninvasive investigations: observation and dermoscopy.A total of 34 cases of onychomatricoma

2015 Dermatology

43. An Efficacy and Safety of CNTO 1959 (Guselkumab) in Participants With Moderate to Severe Plaque-type Psoriasis

Psoriasis Area and Severity Index (NAPSI) Among Participants with Nail Psoriasis at Baseline [ Time Frame: Week 16 and 48 ] The NAPSI is an index used for assessing and grading the severity of nail psoriasis. A target nail representing the worst nail psoriasis is divided into quadrants and is graded for nail matrix psoriasis (pitting, leukonychia, red spots in the lunula, and nail plate crumbling) and nail bed psoriasis (onycholysis, splinter hemorrhages, oil drop discoloration, and nail bed (...) . It is a 10-item questionnaire that in addition to evaluating overall QOL can be used to assess 6 different aspects that may affect QOL: symptoms and feelings, daily activities, leisure, work or school performance, personal relationships, and treatment. The DLQI item response options are rated by the participant from 0 (not at all/not relevant) to 3 (very much) with a total score range of 0 (best) to 30 (worst); higher scores indicate poor quality of life. Percent Improvement From Baseline in Nail

2014 Clinical Trials

44. Efficacy and Safety of Namilumab (MT203) for Plaque Psoriasis

) and nail bed (onycholysis, splinter hemorrhages, subungual hyperkeratosis, oil drop [salmon patch dyschromia]). Each finger nail divided with imaginary lines into quadrants and scored for both nail matrix and nail bed psoriasis (range from 0 [absence of psoriasis] to 4 [presence of psoriasis in all 4 quadrants]). The total NAPSI score equals the sum of scores for all of the finger nails evaluated and ranges from 0 to 80. Higher scores = more severe psoriasis. Eligibility Criteria Go to Information from (...) current health state on a scale from 0 mm ("Worst imaginable health state") to 100 mm ("Best imaginable health state"); higher scores indicate a better health state. Mean Change From Baseline in Nail Psoriasis Severity Index (NAPSI) Score at Weeks 2, 4, 6, 10, and 12 [ Time Frame: Baseline, Weeks 2, 4, 6, 10, and 12 ] The NAPSI quantifies severity of nail psoriasis by evaluating the presence or absence of psoriatic manifestations on the nail matrix (pitting, leukonychia, red spots on lunula, crumbling

2014 Clinical Trials

45. Dermatologic Manifestations of Gastrointestinal Disease (Diagnosis)

macular or papular, sharply demarcated telangiectases on the face, lips, palate, tongue, ears, chest, or extremities, with occasional presentation under nails. The age of onset for the telangiectases is most often the third decade of life, although earlier presentations may occur during adolescence. Although the distribution of lesions and associated bleeding diathesis are clinically suggestive of hereditary hemorrhagic telangiectasia, it may occasionally be difficult to distinguish from similar (...) [ ] Esophagitis Scleroderma GI bleeding Hereditary hemorrhagic telangiectasia Cirrhosis Liver disease secondary to alcohol or other factors Vesicles/blisters/erosions Esophageal webs Epidermolysis bullosa Esophageal erosion Pemphigus vulgaris Pyloric atresia Junctional epidermolysis bullosa Hepatitis Porphyria cutanea tarda Malabsorption Dermatitis herpetiformis and celiac sprue Velvety hyperpigmented plaques, tripe palms, mucosal hyperplasia Gastric cancer Malignant acanthosis nigricans Yellowish papules

2014 eMedicine.com

46. Dermatologic Manifestations of Hematologic Disease (Diagnosis)

, purpura, ecchymoses, painful skin nodules, and subungual splinter hemorrhages. Livedo reticularis is a presenting sign in up to 40% of patients with the diagnosis of SLE. [ ] Skin changes defined as livedo reticularis are violaceous, red or blue, reticular, or mottled pattern of the skin of the arms, legs, and the trunk. They are not reversible with rewarming. [ ] Noninflammatory vascular thrombosis is the most frequent finding in skin lesions of patients with antiphospholipid syndrome. Differential (...) as palpable purpura, is a characteristic lesion of cryoglobulinemia types II and III. The lesions are nonpruritic and transient. Mixed cryoglobulinemias present with the classic Melzer triad of purpura, arthralgias, and weakness in 25-30% of patients. Other cutaneous manifestations include polyarteritis nodosa–like lesions, splinter hemorrhages, and palmar erythema. [ ] Laboratory detection and analysis of monoclonal immunoglobulins or light chains are performed by using serum or urine protein

