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Changes in the nail unit in patients with secondary lymphoedema identified using clinical, dermoscopic and ultrasound examination

Identifieur interne : 000784 ( PascalFrancis/Curation ); précédent : 000783; suivant : 000785

Changes in the nail unit in patients with secondary lymphoedema identified using clinical, dermoscopic and ultrasound examination

Auteurs : E. Le Fourn [France] ; E. Duhard [France] ; V. Tauveron [France] ; A. Maruani [France] ; M. Samimi [France] ; G. Lorette [France] ; L. Vaillant [France] ; L. Machet [France]

Source :

RBID : Pascal:11-0250838

Descripteurs français

English descriptors

Abstract

Background Secondary lymphoedema is characterized by lymphatic stasis that is often the result of a lymph node lesion. At advanced stages it may cause trophic changes in the skin. However, the presence of changes in the nail unit has not been reported to date. Objectives The aim of this study was to determine the presence of nail abnormalities in cases of secondary lymphoedema. Methods This was a prospective study, conducted on patients with unilateral secondary lymphoedema. A comparative clinical and dermoscopic examination and 20-MHz high-resolution ultrasound imaging of the affected limb and the contralateral limb were performed. Results Thirty-three patients were included. On physical examination, hyperkeratosis of the lateral nail folds, friability of the nail surface, 'ragged' proximal nail folds and cuticle and apparent leuconychia were observed more frequently on the lymphoedematous limb. The ultrasound study of the nails of the thumb and the big toe did not reveal any differences in thickness of the different structures of the nail between the lymphoedema side and the opposite side. The nail matrix was longer on the lymphoedema side. Conclusions Our study showed mild changes in the nail unit compatible with the xerosis often associated with severe lymphoedema. However, the study also showed frequent evidence of 'ragged' cuticles, which in these patients at high risk of erysipelas are entry points for bacteria. This should be taken into account when counselling patients with limb lymphoedema in order to prevent erysipelas.
pA  
A01 01  1    @0 0007-0963
A02 01      @0 BJDEAZ
A03   1    @0 Br. j. dermatol. : (1951)
A05       @2 164
A06       @2 4
A08 01  1  ENG  @1 Changes in the nail unit in patients with secondary lymphoedema identified using clinical, dermoscopic and ultrasound examination
A11 01  1    @1 LE FOURN (E.)
A11 02  1    @1 DUHARD (E.)
A11 03  1    @1 TAUVERON (V.)
A11 04  1    @1 MARUANI (A.)
A11 05  1    @1 SAMIMI (M.)
A11 06  1    @1 LORETTE (G.)
A11 07  1    @1 VAILLANT (L.)
A11 08  1    @1 MACHET (L.)
A14 01      @1 Department of Dermatology, CHRU Tours @2 Tours @3 FRA @Z 1 aut. @Z 2 aut. @Z 3 aut. @Z 4 aut. @Z 5 aut. @Z 6 aut. @Z 8 aut.
A14 02      @1 Lymphology Unit, CHRU Tours @2 Tours @3 FRA @Z 3 aut. @Z 5 aut. @Z 7 aut.
A14 03      @1 University François Rabelais de Tours @2 Tours @3 FRA @Z 4 aut. @Z 6 aut. @Z 7 aut. @Z 8 aut.
A14 04      @1 UMR INSERM U930, ERL 3106 @2 Tours @3 FRA @Z 4 aut. @Z 7 aut. @Z 8 aut.
A20       @1 765-770
A21       @1 2011
A23 01      @0 ENG
A43 01      @1 INIST @2 1043 @5 354000189797820120
A44       @0 0000 @1 © 2011 INIST-CNRS. All rights reserved.
A45       @0 24 ref.
A47 01  1    @0 11-0250838
A60       @1 P
A61       @0 A
A64 01  1    @0 British journal of dermatology : (1951)
A66 01      @0 GBR
C01 01    ENG  @0 Background Secondary lymphoedema is characterized by lymphatic stasis that is often the result of a lymph node lesion. At advanced stages it may cause trophic changes in the skin. However, the presence of changes in the nail unit has not been reported to date. Objectives The aim of this study was to determine the presence of nail abnormalities in cases of secondary lymphoedema. Methods This was a prospective study, conducted on patients with unilateral secondary lymphoedema. A comparative clinical and dermoscopic examination and 20-MHz high-resolution ultrasound imaging of the affected limb and the contralateral limb were performed. Results Thirty-three patients were included. On physical examination, hyperkeratosis of the lateral nail folds, friability of the nail surface, 'ragged' proximal nail folds and cuticle and apparent leuconychia were observed more frequently on the lymphoedematous limb. The ultrasound study of the nails of the thumb and the big toe did not reveal any differences in thickness of the different structures of the nail between the lymphoedema side and the opposite side. The nail matrix was longer on the lymphoedema side. Conclusions Our study showed mild changes in the nail unit compatible with the xerosis often associated with severe lymphoedema. However, the study also showed frequent evidence of 'ragged' cuticles, which in these patients at high risk of erysipelas are entry points for bacteria. This should be taken into account when counselling patients with limb lymphoedema in order to prevent erysipelas.
C02 01  X    @0 002B08
C02 02  X    @0 002B12B04
C03 01  X  FRE  @0 Lymphoedème @5 01
C03 01  X  ENG  @0 Lymphedema @5 01
C03 01  X  SPA  @0 Linfedema @5 01
C03 02  X  FRE  @0 Ongle @5 07
C03 02  X  ENG  @0 Nail(anatomy) @5 07
C03 02  X  SPA  @0 Uña @5 07
C03 03  X  FRE  @0 Dermatologie @5 08
C03 03  X  ENG  @0 Dermatology @5 08
C03 03  X  SPA  @0 Dermatología @5 08
C03 04  X  FRE  @0 Homme @5 10
C03 04  X  ENG  @0 Human @5 10
C03 04  X  SPA  @0 Hombre @5 10
C07 01  X  FRE  @0 Pathologie de l'appareil circulatoire @5 37
C07 01  X  ENG  @0 Cardiovascular disease @5 37
C07 01  X  SPA  @0 Aparato circulatorio patología @5 37
C07 02  X  FRE  @0 Pathologie des vaisseaux lymphatiques @5 38
C07 02  X  ENG  @0 Lymphatic vessel disease @5 38
C07 02  X  SPA  @0 Linfático patología @5 38
N21       @1 171
N44 01      @1 OTO
N82       @1 OTO

