Abstract
The basic concepts for performing sonographic examinations of the nail unit will be discussed in this chapter including technical considerations, the normal anatomy and a wide range of pathologies of the nail that gather growth or location abnormalities, congenital diseases, inflammatory conditions, tumors, and pseudotumors. The clinical, sonographic, and histological characteristics of the lesions are considered. Thus, sonography can provide important anatomical information for common nail diseases otherwise unavailable to the clinical examination.
What for, how to study and what to look in nail and periungual lesions
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References
Gonagle M, Tan AL, Benjamin M. The nail as musculoskeletal appendage – implications for an improved understanding of the link between psoriasis and arthritis. Dermatology. 2009;218:97–102.
Hanecke E. Surgical anatomy of the nail apparatus. Dermatol Clin. 2006;24:291–6.
Wortsman X, Jemec GBE. Ultrasound imaging of nails. Dermatol Clin. 2006;24:323–8.
Jemec GB, Serup J. Ultrasound structure of the human nail plate. Arch Dermatol. 1989;125:643–6.
Wortsman X. Common applications of dermatologic sonography. J Ultrasound Med. 2012;31:97–111.
Thomas L, Vaudaine M, Wortsman X, Jemec GBE, Drapé JL. Imaging the nail unit. In: Baran R, de Berker D, Holzberg M, Thomas L, editors. Baran & Dawber’s diseases of the nails and their management. 4th ed. Chichester: Wiley; 2012. p. 132–53.
Heidelbaugh JJ, Lee H. Management of the ingrown toenail. Am Fam Physician. 2009;15(79):303–8.
Chapeskie H, Kovac JR. Case series: soft-tissue nail-fold excision: a definitive treatment for ingrown toenails. Can J Surg. 2010;53:282–6.
Haneke E. Onychomadesis and hand, foot and mouth disease-is there a connection? Euro Surveill. 2010;6(15 pii):19664.
Wortsman X, Wortsman J, Guerrero R, Soto R, Baran R. Anatomical changes in retronychia and onychomadesis detected using ultrasound. Dermatol Surg. 2010;36:1615–20.
Wortsman X, Calderon P, Baran R. Finger retronychias detected early by 3D ultrasound examination. J Eur Acad Dermatol Venereol. 2012;26:254–6.
Baran R, Haneke E. Etiology and treatment of nail malalignment. Dermatol Surg. 1998;24:719–21.
Wagner G, Sachse MM. Congenital malalignment of the big toe nail. J Dtsch Dermatol Ges. 2012;10:326–33.
Hammerton MD, Shrank AB. Congenital hypertrophy of the lateral nail folds of the hallux. Pediatr Dermatol. 1988;5:243–5.
Rufli T, von Schulthess A, Itin P. Congenital hypertrophy of the lateral nail folds of the hallux. Dermatology. 1992;184:296–7.
Piraccini BM, Parente GL, Varotti E, Tosti A. Congenital hypertrophy of the lateral nail folds of the hallux: clinical features and follow-up of seven cases. Pediatr Dermatol. 2000;17:348–51.
Finner AM. Alopecia areata: clinical presentation, diagnosis, and unusual cases. Dermatol Ther. 2011;24:348–54.
Alkhalifah A, Alsantali A, Wang E, McElwee KJ, Shapiro J. Alopecia areata update: part I. Clinical picture, histopathology, and pathogenesis. J Am Acad Dermatol. 2010;62:177–88.
Baran R, Dawber RP, Haneke E. Hair and nail relationship. Skinmed. 2005;4:18–23.
Noronha PA, Zubkov B. Nails and nail disorders in children and adults. Am Fam Physician. 1997;1(55):2129–40.
DiGiovanna JJ, Robinson-Bostom L. Ichthyosis: etiology, diagnosis, and management. Am J Clin Dermatol. 2003;4:81–95.
Van Gysel D, Lijnen RL, Moekti SS, de Laat PC, Oranje AP. Collodion baby: a follow-up study of 17 cases. J Eur Acad Dermatol Venereol. 2002;16:472–5.
