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Nail Telangiectasia

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21. 1404003_OpenPsori.PlaqueTest to Eval.Eff.of Diff.Comp. to Mapracorat

measurement) [ Time Frame: Prior to drug application from Day 1 up to Day 60 ] Assessment was made on occluded test fields on non-lesional skin areas on the forearm Clinical assessment of atrophy using a 5-point score [ Time Frame: Prior to drug application from Day 1 and up to Day 29 ] Assessment was made on occluded test fields on non-lesional skin areas on the forearm Clinical assessment of telangiectasia using a 5-point score [ Time Frame: Prior to drug application from Day 1 and up to Day 29 (...) localized on head and neck, elbows and knees, palms and soles, nails and folds or other mechanically strained sites Volunteers with guttate or pustular psoriasis Volunteers with spontaneously improving or rapidly deteriorating plaque-type psoriasis Volunteers with erythrodermic type of psoriasis Volunteers with severe recalcitrant psoriasis requiring additional therapy Presence of hepatitis B virus surface antigen, hepatitis C virus antibodies or human immune deficiency virus antibodies Clinico-chemical

2018 Clinical Trials

22. Genetics of Skin Cancer (PDQ®): Health Professional Version

30–40 y) XD > AD Xq24-27 [ ] Unknown Hypotrichosis (variable),[ ] hypohidrosis, milia, follicular atrophoderma (dorsal hands), and multiple BCCs (aged teens to early 20s) [ ] AD 16q12-q13 [ , ] CYLD [ , ] Cylindroma (forehead, scalp, trunk, and pubic area),[ , ] trichoepithelioma (around nose), spiradenoma, and BCC AD [ ] Unknown Unknown Multiple BCC (infundibulocystic type) AR > AD Unknown Unknown Ectodermal dysplasia (hypotrichosis, hypodontia, and nail dystrophy [anonychia and trachyonychia

2016 PDQ - NCI's Comprehensive Cancer Database

23. Bruising

haemorrhagic telangiectasia (HHT) A rare autosomal dominant genetic disorder which leads to mucocutaneous telangiectasia of the skin, mucous membranes, and organs. There may be a positive family history, recurrent nosebleeds, fatigue, nail changes, and hair loss. Ehlers-Danlos syndrome This causes joint hypermobility and skin translucency and hyperextensibility. It may present with gingival bleeding, prolonged bleeding after surgical procedures, and menorrhagia. Abnormalities in capillary structure (...) surface of the forearms, and the shins — suggests . Note: the age of a bruise cannot be estimated accurately by its colour; if no bruises are currently present, ask the person to return when they reappear. Examine the skin, hair, and nails for: Age-related changes. Evidence of delayed healing, such as multiple scars or unhealed wounds — suggests corticosteroid use, hypothyroidism, ageing, self-inflicted injury, a collagen defect, or factor XIII deficiency. Laxity — may suggest . Pallor — suggests

2016 NICE Clinical Knowledge Summaries

24. Skin Conditions of Pregnancy

Skin Conditions of Pregnancy Aka: Skin Conditions of Pregnancy , Pregnancy Related Rash , Dermatitis in Pregnancy , Dermatoses of Pregnancy II. Causes: Pregnancy Specific See (e.g. ) Pruritic of pregnancy III. Causes: Pregnancy-Related Pruritic Conditions See Common Prurigo of Pregnancy Uncommon or Pruritic of Pregnancy IV. Causes: Exacerbated by Pregnancy Nail changes (e.g. , brittle nails, grooves) Telangiectasias s (regress after pregnancy) V. References Images: Related links to external sites

2018 FP Notebook

25. Osler-Weber-Rendu Syndrome. (Full text)

Osler-Weber-Rendu Syndrome. A 58-year-old woman presented with intermittent passage of bright red blood from the rectum, progressive fatigue, and dyspnea. Examination revealed telangiectasias on the labial mucosa and nail folds. Her mother was reported to have frequent epistaxis and similar skin lesions.