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Pascal:11-0250838

Le document en format XML

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<title level="j" type="main">British journal of dermatology : (1951)</title>
<title level="j" type="abbreviated">Br. j. dermatol. : (1951)</title>
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<div type="abstract" xml:lang="en">Background Secondary lymphoedema is characterized by lymphatic stasis that is often the result of a lymph node lesion. At advanced stages it may cause trophic changes in the skin. However, the presence of changes in the nail unit has not been reported to date. Objectives The aim of this study was to determine the presence of nail abnormalities in cases of secondary lymphoedema. Methods This was a prospective study, conducted on patients with unilateral secondary lymphoedema. A comparative clinical and dermoscopic examination and 20-MHz high-resolution ultrasound imaging of the affected limb and the contralateral limb were performed. Results Thirty-three patients were included. On physical examination, hyperkeratosis of the lateral nail folds, friability of the nail surface, 'ragged' proximal nail folds and cuticle and apparent leuconychia were observed more frequently on the lymphoedematous limb. The ultrasound study of the nails of the thumb and the big toe did not reveal any differences in thickness of the different structures of the nail between the lymphoedema side and the opposite side. The nail matrix was longer on the lymphoedema side. Conclusions Our study showed mild changes in the nail unit compatible with the xerosis often associated with severe lymphoedema. However, the study also showed frequent evidence of 'ragged' cuticles, which in these patients at high risk of erysipelas are entry points for bacteria. This should be taken into account when counselling patients with limb lymphoedema in order to prevent erysipelas.</div>
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