Wortsman X, Aranibar L, Morales C. Postnatal 2- and 3-Âdimensional sonography of the skin and nail in congenital autosomal recessive ichthyosis correlated with cutaneous Histologic findings. J Ultrasound Med. 2011;30:1437–9.
Hallaji Z, Babaeijandaghi F, Akbarzadeh M, Seyedi SZ, Barzegari M, Noormohammadpour P, et al. A significant association exists between the severity of nail and skin involvement in psoriasis. J Am Acad Dermatol. 2012;66:e12–3.
Wortsman X, Holm EA, Jemec GBE, Gniadecka M, Wulf H. 15 MHz high resolution ultrasound examination of psoriatic nails. Rev Chil Rad. 2004;10:6–9. Spanish.
Gutierrez M, Wortsman X, Filippucci E, De Angelis R, Filosa G, Grassi W. High-frequency sonography in the evaluation of psoriasis: nail and skin involvement. J Ultrasound Med. 2009;28:1569–74.
Gutierrez M, Filippucci E, De Angelis R, Bertolazzi C, Becciolini A, Ariani A, et al. The ultrasound assessment of the psoriatic arthritis: from joint to skin. Reumatismo. 2009;61:309–15.
Di Franco M, Paradiso M, Riccieri V, Basili S, Mammarella A, Valesini G. Autonomic dysfunction and microvascular damage in systemic sclerosis. Clin Rheumatol. 2007;26:1278–83.
Murray AK, Moore TL, Manning JB, Taylor C, Griffiths CE, Herrick AL. Noninvasive imaging techniques in the assessment of scleroderma spectrum disorders. Arthritis Rheum. 2009;15(61):1103–11.
Tunc SE, Ertam I, Pirildar T, Turk T, Ozturk M, Doganavsargil E. Nail changes in connective tissue diseases: do nail changes provide clues for the diagnosis. J Eur Acad Dermatol Venereol. 2007;21:497–503.
Wortsman X, Gutierrez M, Saavedra T, Honeyman J. The role of ultrasound in rheumatic skin and nail lesions: a multi-specialist approach. Clin Rheumatol. 2011;30:739–48.
Mugii N, Hasegawa M, Matsushita T, Hamaguchi Y, Horie S, Yahata T, et al. Association between nail-fold capillary findings and disease activity in dermatomyositis. Rheumatology (Oxford). 2011;|50:1091–8.
Rider LG, Atkinson JC. Images in clinical medicine. Gingival and periungual vasculopathy of juvenile dermatomyositis. N Engl J Med. 2009;9(360):e21.
Chander S, Gordon P. Soft tissue and subcutaneous calcification in connective tissue diseases. Curr Opin Rheumatol. 2012;24:158–64.
Moneib HA, Salem SA, Aly DG, Khedr HT, Wafaey HA, Hassan HE. Assessment of serum vascular endothelial growth factor and nail fold capillaroscopy changes in systemic lupus erythematosus with and without cutaneous manifestations. J Dermatol. 2012;39:52–7.
Trüeb RM. Involvement of scalp and nails in lupus erythematosus. Lupus. 2010;19:1078–86.
Tosti A. The nail apparatus in collagen disorders. Semin Dermatol. 1991;10:71–6.
Michel C, Cribier B, Sibilia J, Kuntz JL, Grosshans E. Nail abnormalities in rheumatoid arthritis. Br J Dermatol. 1997;137:958–62.
Grassi W, Filippucci E, Farina A, Cervini C. Sonographic imaging of the distal phalanx. Semin Arthritis Rheum. 2000;29:379–84.
Fleming TE, Brodell RT. Subungual abscess: a bacterial infection of the nail bed. J Am Acad Dermatol. 1997;37:486–7.
Vanhooteghem O, Richert B, Vindevoghel A, Vandenbossche L, Vandeveire A, de la Brassinne M. Subungual abscess: a new ungual side-effect related to docetaxel therapy. Br J Dermatol. 2000;143:462–4.
Vidal S, Barcala L, Barberán J, Heras JA, Tovar JA, Baran R. A Âsuppurating fistula from a cement foreign body presenting as a tumour of the nail. Acta Derm Venereol. 2000;80:313–4.
