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Biomedical subjects

B M Piraccini

Publications and source records attributed to B M Piraccini.

At least 55 records · Page 3Linked to original sources
PubMed1996

Treatment of dermatophyte nail infections: an open randomized study comparing intermittent terbinafine therapy with continuous terbinafine treatment and intermittent itraconazole therapy.

BACKGROUND: terbinafine persists in the nail at effective concentrations for several weeks after discontinuation of treatment. OBJECTIVE: Our purpose was to verify whether intermittent terbinafine therapy is effective in dermatophytic onychomycosis and to compare the results of intermittent terbinafine with those of intermittent itraconazole and continuous terbinafine treatment. METHODS: An open, randomized study of 63 patients was performed with three treatment regimens: terbinafine, 250 mg daily (21 patients); terbinafine, 500 mg daily for 1 week every month (21 patients); or itraconazole, 400 mg daily for 1 week every month (21 patients). Treatment was continued for 4 months in toenail infections (60 patients) and 2 months in fingernail infections (3 patients). RESULTS: At the end of the follow-up period (6 months after discontinuation of treatment) 16 of the 17 patients (94.1%) with toenail onychomycosis were mycologically cured in the terbinafine 250 mg group, 16 of 20 (80%) in the terbinafine 500 mg group, and 15 of 20 (75%) in the itraconazole group. CONCLUSION: The percentage of patients who were mycologically cured was higher in the continuous terbinafine group than in the intermittent terbinafine and itraconazole groups, but statistical analysis did not reveal any significant difference between these cure rates.

Administration, Oral↗
PubMed1996

Nail matrix nevi: a clinical and histopathologic study of twenty-two patients.

BACKGROUND: Because most dermatologists do not regularly perform biopsies of longitudinal melanonychia, even when the pigmentation presents as a single band, the true prevalence of nail matrix nevi is unknown. OBJECTIVE: Our purpose was to determine the prevalence of nail matrix nevi in white patients with longitudinal melanonychia involving a single digit and to determine whether longitudinal melanonychia caused by a nail matrix nevus can be clinically distinguished from longitudinal melanonychia from other causes. METHODS: From January 1989 to December 1994 we performed a nail biopsy on 100 of 128 consecutive white patients who had a single band of "idiopathic" longitudinal melanonychia. RESULTS: A nail matrix nevus was detected in 22 patients. A junctional nevus was found in 19 specimens and a compound nevus in three specimens. CONCLUSION: Nail matrix nevi in Caucasian patients are uncommon but not exceptional. The number of nevi presenting with longitudinal melanonychia exceeded that of melanoma. The diagnosis of nail matrix nevi is impossible clinically and always requires histopathologic study. The pathologic features of nail matrix nevi are similar to those of skin nevi except for their architectural pattern, which reflects the peculiar anatomy of the nail unit.

Adolescent↗
PubMed1996

Onychomycosis due to Scopulariopsis brevicaulis: clinical features and response to systemic antifungals.

Six cases of Scopulariopsis onychomycosis, including four patients with onychomycosis exclusively caused by Scopulariopsis brevicaulis and two patients with a mixed nail infection (S. brevicaulis + Tricophyton rubrum and S. brevicaulis + T. interdigitale), are reported. Four patients presented with a typical distal subungual onychomycosis characterized by subungual hyperkeratosis and onycholysis of the distal nail plate. In two patients, Scopulariopsis infection produced a total dystrophic onychomycosis associated with painful periungual inflammation. Three patients were treated with four pulses of itraconazole, 400 mg daily for 1 week a month, and three patients with terbinafine, 250 mg daily for 4 months. The mycological examination 8 months after discontinuation of treatment showed that one patient was mycologically cured whereas the remaining five patients still carried S. brevicaulis in their nails. The clinical examination at the end of the follow-up period showed a complete cure of the nail abnormalities in only one patient.

Adult↗
PubMed1996

Sea urchin granuloma of the nail apparatus: report of 2 cases.

The authors report 2 cases of sea urchin granuloma of the nail apparatus resulting in permanent nail deformity. Both patients developed periungual and subungual nodular lesions 1-2 months after sea urchin spine injuries in the Mediterranean sea. The affected nails showed periungual nodules associated with splitting of the nail plate distal to the nodules. Surgical excision of the nail lesions required the removal of a large amount of nail matrix that resulted in permanent nail plate dystrophy. Histopathology revealed typical foreign-body granulomas in the nail dermis.

Adult↗
PubMed1996

Proximal subungual onychomycosis due to Microsporum canis.

