Hair & Nails

MIAMI BEACH – Remain skeptical about new devices or drugs that claim the ability to target fungal infections, recommended Dr. Alan B. Fleischer Jr.

"You are probably going to be barraged by devices that do something for nail fungus," Dr. Fleischer said. "As a physician, try to focus on curing the fungus and not just making them [patients] look better," he said at the South Beach Symposium.

For example, enrollment is underway for a study to assess a 1320-nm Nd:YAG device to fight onychomycosis. However, the primary outcome in the trial is "improved appearance," not fungal cure, he said. "It is confusing ... to a consumer. Improving the appearance sounds similar, but it is not the same."

Photo (c) 1993, Elsevier

When it comes to topical treatments for onychomycosis, efinaconazole is in development for treating mild to moderate forms of toenail infection, noted Dr. Fleischer. The manufacturer, Valeant Pharmaceuticals, reported promising results in two international phase III studies in December 2011. However, Valeant has not released mycology results.

"Pay attention to the cure rate when it is approved, probably sometime in the next year," said Dr. Fleischer, professor of dermatology at Wake Forest University in Winston-Salem, N.C.

Patients may ask about natural cures for fungal infections, but the data are generally unconvincing or lacking, Dr. Fleischer said. For example, some people advocate melaleuca oil from the tea tree to clear tinea pedis. However, when 104 patients were randomized to creams containing 10% melaleuca oil, 1% tolnaftate, or placebo, "melaleuca oil cleared 30% of subjects of tinea pedis. That is very low," he said (Australas. J. Dermatol. 1992;33:145-9). Of the tolnaftate-treated patients, 85% had a negative culture at the end of therapy, and 21% of placebo patients were considered cleared.

Other patients might ask about using vinegar to cure foot fungus. They may have read about this natural remedy on the Internet, where a Google search for the keywords "vinegar" and "foot fungus" yields about 116,000 results. "Although there are no data, topical vinegar immersion probably does something," Dr. Fleischer said.

"Fungal infections are still out there, but new drugs and modalities are continually evolving," he added.

Dr. Fleischer disclosed that he is a consultant for Intendis and Upsher-Smith Laboratories. He is also a researcher for Abbott, Amgen, Astellas, Galderma, GlaxoSmithKline, Intendis, and Pfizer. He receives a salary from Merz Pharma.

MIAMI BEACH – Remain skeptical about new devices or drugs that claim the ability to target fungal infections, recommended Dr. Alan B. Fleischer Jr.

"You are probably going to be barraged by devices that do something for nail fungus," Dr. Fleischer said. "As a physician, try to focus on curing the fungus and not just making them [patients] look better," he said at the South Beach Symposium.

For example, enrollment is underway for a study to assess a 1320-nm Nd:YAG device to fight onychomycosis. However, the primary outcome in the trial is "improved appearance," not fungal cure, he said. "It is confusing ... to a consumer. Improving the appearance sounds similar, but it is not the same."

Photo (c) 1993, Elsevier

When it comes to topical treatments for onychomycosis, efinaconazole is in development for treating mild to moderate forms of toenail infection, noted Dr. Fleischer. The manufacturer, Valeant Pharmaceuticals, reported promising results in two international phase III studies in December 2011. However, Valeant has not released mycology results.

"Pay attention to the cure rate when it is approved, probably sometime in the next year," said Dr. Fleischer, professor of dermatology at Wake Forest University in Winston-Salem, N.C.

Patients may ask about natural cures for fungal infections, but the data are generally unconvincing or lacking, Dr. Fleischer said. For example, some people advocate melaleuca oil from the tea tree to clear tinea pedis. However, when 104 patients were randomized to creams containing 10% melaleuca oil, 1% tolnaftate, or placebo, "melaleuca oil cleared 30% of subjects of tinea pedis. That is very low," he said (Australas. J. Dermatol. 1992;33:145-9). Of the tolnaftate-treated patients, 85% had a negative culture at the end of therapy, and 21% of placebo patients were considered cleared.

Other patients might ask about using vinegar to cure foot fungus. They may have read about this natural remedy on the Internet, where a Google search for the keywords "vinegar" and "foot fungus" yields about 116,000 results. "Although there are no data, topical vinegar immersion probably does something," Dr. Fleischer said.