Freiman A, Bouganim N, O’Brien EA. Case reports: mitozantrone-induced onycholysis associated with subungual abscesses, paronychia, and pyogenic granuloma. J Drugs Dermatol. 2005;4:490–2.
Newmeyer WL, Kilgore Jr ES. Common injuries of the fingernail and nail bed. Am Fam Physician. 1977;16:93–5.
Salazard B, Launay F, Desouches C, Samson P, Jouve JL, Magalon G. Fingertip injuries in children: 81 cases with at least one year follow-up. Rev Chir Orthop Reparatrice Appar Mot. 2004;90:621–7. French.
Hart RG, Kleinert HE. Fingertip and nail bed injuries. Emerg Med Clin North Am. 1993;11:755–65.
Wu CY, Chen GS, Lin HL. Median canaliform dystrophy of Heller with associated swan neck deformity. J Eur Acad Dermatol Venereol. 2009;23:1102–3.
Sweeney SA, Cohen PR, Schulze KE, Nelson BR. Familial median canaliform nail dystrophy. Cutis. 2005;75:161–5.
Dharmagunawardena B, Charles-Holmes R. Median canaliform dystrophy following isotretinoin therapy. Br J Dermatol. 1997;137:658–9.
Cruz MJ, Baudrier T, Cunha AP, Ferreira O, Azevedo F. Severe onychodystrophy caused by allergic contact dermatitis to acrylates in artificial nails. Cutan Ocul Toxicol. 2011;30:323–4.
Hinkelbein J, Koehler H, Genzwuerker HV, Fiedler F. Artificial acrylic finger nails may alter pulse oximetry measurement. Resuscitation. 2007;74:75–82.
Peters SM. The effect of acrylic nails on the measurement of oxygen saturation as determined by pulse oximetry. AANA J. 1997;65:361–3.
Torres MC, Linares T, Hernandez MD. Acrylates induced rhinitis and contact dermatitis. Contact Dermatitis. 2005;53:114.
Richert B, Lateur N, Theunis A, Andre J. New tools in nail Âdisorders. Semin Cutan Med Surg. 2009;28:44–8.
Wortsman X, Wortsman J, Soto R, Saavedra T, Honeyman J, Sazunic I, et al. Benign tumors and pseudotumors of the nail: a novel application of sonography. J Ultrasound Med. 2010;29:803–16.
Paliogiannis P, Trignano E, Trignano M. Surgical management of the glomus tumors of the fingers: a single center experience. Ann Ital Chir. 2011;82:465–8.
Wortsman X, Jemec GB. Role of high-variable frequency ultrasound in preoperative diagnosis of glomus tumors: a pilot study. Am J Clin Dermatol. 2009;10:23–7.
Chen SH, Chen YL, Cheng MH, Yeow KM, Chen HC, Wei FC. The use of ultrasonography in preoperative localization of digital Âglomus tumors. Plast Reconstr Surg. 2003;112:115–9.
Matsunaga A, Ochiai T, Abe I, et al. Subungual glomus tumour: evaluation of ultrasound imaging in preoperative assessment. Eur J Dermatol. 2007;17:67–9.
MacKee P, Calonje E, Granter S. Tumors of perivascular cells. In: MacKee P, Calonje E, Granter S, editors. Pathology of the skin with clinical correlation. 3rd ed. Philadelphia: Elsevier/Mosby; 2005. p. 1848–51.
Baek HJ, Lee SJ, Cho KH, Choo HJ, Lee SM, Lee YH, et al. Subungual tumors: clinicopathologic correlation with US and MR imaging findings. Radiographics. 2010;30:1621–36.
Baran R, Haneke E, Drape JL, Zook EG. Tumors of the nail and adjacent tissues. In: Baran, Dawber RPR, de Berker D, Haneke E, Tosti A, editors. Diseases of the nails and their management. 3rd ed. Oxford: Blackwell and Science; 2001. p. 515–601.
Baran R, Richert B. Common nail tumors. Dermatol Clin. 2006;24:297–311.
Baran R, Klint A. Onychomatrixoma. Filamentous tufted tumor in the matrix of a funnel-shaped entity (report of three cases). Br J Dermatol. 1992;126:510–5.