2015 NEJM PubMed

26. Raynaud's phenomenon

with an underlying cause and should be suspected if any of the following criteria are met: Onset at more than 30 years of age. Episodes that are intense, painful, or asymmetrical. Clinical features suggestive of an underlying disease. Positive anti-nuclear antibody tests. Abnormal nail-fold capillaries (although this may be difficult to determine). Digital ulcers. Primary Raynaud’s phenomenon (occurring without an underlying cause) should be diagnosed if there are no features of secondary Raynaud's phenomenon (...) (Calcinosis, Raynaud's phenomenon, Esophageal dysfunction, Sclerodactyly, and Telangiectasia) syndrome, which is now more usually termed 'limited cutaneous systemic sclerosis'. Systemic lupus erythematosus. Rheumatoid arthritis. Sjogren's syndrome. Mixed or undifferentiated connective-tissue disease. Dermatomyositis and polymyositis. However, digital vasospasm can also be caused by a number of drugs and noninflammatory conditions: Drugs: Amphetamines and cocaine. Beta-blockers. Cancer chemotherapy

2014 NICE Clinical Knowledge Summaries

27. Psoriasis

Psoriasis Psoriasis - NICE CKS Clinical Knowledge Summaries Share Psoriasis: Summary Psoriasis is a systemic, immune-mediated, inflammatory skin disease which typically has a chronic relapsing-remitting course, and may have nail and joint (psoriatic arthritis) involvement. Chronic plaque psoriasis (including scalp psoriasis, flexural psoriasis, and facial psoriasis) is the most common form, affecting 80–90% of people with psoriasis. The second most common form is localized pustular psoriasis (...) of the palms and soles. Other forms of psoriasis include: Guttate psoriasis. Nail psoriasis. Erythrodermic and generalized pustular psoriasis (rare medical emergencies, may be life-threatening). Psoriasis is common, with about 1.3–2.2% of the UK population affected. Several factors are associated with the onset or exacerbation of psoriasis, including infection, drugs (including corticosteroid withdrawal), ultraviolet light exposure, trauma, hormonal changes, stress, smoking, and alcohol. Psoriasis may

2014 NICE Clinical Knowledge Summaries

28. Balanitis

be itchy, painful, atrophic white patches or plaques on the glans penis and foreskin, possible telangiectasia, haemorrhagic vesicles, blisters, erosions, or ulceration. Repeated chronic inflammation causes white, firm scarring of the foreskin tip which may lead to inability to retract the foreskin (phimosis), meatal stenosis, and urethral stricture. Lichen planus — this is an inflammatory disorder which can affect the skin, genital, and oral mucous membranes. This typically presents with purplish, well (...) weeks. Topical miconazole 2% is licensed for treatment of mycotic infections of the skin and nails. Advise the person to apply topical miconazole to the affected area twice daily. Treatment should be continued for 10 days after lesions have healed. Topical econazole 1% is licensed for the treatment of mycotic balanitis. Advise the person to apply topical econazole to the affected area twice daily for at least two weeks. Topical ketoconazole 2% is licensed for the treatment of fungal infections

2014 NICE Clinical Knowledge Summaries

29. Anaemia - iron deficiency

, malabsorption, increased loss, or increased requirements. Symptoms commonly include fatigue, dyspnoea, and headache. Symptoms of iron deficiency may occur without anaemia. Common signs of iron deficiency anaemia include pallor and atrophic glossitis. Less common signs include: tachycardia, nail changes, and angular cheilosis. There may be an absence of signs, even if the person has severe anaemia. Serum ferritin level is the biochemical test, which most reliably correlates with relative total body iron (...) , and ask about: of anaemia. If the anaemia is severe, ask about specific cardiac symptoms (for example angina, palpitations, and ankle swelling). Diet (to identify poor iron intake). Drug history (for example the use of aspirin, nonsteroidal anti-inflammatory drugs, selective serotonin reuptake inhibitors, clopidogrel, or corticosteroids). A family history of: Iron deficiency anaemia (which may indicate inherited disorders of iron absorption). Bleeding disorders and telangiectasia. Colorectal carcinoma

2013 NICE Clinical Knowledge Summaries

30. New Classification Criteria for Systemic Sclerosis (Scleroderma). (PubMed)

a numerical weight: skin thickening, fingertip lesions, telangiectasia, abnormal nail fold capillaries, lung involvement, Raynaud's phenomenon, and SSc-related autoantibodies. The ACR/EULAR classification criteria for SSc have good sensitivity and specificity but do not substitute for diagnostic criteria. Copyright © 2015 Elsevier Inc. All rights reserved.