"Fungal infections are still out there, but new drugs and modalities are continually evolving," he added.

Dr. Fleischer disclosed that he is a consultant for Intendis and Upsher-Smith Laboratories. He is also a researcher for Abbott, Amgen, Astellas, Galderma, GlaxoSmithKline, Intendis, and Pfizer. He receives a salary from Merz Pharma.

MIAMI BEACH – Remain skeptical about new devices or drugs that claim the ability to target fungal infections, recommended Dr. Alan B. Fleischer Jr.

"You are probably going to be barraged by devices that do something for nail fungus," Dr. Fleischer said. "As a physician, try to focus on curing the fungus and not just making them [patients] look better," he said at the South Beach Symposium.

For example, enrollment is underway for a study to assess a 1320-nm Nd:YAG device to fight onychomycosis. However, the primary outcome in the trial is "improved appearance," not fungal cure, he said. "It is confusing ... to a consumer. Improving the appearance sounds similar, but it is not the same."

Photo (c) 1993, Elsevier

When it comes to topical treatments for onychomycosis, efinaconazole is in development for treating mild to moderate forms of toenail infection, noted Dr. Fleischer. The manufacturer, Valeant Pharmaceuticals, reported promising results in two international phase III studies in December 2011. However, Valeant has not released mycology results.

"Pay attention to the cure rate when it is approved, probably sometime in the next year," said Dr. Fleischer, professor of dermatology at Wake Forest University in Winston-Salem, N.C.

Patients may ask about natural cures for fungal infections, but the data are generally unconvincing or lacking, Dr. Fleischer said. For example, some people advocate melaleuca oil from the tea tree to clear tinea pedis. However, when 104 patients were randomized to creams containing 10% melaleuca oil, 1% tolnaftate, or placebo, "melaleuca oil cleared 30% of subjects of tinea pedis. That is very low," he said (Australas. J. Dermatol. 1992;33:145-9). Of the tolnaftate-treated patients, 85% had a negative culture at the end of therapy, and 21% of placebo patients were considered cleared.

Other patients might ask about using vinegar to cure foot fungus. They may have read about this natural remedy on the Internet, where a Google search for the keywords "vinegar" and "foot fungus" yields about 116,000 results. "Although there are no data, topical vinegar immersion probably does something," Dr. Fleischer said.

"Fungal infections are still out there, but new drugs and modalities are continually evolving," he added.

Dr. Fleischer disclosed that he is a consultant for Intendis and Upsher-Smith Laboratories. He is also a researcher for Abbott, Amgen, Astellas, Galderma, GlaxoSmithKline, Intendis, and Pfizer. He receives a salary from Merz Pharma.

As a pediatric dermatologist, Dr. Robert A. Silverman is all too familiar with this scenario: A child is referred to him with a diagnosis of nail fungus, and the parents are frustrated that the oral antifungal agents did not work.

What bothers him the most is not the antifungals, but that the patients didn’t need them to begin with because the child didn’t have a fungal infection, he said at the annual Hawaii Dermatology Seminar, sponsored by Skin Disease Education Foundation (SDEF). Several conditions of the nail in children can easily be mistaken for fungal infections.

Dr. Silverman of the department of pediatrics at Georgetown University Medical Center in Washington discussed how to distinguish fungal disease mimics from other pediatric nail conditions in children.

Onychomycosis, the most common nail infection in adults, is not all that common in children, Dr. Silverman said. Studies have shown the prevalence in children to be less than 3% in developed countries, although it is increased among children who have Down syndrome and HIV, or children from households with moccasintype Trichophyton rubrum. Clinical variants are similar to those that occur in adults, such as white superficial onychomycosis, distal lateral subungual onychomycosis, proximal subungual onychomycosis, and endonyx onychomycosis.

Other conditions that may be mistaken for fungal infections include:

• Psoriasis. Nail findings in patients who have psoriasis can be misinterpreted as fungal disease. Telltale signs of psoriasis in the nails, however, are large, irregular pits and the oil spot sign.

• Subungual tumors. These include subungual exostosis and onychomatricoma. These benign growths push on the skin surface, leading to separation of the nail. "Some people think fungus when it’s really a tumor of the underlying bone," Dr. Silverman said.