2014 eMedicine.com

47. Dermatologic Manifestations of Cardiac Disease (Diagnosis)

a common pathogenetic mechanism for baldness and coronary atherosclerosis. Petechiae Petechiae are found most frequently on the conjunctivae, palate, buccal mucosa, and upper extremities. They are found in persons with infective endocarditis. Splinter Hemorrhages Splinter hemorrhages are subungual, linear, dark-red streaks that may appear in persons with infective endocarditis. Roth Spots Roth spots are oval, retinal hemorrhages with a clear, pale center. Differential diagnoses include connective (...) Clubbing (Hypertrophic Osteoarthropathy) Definition represents a localized drumsticklike swelling of the distal segments of fingers and toes, particularly over the extensor surface. It is caused by connective tissue proliferation leading to increases in the sponginess of the soft tissue at the base of the nails due to stimulation by a humoral substance that causes dilation of the vessels of the fingertip or toe tip. [ ] Differential diagnosis Clubbing, as illustrated below, is seen in persons

2014 eMedicine.com

48. Drug Eruptions (Diagnosis)

the images below. Paronychia. Papules and annular plaques. Superficial and mid-dermal perivascular infiltrate of lymphocytes and eosinophils. Foci of extravasation of erythrocytes. Sorafenib [ ] (a novel multikinase inhibitor) - Hand-foot skin reaction, facial and scalp eruption, scalp dysesthesia, subungual splinter hemorrhages, alopecia, body hair loss, stomatitis, nipple hyperkeratosis or pain, and eruptive facial cysts Vemurafenib is a systemic medication recently approved by the Food and Drug (...) of accumulation is argyria (blue-gray discoloration of skin and nails) observed with use of silver nitrate nasal sprays. Adverse effects are normal but unwanted effects of a drug. For example, antimetabolite chemotherapeutic agents, such as cyclophosphamide, are associated with hair loss. The direct release of mast cell mediators is a dose-dependent phenomenon that does not involve antibodies. For example, aspirin and other NSAIDs cause a shift in leukotriene production, which triggers the release

2014 eMedicine.com

49. Psoriatic Arthritis (Treatment)

with psoriatic arthritis, may include the following: Beau lines Leukonychia Onycholysis Oil spots Subungual hyperkeratosis Splinter hemorrhages Spotted lunulae Transverse ridging Cracking of the free edge of the nail Uniform nail pitting Extra-articular features are observed less frequently in patients with psoriatic arthritis than in those with rheumatoid arthritis (RA) but may include the following: Synovitis affecting flexor tendon sheaths, with sparing of the extensor tendon sheath Subcutaneous nodules (...) at the attachment of the Achilles tendon and the plantar fascia to the calcaneus with the development of insertional spurs Dactylitis with sausage digits is seen in as many as 35% of patients Skin lesions include scaly, erythematous plaques; guttate lesions; lakes of pus; and erythroderma Psoriasis may occur in hidden sites, such as the scalp (where psoriasis frequently is mistaken for dandruff), perineum, intergluteal cleft, and umbilicus Psoriatic nail changes, which may be a solitary finding in patients

2014 eMedicine.com

50. Psoriatic Arthritis (Overview)

with psoriatic arthritis, may include the following: Beau lines Leukonychia Onycholysis Oil spots Subungual hyperkeratosis Splinter hemorrhages Spotted lunulae Transverse ridging Cracking of the free edge of the nail Uniform nail pitting Extra-articular features are observed less frequently in patients with psoriatic arthritis than in those with rheumatoid arthritis (RA) but may include the following: Synovitis affecting flexor tendon sheaths, with sparing of the extensor tendon sheath Subcutaneous nodules (...) at the attachment of the Achilles tendon and the plantar fascia to the calcaneus with the development of insertional spurs Dactylitis with sausage digits is seen in as many as 35% of patients Skin lesions include scaly, erythematous plaques; guttate lesions; lakes of pus; and erythroderma Psoriasis may occur in hidden sites, such as the scalp (where psoriasis frequently is mistaken for dandruff), perineum, intergluteal cleft, and umbilicus Psoriatic nail changes, which may be a solitary finding in patients

2014 eMedicine.com

51. Psoriatic Arthritis (Overview)

with psoriatic arthritis, may include the following: Beau lines Leukonychia Onycholysis Oil spots Subungual hyperkeratosis Splinter hemorrhages Spotted lunulae Transverse ridging Cracking of the free edge of the nail Uniform nail pitting Extra-articular features are observed less frequently in patients with psoriatic arthritis than in those with rheumatoid arthritis (RA) but may include the following: Synovitis affecting flexor tendon sheaths, with sparing of the extensor tendon sheath Subcutaneous nodules (...) at the attachment of the Achilles tendon and the plantar fascia to the calcaneus with the development of insertional spurs Dactylitis with sausage digits is seen in as many as 35% of patients Skin lesions include scaly, erythematous plaques; guttate lesions; lakes of pus; and erythroderma Psoriasis may occur in hidden sites, such as the scalp (where psoriasis frequently is mistaken for dandruff), perineum, intergluteal cleft, and umbilicus Psoriatic nail changes, which may be a solitary finding in patients