2015 Rheumatic Diseases Clinics of North America

31. Test your medicine knowledge: 27-year-old woman with an intensely pruritic rash

and allergens. Cosmetics, including nail products, shampoo, and fragrances, frequently result in an allergy on the eyelids, even when not directly applied to that location, because of the thin eyelid skin. This patient has mild allergic contact dermatitis; she should avoid the trigger, and topical glucocorticoids will relieve her symptoms. The other three medications are all very potent topical glucocorticoids. The potencies of topical glucocorticoids in the United States are designated by classification (...) into one of seven groups, with group 7 (1% and 2.5% hydrocortisone) being the least potent and group 1 being the most potent (up to 600 times more potent than the group 7 agents). Higher-potency glucocorticoids can rapidly lead to adverse effects, including lightening of the skin, atrophy, and telangiectasias, when used on areas of thin skin such as the eyelids. In addition, patients are at risk of ocular exposure and eventual cataract formation if chronically exposed. Therefore, treatment of facial

2015 KevinMD blog

32. 9q33.3q34.11 microdeletion: new contiguous gene syndrome encompassing STXBP1, LMX1B and ENG genes assessed using reverse phenotyping. (Full text)

overlapping deletions of chromosome 9q33.3q34.11, including the STXBP1, the LMX1B and the ENG genes. We restrained the selection to these three genes because the effects of their haploinsufficency are well described in the literature and easily recognizable clinically. All deletions were detected by array-CGH and confirmed by FISH. The patients display common clinical features, including intellectual disability with epilepsy, owing to the presence of STXBP1 within the deletion, nail dysplasia and bone (...) malformations, in particular patellar abnormalities attributed to LMX1B deletion, epistaxis and cutaneous-mucous telangiectasias explained by ENG haploinsufficiency and common facial dysmorphism. This systematic analysis of the genes comprised in the deletion allowed us to identify genes whose haploinsufficiency is expected to lead to disease manifestations and complications that require personalized follow-up, in particular for renal, eye, ear, vascular and neurological manifestations.

2015 European Journal of Human Genetics PubMed

33. Genetics of Skin Cancer

teens to early 20s) [ ] AD 16q12-q13 [ , ] CYLD [ , ] Cylindroma (forehead, scalp, trunk, and pubic area),[ , ] trichoepithelioma (around nose), spiradenoma, and BCC AD [ ] Unknown Unknown Multiple BCC (infundibulocystic type) AR > AD Unknown Unknown Ectodermal dysplasia (hypotrichosis, hypodontia, and nail dystrophy [anonychia and trachyonychia]), hidrocystomas of eyelids, palmo-plantar keratosis and hyperhidrosis, and BCC [ ] (Refer to the section in the section of this summary for more

2012 PDQ - NCI's Comprehensive Cancer Database

34. Leg ulcer - venous

by induration and dermal fibrosis. A rigid woody hardness often develops which may result in the leg resembling an 'inverted champagne bottle'. Atrophie blanche: smooth, ivory-white plaques stippled with telangiectasia. Look for signs of infection, such as: Enlarging ulcer. Increased exudate or pain. Pyrexia. Foul odour. Cellulitis — surrounding skin is painful, red, hot, swollen, and tender. For more information, see the CKS topic on . Examine the person (lying and standing) for evidence of varicose veins (...) diagnosis What else might it be? Alternative causes of a leg ulcer include: Arterial ulcer: a punched-out appearance, with ischaemia and necrosis, typical in a person with atherosclerosis. Features include pale or blue, mottled, shiny, cold skin; prolonged capillary refill; nail dystrophy; reduced hair growth; and calf muscle wasting of the limb. Combined arterial and venous insufficiency: seen in 10–20% of leg ulcers. Rheumatoid ulcer (vasculitic) : typically deep, well demarcated and punched out

2012 NICE Clinical Knowledge Summaries

35. Nevus Araneus (Spider Nevus) (Overview)

failure, and cirrhosis. [ , , ] In fact, the spider angioma is rumored to have received its name from barmaids in New York, who used the lesion as a marker of liver disease in their customers. [ ] When associated with liver disease, spider angiomas may be numerous, large in size, [ ] and appear in atypical locations [ ] ; other findings may be present, including palmar erythema, muscle atrophy, gynecomastia, ascites, jaundice, splenomegaly, [ ] leukonychia, , and longitudinal nail striations (...) , Galal S. Nail changes in patients with liver disease. J Eur Acad Dermatol Venereol . 2010 Jun. 24(6):649-54. . . Li CP, Lee FY, Hwang SJ, Chang FY, Lin HC, Lu RH, et al. Role of substance P in the pathogenesis of spider angiomas in patients with nonalcoholic liver cirrhosis. Am J Gastroenterol . 1999 Feb. 94(2):502-7. . . Isner JM, Pieczek A, Schainfeld R, Blair R, Haley L, Asahara T, et al. Clinical evidence of angiogenesis after arterial gene transfer of phVEGF165 in patient with ischaemic limb