• Pachyonychia congenita. Though often confused with fungal disease, this condition, which involves a single thickened toenail, is somewhat rare. "If someone came in with a thick toenail, I’d culture him or her," Dr. Silverman said. "If the culture is negative, then you have to start thinking of these other conditions."

• Alopecia areata. Children may have nail signs of alopecia areata before hair loss occurs. In alopecia areata, the nail surface is studded to near confluence with tiny pits, also known as Scotch plaid nails. Also, the nail will have lost its luster and has a sandpaperlike texture.

"If you see what looks like alopecia areata of the nail, but don’t see any hair findings, you ought to scrape the nail to rule out fungus, because fungus can look like alopecia areata of the nails," Dr. Silverman said. "And, of course, then you would want to treat it."

Treatment for fungal infections requires the use of an oral agent for 6-12 weeks, so Dr. Silverman emphasized the importance of obtaining a culture. "If you’re going to treat someone for that length of time, it makes sense to know exactly what you’re treating," he said.

Also, Dr. Silverman said, any time he sees that a child’s parent appears to have a fungal infection, he considers that to be a red flag when trying to diagnose the patient.

As a pediatric dermatologist, Dr. Robert A. Silverman is all too familiar with this scenario: A child is referred to him with a diagnosis of nail fungus, and the parents are frustrated that the oral antifungal agents did not work.

What bothers him the most is not the antifungals, but that the patients didn’t need them to begin with because the child didn’t have a fungal infection, he said at the annual Hawaii Dermatology Seminar, sponsored by Skin Disease Education Foundation (SDEF). Several conditions of the nail in children can easily be mistaken for fungal infections.

Dr. Silverman of the department of pediatrics at Georgetown University Medical Center in Washington discussed how to distinguish fungal disease mimics from other pediatric nail conditions in children.

Onychomycosis, the most common nail infection in adults, is not all that common in children, Dr. Silverman said. Studies have shown the prevalence in children to be less than 3% in developed countries, although it is increased among children who have Down syndrome and HIV, or children from households with moccasintype Trichophyton rubrum. Clinical variants are similar to those that occur in adults, such as white superficial onychomycosis, distal lateral subungual onychomycosis, proximal subungual onychomycosis, and endonyx onychomycosis.

Other conditions that may be mistaken for fungal infections include:

• Psoriasis. Nail findings in patients who have psoriasis can be misinterpreted as fungal disease. Telltale signs of psoriasis in the nails, however, are large, irregular pits and the oil spot sign.

• Subungual tumors. These include subungual exostosis and onychomatricoma. These benign growths push on the skin surface, leading to separation of the nail. "Some people think fungus when it’s really a tumor of the underlying bone," Dr. Silverman said.

• Pachyonychia congenita. Though often confused with fungal disease, this condition, which involves a single thickened toenail, is somewhat rare. "If someone came in with a thick toenail, I’d culture him or her," Dr. Silverman said. "If the culture is negative, then you have to start thinking of these other conditions."

• Alopecia areata. Children may have nail signs of alopecia areata before hair loss occurs. In alopecia areata, the nail surface is studded to near confluence with tiny pits, also known as Scotch plaid nails. Also, the nail will have lost its luster and has a sandpaperlike texture.

"If you see what looks like alopecia areata of the nail, but don’t see any hair findings, you ought to scrape the nail to rule out fungus, because fungus can look like alopecia areata of the nails," Dr. Silverman said. "And, of course, then you would want to treat it."

Treatment for fungal infections requires the use of an oral agent for 6-12 weeks, so Dr. Silverman emphasized the importance of obtaining a culture. "If you’re going to treat someone for that length of time, it makes sense to know exactly what you’re treating," he said.

Also, Dr. Silverman said, any time he sees that a child’s parent appears to have a fungal infection, he considers that to be a red flag when trying to diagnose the patient.

As a pediatric dermatologist, Dr. Robert A. Silverman is all too familiar with this scenario: A child is referred to him with a diagnosis of nail fungus, and the parents are frustrated that the oral antifungal agents did not work.