2014 eMedicine.com

52. Psoriatic Arthritis (Overview)

with psoriatic arthritis, may include the following: Beau lines Leukonychia Onycholysis Oil spots Subungual hyperkeratosis Splinter hemorrhages Spotted lunulae Transverse ridging Cracking of the free edge of the nail Uniform nail pitting Extra-articular features are observed less frequently in patients with psoriatic arthritis than in those with rheumatoid arthritis (RA) but may include the following: Synovitis affecting flexor tendon sheaths, with sparing of the extensor tendon sheath Subcutaneous nodules (...) at the attachment of the Achilles tendon and the plantar fascia to the calcaneus with the development of insertional spurs Dactylitis with sausage digits is seen in as many as 35% of patients Skin lesions include scaly, erythematous plaques; guttate lesions; lakes of pus; and erythroderma Psoriasis may occur in hidden sites, such as the scalp (where psoriasis frequently is mistaken for dandruff), perineum, intergluteal cleft, and umbilicus Psoriatic nail changes, which may be a solitary finding in patients

2014 eMedicine.com

53. Infective Endocarditis (Overview)

signs of IE are found in as many as 50% of patients. They include the following: Petechiae: Common, but nonspecific, finding Subungual (splinter) hemorrhages: Dark-red, linear lesions in the nail beds Osler nodes: Tender subcutaneous nodules usually found on the distal pads of the digits Janeway lesions: Nontender maculae on the palms and soles Roth spots: Retinal hemorrhages with small, clear centers; rare Signs of neurologic disease, which occur in as many as 40% of patients, include the following (...) [ ] : Embolic stroke with focal neurologic deficits: The most common neurologic sign Intracerebral hemorrhage Multiple microabscesses Other signs of IE include the following: Splenomegaly Stiff neck Delirium Paralysis, hemiparesis, aphasia Conjunctival hemorrhage Pallor Gallops Rales Cardiac arrhythmia Pericardial rub Pleural friction rub Subacute native valve endocarditis The symptoms of early subacute native valve endocarditis (NVE) are usually subtle and nonspecific; they include the following: Low-grade

2014 eMedicine.com

54. Drug Eruptions (Overview)

the images below. Paronychia. Papules and annular plaques. Superficial and mid-dermal perivascular infiltrate of lymphocytes and eosinophils. Foci of extravasation of erythrocytes. Sorafenib [ ] (a novel multikinase inhibitor) - Hand-foot skin reaction, facial and scalp eruption, scalp dysesthesia, subungual splinter hemorrhages, alopecia, body hair loss, stomatitis, nipple hyperkeratosis or pain, and eruptive facial cysts Vemurafenib is a systemic medication recently approved by the Food and Drug (...) of accumulation is argyria (blue-gray discoloration of skin and nails) observed with use of silver nitrate nasal sprays. Adverse effects are normal but unwanted effects of a drug. For example, antimetabolite chemotherapeutic agents, such as cyclophosphamide, are associated with hair loss. The direct release of mast cell mediators is a dose-dependent phenomenon that does not involve antibodies. For example, aspirin and other NSAIDs cause a shift in leukotriene production, which triggers the release

2014 eMedicine.com

55. Dermatologic Manifestations of Hematologic Disease (Overview)

, purpura, ecchymoses, painful skin nodules, and subungual splinter hemorrhages. Livedo reticularis is a presenting sign in up to 40% of patients with the diagnosis of SLE. [ ] Skin changes defined as livedo reticularis are violaceous, red or blue, reticular, or mottled pattern of the skin of the arms, legs, and the trunk. They are not reversible with rewarming. [ ] Noninflammatory vascular thrombosis is the most frequent finding in skin lesions of patients with antiphospholipid syndrome. Differential (...) as palpable purpura, is a characteristic lesion of cryoglobulinemia types II and III. The lesions are nonpruritic and transient. Mixed cryoglobulinemias present with the classic Melzer triad of purpura, arthralgias, and weakness in 25-30% of patients. Other cutaneous manifestations include polyarteritis nodosa–like lesions, splinter hemorrhages, and palmar erythema. [ ] Laboratory detection and analysis of monoclonal immunoglobulins or light chains are performed by using serum or urine protein