36. Arteriovenous Fistulas (Diagnosis)

of first year of life and is characterized by decreased tempo of the tumor growth, with the gradual color fading from the center of the mass and less tense consistency. Transition to the involuted phase occurs during the second half of the first decade of life. Normal skin is restored in half of patients, and persistent skin changes such as telangiectasias, skin thinning and may occur. Other congenital tumors include tufted angioma, congenital hemangioma, and kaposiform hemangioepithelioma (...) syndromes. These malformations are frequently associated with dilated capillary vessels in the dermis, asymmetric overgrowth of the involved limbs, and sometimes multiple soft tissue tumors, abnormal development of venous and arterial systems, and the presence of port-wine stains (see the image below). Buttock port-wine stain. Lymphatic malformations Lymphatic malformations are usually related to genomic mutations and include , Meige syndrome, yellow-nail syndrome, and . They are usually characterized

2014 eMedicine Surgery

37. Skin, Anatomy

of the epidermis. They serve as antigen-presenting cells. They are capable of ingesting foreign antigens, processing them into small peptide fragments, binding them with major histocompatibility complexes, and subsequently presenting them to lymphocytes for activation of the immune system. An example of activation of this component of the immune system is contact hypersensitivity. Merkel Cells Merkel cells, also derived from neural crest cells, are found on the volar aspect of digits, in nail beds (...) and makes the skin more impervious to moisture. Sweat Glands Sweat glands, or eccrine glands, are found over the entire surface of the body except the vermillion border of the lips, the external ear canal, the nail beds, the labia minora, and the glans penis and the inner aspect of the prepuce. They are most concentrated in the palms and soles and the axillae. Each gland consists of a coiled secretory intradermal portion that connects to the epidermis via a relatively straight distal duct. The normal

2014 eMedicine Surgery

38. Wound Healing, Keloids

of the original wound and may reduce over time. [ ] See the image below. Keloid located on the foot. The initial injury was a nail puncture. The foot has been cleaned with povidone-iodine solution (Betadine) prior to surgery. Ear lobe keloid scar from piercing. Keloids are benign dermal fibroproliferative tumors with no malignant potential. The first description of abnormal scar formation in the form of keloids was recorded in the Smith papyrus regarding surgical techniques in Egypt around 1700 BC (...) for a total of 6 months. Adverse effects of corticosteroid injections include atrophy of the skin or subcutaneous tissue, hypopigmentation, telangiectasia, necrosis ulceration, visible deposition of steroid in the form of white flecks in the scar, and systemic effects resulting in cushingoid habitus. Most of these adverse effects can be avoided by confining injections of the lowest possible dose of steroid to the dermal layer. Excisional surgery Simple excisional surgery should involve the least amount

2014 eMedicine Surgery

40. Collagen-Vascular Disease Associated With Interstitial Lung Disease (Follow-up)

severe interstitial fibrosis and medial fibrosis and smooth muscle hyperplasia of pulmonary arteriole, compatible with pulmonary hypertension. Heliotrope rash in woman with dermatomyositis. Gottron papules and nail-fold telangiectasia in patient with dermatomyositis. Classic malar rash (butterfly rash) with distribution over cheeks and nasal bridge. Note that fixed erythema (sometimes associated with mild induration, as here) characteristically spares nasolabial folds. High-resolution CT scan (...) in Collagen-Vascular Diseases CVD Skin and Musculoskeletal System Lungs Heart Salivary Glands Eyes RA * Subcutaneous nodules, digital ulcers, nail-fold infarcts Bibasilar Velcro crackles, signs of pulmonary hypertension, pleural effusion Pericarditis, myocarditis N/A N/A SLE * Malar rash, alopecia, livedo reticularis, erythema, telangiectasia, capillary infarcts, polyarthritis Pleural effusion or rub, pneumonitis, cor pulmonale, diaphragmatic weakness Pericarditis, myocarditis, CAD N/A N/A SD Thickening


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