What bothers him the most is not the antifungals, but that the patients didn’t need them to begin with because the child didn’t have a fungal infection, he said at the annual Hawaii Dermatology Seminar, sponsored by Skin Disease Education Foundation (SDEF). Several conditions of the nail in children can easily be mistaken for fungal infections.

Dr. Silverman of the department of pediatrics at Georgetown University Medical Center in Washington discussed how to distinguish fungal disease mimics from other pediatric nail conditions in children.

Onychomycosis, the most common nail infection in adults, is not all that common in children, Dr. Silverman said. Studies have shown the prevalence in children to be less than 3% in developed countries, although it is increased among children who have Down syndrome and HIV, or children from households with moccasintype Trichophyton rubrum. Clinical variants are similar to those that occur in adults, such as white superficial onychomycosis, distal lateral subungual onychomycosis, proximal subungual onychomycosis, and endonyx onychomycosis.

Other conditions that may be mistaken for fungal infections include:

• Psoriasis. Nail findings in patients who have psoriasis can be misinterpreted as fungal disease. Telltale signs of psoriasis in the nails, however, are large, irregular pits and the oil spot sign.

• Subungual tumors. These include subungual exostosis and onychomatricoma. These benign growths push on the skin surface, leading to separation of the nail. "Some people think fungus when it’s really a tumor of the underlying bone," Dr. Silverman said.

• Pachyonychia congenita. Though often confused with fungal disease, this condition, which involves a single thickened toenail, is somewhat rare. "If someone came in with a thick toenail, I’d culture him or her," Dr. Silverman said. "If the culture is negative, then you have to start thinking of these other conditions."

• Alopecia areata. Children may have nail signs of alopecia areata before hair loss occurs. In alopecia areata, the nail surface is studded to near confluence with tiny pits, also known as Scotch plaid nails. Also, the nail will have lost its luster and has a sandpaperlike texture.

"If you see what looks like alopecia areata of the nail, but don’t see any hair findings, you ought to scrape the nail to rule out fungus, because fungus can look like alopecia areata of the nails," Dr. Silverman said. "And, of course, then you would want to treat it."

Treatment for fungal infections requires the use of an oral agent for 6-12 weeks, so Dr. Silverman emphasized the importance of obtaining a culture. "If you’re going to treat someone for that length of time, it makes sense to know exactly what you’re treating," he said.

Also, Dr. Silverman said, any time he sees that a child’s parent appears to have a fungal infection, he considers that to be a red flag when trying to diagnose the patient.

For those of you who have had a busy year and haven't had the chance to regularly read the latest dermatology news on Skin and Allergy News Digital Network, we have you covered. As we ring in the new year, here's a rundown of last year's most-viewed stories:

10. Experts: Medical Dermatology Is Losing Ground, By Bruce Jancin: Experts in medical dermatology predicted the specialty will become narrower and less medically oriented by 2020. As we enter 2012, some experts said they were concerned about the emphasis on aesthetic dermatology and dermatologic surgery. 

Courtesy flickr user woodleywonderworks (Creative Commons)

9. Mohs Surgery in Medicare Patients Skyrocketing, By Sherry Boschert: Several Mohs surgery experts found that the rate of Mohs surgery per 1,000 Medicare beneficiaries increased by 236% between 1999 and 2009. Dr. Matthew Donaldson and his associates presented the data at the annual meeting of the American College of Mohs Surgery. 

8. Blog: New Isotretinoin Drug May Address Safety Concerns, By Amy Pfeiffer: This much-viewed blog post highlighted an investigational isotretinoin drug that may eliminate safety concerns associated with the drug, like IBD and depression. The gelatin capsules of CIP-iisotretinoin help reduce GI irritation and the drug is less food dependent.

7. Dosing Isotretinoin: Go Big to Avoid Second Course, By Jeffrey Eisenberg: In another isotretinoin study, investigators found that patients receiving a higher cumulative dose of the drug were no less likely to experience an acne relapse than those who received a lower cumulative dose. However, the investigators found that patients treated with a higher dose were less likely to need a second course of treatment. 

6. Knifelike Vulvar Ulcers May Signal Crohn's Disease, By Kate Johnson: Knifelike vulvar ulcers could be a sign of Crohn's disease in women, according to experts at a conference on vulvovaginal diseases. For some patients, ulcers may be the only manifestation of the disorder. 