2014 eMedicine.com

56. Dermatologic Manifestations of Gastrointestinal Disease (Overview)

macular or papular, sharply demarcated telangiectases on the face, lips, palate, tongue, ears, chest, or extremities, with occasional presentation under nails. The age of onset for the telangiectases is most often the third decade of life, although earlier presentations may occur during adolescence. Although the distribution of lesions and associated bleeding diathesis are clinically suggestive of hereditary hemorrhagic telangiectasia, it may occasionally be difficult to distinguish from similar (...) [ ] Esophagitis Scleroderma GI bleeding Hereditary hemorrhagic telangiectasia Cirrhosis Liver disease secondary to alcohol or other factors Vesicles/blisters/erosions Esophageal webs Epidermolysis bullosa Esophageal erosion Pemphigus vulgaris Pyloric atresia Junctional epidermolysis bullosa Hepatitis Porphyria cutanea tarda Malabsorption Dermatitis herpetiformis and celiac sprue Velvety hyperpigmented plaques, tripe palms, mucosal hyperplasia Gastric cancer Malignant acanthosis nigricans Yellowish papules

2014 eMedicine.com

57. Dermatologic Manifestations of Cardiac Disease (Overview)

a common pathogenetic mechanism for baldness and coronary atherosclerosis. Petechiae Petechiae are found most frequently on the conjunctivae, palate, buccal mucosa, and upper extremities. They are found in persons with infective endocarditis. Splinter Hemorrhages Splinter hemorrhages are subungual, linear, dark-red streaks that may appear in persons with infective endocarditis. Roth Spots Roth spots are oval, retinal hemorrhages with a clear, pale center. Differential diagnoses include connective (...) Clubbing (Hypertrophic Osteoarthropathy) Definition represents a localized drumsticklike swelling of the distal segments of fingers and toes, particularly over the extensor surface. It is caused by connective tissue proliferation leading to increases in the sponginess of the soft tissue at the base of the nails due to stimulation by a humoral substance that causes dilation of the vessels of the fingertip or toe tip. [ ] Differential diagnosis Clubbing, as illustrated below, is seen in persons

2014 eMedicine.com

58. Dermatologic Manifestations of Hematologic Disease (Treatment)

, purpura, ecchymoses, painful skin nodules, and subungual splinter hemorrhages. Livedo reticularis is a presenting sign in up to 40% of patients with the diagnosis of SLE. [ ] Skin changes defined as livedo reticularis are violaceous, red or blue, reticular, or mottled pattern of the skin of the arms, legs, and the trunk. They are not reversible with rewarming. [ ] Noninflammatory vascular thrombosis is the most frequent finding in skin lesions of patients with antiphospholipid syndrome. Differential (...) as palpable purpura, is a characteristic lesion of cryoglobulinemia types II and III. The lesions are nonpruritic and transient. Mixed cryoglobulinemias present with the classic Melzer triad of purpura, arthralgias, and weakness in 25-30% of patients. Other cutaneous manifestations include polyarteritis nodosa–like lesions, splinter hemorrhages, and palmar erythema. [ ] Laboratory detection and analysis of monoclonal immunoglobulins or light chains are performed by using serum or urine protein

2014 eMedicine.com

59. Dermatologic Manifestations of Cardiac Disease (Treatment)

a common pathogenetic mechanism for baldness and coronary atherosclerosis. Petechiae Petechiae are found most frequently on the conjunctivae, palate, buccal mucosa, and upper extremities. They are found in persons with infective endocarditis. Splinter Hemorrhages Splinter hemorrhages are subungual, linear, dark-red streaks that may appear in persons with infective endocarditis. Roth Spots Roth spots are oval, retinal hemorrhages with a clear, pale center. Differential diagnoses include connective (...) Clubbing (Hypertrophic Osteoarthropathy) Definition represents a localized drumsticklike swelling of the distal segments of fingers and toes, particularly over the extensor surface. It is caused by connective tissue proliferation leading to increases in the sponginess of the soft tissue at the base of the nails due to stimulation by a humoral substance that causes dilation of the vessels of the fingertip or toe tip. [ ] Differential diagnosis Clubbing, as illustrated below, is seen in persons

2014 eMedicine.com

60. Dermatologic Manifestations of Gastrointestinal Disease (Treatment)

macular or papular, sharply demarcated telangiectases on the face, lips, palate, tongue, ears, chest, or extremities, with occasional presentation under nails. The age of onset for the telangiectases is most often the third decade of life, although earlier presentations may occur during adolescence. Although the distribution of lesions and associated bleeding diathesis are clinically suggestive of hereditary hemorrhagic telangiectasia, it may occasionally be difficult to distinguish from similar (...) [ ] Esophagitis Scleroderma GI bleeding Hereditary hemorrhagic telangiectasia Cirrhosis Liver disease secondary to alcohol or other factors Vesicles/blisters/erosions Esophageal webs Epidermolysis bullosa Esophageal erosion Pemphigus vulgaris Pyloric atresia Junctional epidermolysis bullosa Hepatitis Porphyria cutanea tarda Malabsorption Dermatitis herpetiformis and celiac sprue Velvety hyperpigmented plaques, tripe palms, mucosal hyperplasia Gastric cancer Malignant acanthosis nigricans Yellowish papules

2014 eMedicine.com

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