A case of proximal subungual onychomycosis due to Microsporum canis in a 36-year-old woman is presented. The onychomycosis involved the left thumb and the little fingernails, with thinning of the nail plate and crumbling of the nail plate surface. A milky-white discoloration of the proximal portion of the left thumbnail was also evident. A 2-mm longitudinal nail biopsy showed a large number of fungal elements in the whole length of the nail plate. Fungal hyphae were more numerous in the ventral nail plate and produced detachment of the superficial nail plate. The nail bed was not invaded by fungal elements and was devoid of inflammatory changes. Proximal subungual onychomycosis is uncommon in immunocompetent individuals but has frequently been described in patients with AIDS. In our patient, in whom the proximal subungual onychomycosis was due to M. canis, there were no clinical or biochemical signs of immunodeficiency. Oral treatment with terbinafine, 250 mg/daily for 2 months, produced clinical and mycological cure.

Adult↗
PubMed1995

Idiopathic atrophy of the nails: clinical and pathological study of 2 cases.

BACKGROUND: Whether idiopathic atrophy of the nails (IAN) should be considered a separate entity or a clinical variant of nail lichen planus is still controversial. OBJECTIVE: We report here the pathological study of 2 patients with IAN. METHODS: Our patients had similar clinical features consisting of severe nail atrophy with and without pterygium. RESULTS: The nail matrix architecture was markedly deformed with complete disappearance of the keratogenous zone that was replaced by a 3- to 10-cell-thick granular layer. CONCLUSION: The hypothesis that IAN is an acute and self-limited variety of lichen planus is still the most presumable. Even though this hypothesis can not be definitely proven, it is nevertheless not excluded by the clinical and pathological findings of our cases.

Adult↗
PubMed1995

Diffuse partial woolly hair.

We report here a 14-year-old girl with diffuse partial woolly hair. The patient presented mild hair loss associated with the presence of fine, short and kinky hairs closely interspersed with the normal hair throughout the scalp. The pathology of the scalp revealed the presence of intermediate-sized hair follicles regularly intermingled with normal follicles in each follicular unit. The possibility that diffuse partial woolly hair may result from a progressive miniaturization of the hair follicles may explain the presence of evident hair thinning in several adult patients affected by this rare abnormality.

Adolescent↗
PubMed1994

Characterization of nail matrix melanocytes with anti-PEP1, anti-PEP8, TMH-1, and HMB-45 antibodies.

BACKGROUND: The normal nail matrix contains quiescent melanocytes with a peculiar arrangement and behavior. OBJECTIVE: Our purpose was to identify nail matrix melanocytes with antibodies that recognize melanocytic cells in tissue sections. METHODS: We used the polyclonal antibodies anti-PEP1 and anti-PEP8 and the monoclonal antibody TMH-1, which recognize melanocytic enzymes, and the monoclonal antibody HMB-45, which reacts with melanoma cells and fetal melanocytes, but not with normal adult melanocytes. Nail matrix specimens were obtained from longitudinal specimens of eight white patients with ingrown toenails. Specimens from normal adult forearm skin were used as controls. RESULTS: All nail specimens gave similar results. Dendritic melanocytes were more numerous in the distal than in the proximal nail matrix. They were not restricted to the basal layer, but were also found in the suprabasal layers of the nail matrix epithelium. Melanocytes were seen both a single dendritic cells among the nail matrix keratinocytes and as small clusters that appeared irregularly distributed along the length of the nail matrix. Each cluster usually consisted of three to four cells. CONCLUSION: Even if normally quiescent, nail matrix melanocytes possess the key enzymes responsible for the formation of melanin. The suprabasal location of nail matrix melanocytes may be a consequence of the distribution of adhesion molecules in the nail epithelium. In fact, in the nail matrix alpha 2, alpha 3, and beta 1 integrins are not only expressed on the basal, but also on the fourth to fifth suprabasal layers, with suprabasal expression gradually decreasing from distal to proximal matrix. The behavior of nail matrix keratinocytes may cause the peculiar arrangement and behavior of nail matrix melanocytes.

Antibodies, Monoclonal↗
PubMed1994

Idiopathic trachyonychia (twenty-nail dystrophy): a pathological study of 23 patients.

We report the clinical features and pathological findings in 23 patients with idiopathic trachyonychia (twenty-nail dystrophy). Clinically, the nail changes in the majority of patients consisted of the typical 'sandpapered' appearance, with a rough, lustreless nail plate. In some, however, the nail plate abnormality was less severe, with numerous small, superficial pits, which imparted a shiny appearance to the surface of the nail. Histology of nail biopsy specimens showed spongiotic changes in 19 patients, psoriasiform features in three, and features of lichen planus in one patient. The mean follow-up of these patients was 2 years, during which time none developed alopecia areata or mucocutaneous lesions. Idiopathic trachyonychia is therefore a consequence of several inflammatory disorders, which produce a disturbance of nail matrix kinetics. The course of the inflammation and the extent of the inflammatory process within the nail matrix produce two different patterns of nail plate surface abnormalities.