5. Biologics Up Cardiovascular Risk, New Analysis Finds, By Sherry Boschert: Biologic therapies used to treat psoriasis have been linked to an increase in major cardiovascular events, according to researchers. One patient on placebo developed a major cardiovascular event in a study of etanercept. Five patients on ustekinumab, five on briakinumab, and one on adalimumab also developed major cardiovascular events.

4. Future Technologies Hold Promise for Hair Restoration, By Damian McNamara: At an annual meeting of dermatologic surgeons, Dr. Ricardo Mejia discussed technological advancements in hair restoration. He said the future for hair restoration could include technologies like robotic hair transfer, hair cloning, and technologies to optimize new growth. 

3. AAD: Potential Doxycycline, IBD Link Considered Worrisome, By Bruce Jancin: In more acne news, a retrospective cohort study linked tetracycline-class antibiotics with an increase in inflammatory bowel disease. The highly controversial findings were one of the hottest topics at the annual meeting of the American Academy of Dermatology and on this website.

2. Bimatoprost Repigments Vitiligo Patient Skin, By Bruce Jancin: A topical bimatoprost ophthalmic solution could serve as treatment for focal vitiligo, according to a pilot study presented at the World Congress of Dermatology. Researchers said 7 out of 10 patients exhibited pronounced repigmentation after 2 months of treatment. 

1. Marijuana Allergies "Fairly Common," Expert Says, By M. Alexander Otto: A heads up to physicians: allergy experts said marijuana allergies are more common than most people think. Patients with with a marijuana allergy exhibit symptoms including wheezing, sinusitis, throat swelling, and inhalation issues. 

Best wishes for 2012!

-- Frances Correa (FMCReporting)

For those of you who have had a busy year and haven't had the chance to regularly read the latest dermatology news on Skin and Allergy News Digital Network, we have you covered. As we ring in the new year, here's a rundown of last year's most-viewed stories:

10. Experts: Medical Dermatology Is Losing Ground, By Bruce Jancin: Experts in medical dermatology predicted the specialty will become narrower and less medically oriented by 2020. As we enter 2012, some experts said they were concerned about the emphasis on aesthetic dermatology and dermatologic surgery. 

Courtesy flickr user woodleywonderworks (Creative Commons)

9. Mohs Surgery in Medicare Patients Skyrocketing, By Sherry Boschert: Several Mohs surgery experts found that the rate of Mohs surgery per 1,000 Medicare beneficiaries increased by 236% between 1999 and 2009. Dr. Matthew Donaldson and his associates presented the data at the annual meeting of the American College of Mohs Surgery. 

8. Blog: New Isotretinoin Drug May Address Safety Concerns, By Amy Pfeiffer: This much-viewed blog post highlighted an investigational isotretinoin drug that may eliminate safety concerns associated with the drug, like IBD and depression. The gelatin capsules of CIP-iisotretinoin help reduce GI irritation and the drug is less food dependent.

7. Dosing Isotretinoin: Go Big to Avoid Second Course, By Jeffrey Eisenberg: In another isotretinoin study, investigators found that patients receiving a higher cumulative dose of the drug were no less likely to experience an acne relapse than those who received a lower cumulative dose. However, the investigators found that patients treated with a higher dose were less likely to need a second course of treatment. 

6. Knifelike Vulvar Ulcers May Signal Crohn's Disease, By Kate Johnson: Knifelike vulvar ulcers could be a sign of Crohn's disease in women, according to experts at a conference on vulvovaginal diseases. For some patients, ulcers may be the only manifestation of the disorder. 

5. Biologics Up Cardiovascular Risk, New Analysis Finds, By Sherry Boschert: Biologic therapies used to treat psoriasis have been linked to an increase in major cardiovascular events, according to researchers. One patient on placebo developed a major cardiovascular event in a study of etanercept. Five patients on ustekinumab, five on briakinumab, and one on adalimumab also developed major cardiovascular events.

4. Future Technologies Hold Promise for Hair Restoration, By Damian McNamara: At an annual meeting of dermatologic surgeons, Dr. Ricardo Mejia discussed technological advancements in hair restoration. He said the future for hair restoration could include technologies like robotic hair transfer, hair cloning, and technologies to optimize new growth. 