Haneke E, Fränken J. Onychomatricoma. Dermatol Surg. 1995;21:984–7.
Perrin C, Goettmann S, Baran R. Onychomatricoma: clinical and histopathologic findings in 12 cases. J Am Acad Dermatol. 1998;39:560–4.
Soto R, Wortsman X, Corredoira Y. Onychomatricoma: clinical and sonographic findings. Arch Dermatol. 2009;145:1461–2.
Baran R, Perrin C. Subungual perineurioma: a peculiar location. Br J Dermatol. 2002;146:125–8.
Wortsman X, Merino D, Catalan V, Morales C, Baran R. Perineurioma of the nail on sonography. J Ultrasound Med. 2010;29:1379–82.
Macaulay WL. Subungual keratoacanthoma. Arch Dermatol. 1976;112:1004–5.
Connolly M, Narayan S, Oxley J, de Berker DA. Immunohistochemical staining for the differentiation of subungual keratoacanthoma from subungual squamous cell carcinoma. Clin Exp Dermatol. 2008;33:625–8.
Choi JH, Shin DH, Shin DS, Cho KH. Subungual keratoacanthoma: ultrasound and magnetic resonance imaging findings. Skeletal Radiol. 2007;36:769–72.
Wortsman X, Sazunic I, Jemec GB. Sonography of plantar warts: role in diagnosis and treatment. J Ultrasound Med. 2009;28:787–93.
Wortsman X, Wortsman J. Skin ultrasound, chapter 9. In: Dogra V, Gaitini D, editors. Musculoskeletal ultrasound with CT and MRI correlation. 1st ed. New York: Thieme; 2010. p. 147–70.
GarcÃa Carmona FJ, Pascual Huerta J, Fernández Morato D. A proposed subungual exostosis clinical classification and treatment plan. J Am Podiatr Med Assoc. 2009;99:519–24.
Piraccini BM, Bellavista S, Misciali C, Tosti A, de Berker D, Richert B. Periungual and subungual pyogenic granuloma. Br J Dermatol. 2010;163:941–53.
Armstrong K, Weinstein M. Pyogenic granulomas during isotretinoin therapy. J Dermatol Case Rep. 2011;26(5):5–7.
Paul LJ, Cohen PR. Paclitaxel-associated subungual pyogenic granuloma: report in a patient with breast cancer receiving paclitaxel and review of drug-induced pyogenic granulomas adjacent to and beneath the nail. J Drugs Dermatol. 2012;11:262–8.
Kint A, Baran R. Histopathologic study of koenen tumors. Are they different from acquired digital fibrokeratoma. J Am Acad Dermatol. 1988;18(2 Pt 1):369–72.
de Berker D, Lawrence C. Ganglion of the distal interphalangeal joint (myxoid cyst): therapy by identification and repair of the leak of joint fluid. Arch Dermatol. 2001;137:607–10.
Miranda BH, Haughton DN, Fahmy FS. Subungual melanoma: an important tip. J Plast Reconstr Aesthet Surg. 2012;65:1422.
Yun SJ, Kim SJ. Images in clinical medicine. Hutchinson’s nail sign. N Engl J Med. 2011;5(364):e38.
De Giorgi V, Saggini A, Grazzini M, Gori A, Rossari S, Scarfì F, et al. Specific challenges in the management of subungual melanoma. Expert Rev Anticancer Ther. 2011;11:749–61.
Wortsman X, Wortsman J. Clinical usefulness of variable-frequency ultrasound in localized lesions of the skin. J Am Acad Dermatol. 2010;62:247–56.
Nasca MR, Innicenzi D, Micalli G. Subungual squamous cell carcinoma of the toe: report on three cases. Dermatol Surg. 2004;30:345–8.
Choughri H, Villani F, Sawaya E, Pelissier P. Atypical squamous cell carcinoma of the nail bed with Phalangeal involvement. J Plast Surg Hand Surg. 2011;45:173–6.
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Wortsman, X. (2013). Sonography of the Nail. In: Wortsman, X. (eds) Dermatologic Ultrasound with Clinical and Histologic Correlations. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7184-4_18
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