Adolescent↗
PubMed1994

Drug-induced hair loss and hair growth. Incidence, management and avoidance.

A large number of drugs may interfere with the hair cycle and produce hair loss. Drugs may affect anagen follicles through 2 main different modalities: (i) by inducing an abrupt cessation of mitotic activity in rapidly dividing hair matrix cells (anagen effluvium) or (ii) by precipitating the follicles into premature rest (telogen effluvium). In anagen effluvium, hair loss usually occurs within days to weeks of drug administration, whereas in telogen effluvium, hair loss becomes evident 2 to 4 months after starting treatment. Anagen effluvium is a prominent adverse effect of antineoplastic agents, which cause acute damage of rapidly dividing hair matrix cells. Telogen effluvium may be a consequence of a large number of drugs including anticoagulants, retinol (vitamin A) and its derivatives, interferons and antihyperlipidaemic drugs. Drug-induced hair loss is usually reversible after interruption of treatment. The prevalence and severity of alopecia depend on the drug as well as on individual predisposition. Some drugs produce hair loss in most patients receiving appropriate dosages while other drugs are only occasionally responsible for hair abnormalities. Both hirsutism and hypertrichosis may be associated with drug administration. Drugs most commonly responsible for the development of hirsutism include testosterone, danazol, corticotrophin (ACTH), metyrapone, anabolic steroids and glucocorticoids. Hypertrichosis is a common adverse effect of cyclosporin, minoxidil and diazoxide.

Alopecia↗
PubMed1994

Hallopeau's acrodermatitis continua of the nail apparatus: a clinical and pathological study of 20 patients.

The clinical diagnosis of Hallopeau's acrodermatitis (HA) restricted to nail and digital pulp may be difficult, and even dermatologists often fail to recognize this condition. The aim of this study was to review the clinical and pathological features of 20 patients, observed over a period of 5 years (1988-1993), who were affected by HA limited to the nails. Our study shows that HA of the nail unit more commonly affects middle-aged females. In all our patients HA of the nail was restricted to one digit and not associated with other manifestations of pustular psoriasis. HA of the nail unit is characterized by a chronic course. None of our patients had a complete clearing of the dermatitis during the follow-up period. In 4 patients the acute phases of HA were treated with the non-steroidal anti-inflammatory agent nimesulide 200 mg/day, with great improvement of inflammatory signs and subjective pain within a few days. In these patients, prolongation of treatment with nimesulide during remission phases prevented relapses of the dermatitis.

Acrodermatitis↗
PubMed1993

Nail lichen planus: clinical and pathologic study of twenty-four patients.

BACKGROUND: We studied a large series of patients with lichen planus (LP) limited to the nails. OBJECTIVE: Our purpose was to review the clinical and histopathologic features of 24 patients with LP limited to the nails and to discuss treatment and long-term prognosis. METHODS: The records of 24 patients with biopsy-confirmed nail LP were analyzed. Clinical and follow-up data were obtained. RESULTS: Nail LP usually appears during the fifth or sixth decade of life. Neither gender-associated susceptibility nor seasonal influences were detected. In most cases, nail LP is self-limiting or promptly regresses with treatment. Recurrences of nail lesions as well as development of LP in other regions of the body are possible. The development of severe and early destruction of the nail matrix characterizes a small subset of patients with nail LP. CONCLUSION: Approximately 25% of patients with nail LP have LP in other sites before or after the onset of nail lesions. Long-term observation indicates that permanent damage to the nail is rare even in patients with diffuse involvement of the matrix.

Administration, Oral↗
PubMed1993

Lichen planus limited to the nails in childhood: case report and literature review.

Although nail abnormalities have been reported to occur in 1% to 10% of patients with lichen planus, in children with lichen planus they are rarely mentioned in the literature. An 11-year-old boy had a two-month history of nail dystrophy affecting all the fingernails and the great toenails. The nail plates showed longitudinal ridging and thinning as well as onycholysis and distal splitting. There were no cutaneous or mucous membrane abnormalities. A nail biopsy specimen showed hyperkeratosis, hypergranulosis, and acanthosis in the ventral portion of the proximal nail fold and in the nail matrix. A band-like lymphocytic infiltrate was present in the superficial dermis, and the basal layer showed vacuolar alterations. A diagnosis of lichen planus was made. Treatment was intramuscular triamcinolone 20 mg once a month for six months. Since 1969 only 13 proved pediatric cases of lichen planus limited to the nails have been reported, including two children with 20-nail dystrophy and four with idiopathic atrophy of the nails.

Biopsy↗