3. AAD: Potential Doxycycline, IBD Link Considered Worrisome, By Bruce Jancin: In more acne news, a retrospective cohort study linked tetracycline-class antibiotics with an increase in inflammatory bowel disease. The highly controversial findings were one of the hottest topics at the annual meeting of the American Academy of Dermatology and on this website.

2. Bimatoprost Repigments Vitiligo Patient Skin, By Bruce Jancin: A topical bimatoprost ophthalmic solution could serve as treatment for focal vitiligo, according to a pilot study presented at the World Congress of Dermatology. Researchers said 7 out of 10 patients exhibited pronounced repigmentation after 2 months of treatment. 

1. Marijuana Allergies "Fairly Common," Expert Says, By M. Alexander Otto: A heads up to physicians: allergy experts said marijuana allergies are more common than most people think. Patients with with a marijuana allergy exhibit symptoms including wheezing, sinusitis, throat swelling, and inhalation issues. 

Best wishes for 2012!

-- Frances Correa (FMCReporting)

For those of you who have had a busy year and haven't had the chance to regularly read the latest dermatology news on Skin and Allergy News Digital Network, we have you covered. As we ring in the new year, here's a rundown of last year's most-viewed stories:

10. Experts: Medical Dermatology Is Losing Ground, By Bruce Jancin: Experts in medical dermatology predicted the specialty will become narrower and less medically oriented by 2020. As we enter 2012, some experts said they were concerned about the emphasis on aesthetic dermatology and dermatologic surgery. 

Courtesy flickr user woodleywonderworks (Creative Commons)

9. Mohs Surgery in Medicare Patients Skyrocketing, By Sherry Boschert: Several Mohs surgery experts found that the rate of Mohs surgery per 1,000 Medicare beneficiaries increased by 236% between 1999 and 2009. Dr. Matthew Donaldson and his associates presented the data at the annual meeting of the American College of Mohs Surgery. 

8. Blog: New Isotretinoin Drug May Address Safety Concerns, By Amy Pfeiffer: This much-viewed blog post highlighted an investigational isotretinoin drug that may eliminate safety concerns associated with the drug, like IBD and depression. The gelatin capsules of CIP-iisotretinoin help reduce GI irritation and the drug is less food dependent.

7. Dosing Isotretinoin: Go Big to Avoid Second Course, By Jeffrey Eisenberg: In another isotretinoin study, investigators found that patients receiving a higher cumulative dose of the drug were no less likely to experience an acne relapse than those who received a lower cumulative dose. However, the investigators found that patients treated with a higher dose were less likely to need a second course of treatment. 

6. Knifelike Vulvar Ulcers May Signal Crohn's Disease, By Kate Johnson: Knifelike vulvar ulcers could be a sign of Crohn's disease in women, according to experts at a conference on vulvovaginal diseases. For some patients, ulcers may be the only manifestation of the disorder. 

5. Biologics Up Cardiovascular Risk, New Analysis Finds, By Sherry Boschert: Biologic therapies used to treat psoriasis have been linked to an increase in major cardiovascular events, according to researchers. One patient on placebo developed a major cardiovascular event in a study of etanercept. Five patients on ustekinumab, five on briakinumab, and one on adalimumab also developed major cardiovascular events.

4. Future Technologies Hold Promise for Hair Restoration, By Damian McNamara: At an annual meeting of dermatologic surgeons, Dr. Ricardo Mejia discussed technological advancements in hair restoration. He said the future for hair restoration could include technologies like robotic hair transfer, hair cloning, and technologies to optimize new growth. 

3. AAD: Potential Doxycycline, IBD Link Considered Worrisome, By Bruce Jancin: In more acne news, a retrospective cohort study linked tetracycline-class antibiotics with an increase in inflammatory bowel disease. The highly controversial findings were one of the hottest topics at the annual meeting of the American Academy of Dermatology and on this website.

2. Bimatoprost Repigments Vitiligo Patient Skin, By Bruce Jancin: A topical bimatoprost ophthalmic solution could serve as treatment for focal vitiligo, according to a pilot study presented at the World Congress of Dermatology. Researchers said 7 out of 10 patients exhibited pronounced repigmentation after 2 months of treatment. 

1. Marijuana Allergies "Fairly Common," Expert Says, By M. Alexander Otto: A heads up to physicians: allergy experts said marijuana allergies are more common than most people think. Patients with with a marijuana allergy exhibit symptoms including wheezing, sinusitis, throat swelling, and inhalation issues. 

Best wishes for 2012!

-- Frances Correa (FMCReporting)

LISBON – Pulsed dye laser therapy may be an attractive new option for treating nail psoriasis, according to Dr. Veronique Blatiere.

Nail psoriasis is challenging to treat because the psoriatic disease process damages the nails while they are still being formed. But Turkish investigators have reported positive results with three once-monthly pulsed dye laser (PDL) treatment sessions in a small uncontrolled patient series, Dr. Blatiere reported at the annual congress of the European Academy of Dermatology and Venereology.

Dr. Yasemin Oram and coworkers at the American Hospital in Istanbul, Turkey, reported on five patients with nail psoriasis treated using PDL. The laser therapy was applied at 595 nm with a pulse duration of 1.5 milliseconds, a beam diameter of 7 mm, and an energy fluence of 8-10 J/cm². A treatment session was continued until a purple discoloration appeared.

The hypothesized mechanism of action involves destruction of the abnormal vasculature, according to the investigators (Dermatol. Surg. 2010;36:377-81).

Nail bed lesions, particularly onycholysis and subungual hyperkeratosis, responded to PDL better than did nail matrix lesions. After three treatment sessions, the average Nail Psoriasis Severity Index (NAPSI) score for nail bed lesions dropped from 14.8 to 8.

While the Turkish report is certainly encouraging, it should be viewed as a proof of concept pilot study, said Dr. Blatiere of Saint Eloi University Hospital in Montpellier, France. It needs confirmation with larger numbers of patients, a control arm, and blinded investigator assessment.

Dr. Blatiere noted that interest has been mounting in evaluating biologic agents for nail psoriasis. Favorable clinical experiences, albeit all of them open label, have recently been reported for the use of infliximab (J. Eur. Acad. Dermatol. Venereol. 2011;25:549-53); adalimumab (J. Eur. Acad. Dermatol. Venereol. 2010;24:530-4); ustekinumab (Arch. Dermatol. 2010;146:1315-6); and etanercept for nail psoriasis (J. Eur. Acad. Dermatol. Venereol. 2009;23:896-904).

But important questions remain about biologics for nail psoriasis, such as the appropriate duration of treatment, length of response, and whether they will help prevent psoriatic arthritis. And then there are the still incompletely answered questions regarding the long-term safety of the agents, as well as the issue of their considerable expense, Dr. Blatiere said.

She reported having no relevant financial disclosures.

LISBON – Pulsed dye laser therapy may be an attractive new option for treating nail psoriasis, according to Dr. Veronique Blatiere.

Nail psoriasis is challenging to treat because the psoriatic disease process damages the nails while they are still being formed. But Turkish investigators have reported positive results with three once-monthly pulsed dye laser (PDL) treatment sessions in a small uncontrolled patient series, Dr. Blatiere reported at the annual congress of the European Academy of Dermatology and Venereology.

Dr. Yasemin Oram and coworkers at the American Hospital in Istanbul, Turkey, reported on five patients with nail psoriasis treated using PDL. The laser therapy was applied at 595 nm with a pulse duration of 1.5 milliseconds, a beam diameter of 7 mm, and an energy fluence of 8-10 J/cm². A treatment session was continued until a purple discoloration appeared.

The hypothesized mechanism of action involves destruction of the abnormal vasculature, according to the investigators (Dermatol. Surg. 2010;36:377-81).

Nail bed lesions, particularly onycholysis and subungual hyperkeratosis, responded to PDL better than did nail matrix lesions. After three treatment sessions, the average Nail Psoriasis Severity Index (NAPSI) score for nail bed lesions dropped from 14.8 to 8.

While the Turkish report is certainly encouraging, it should be viewed as a proof of concept pilot study, said Dr. Blatiere of Saint Eloi University Hospital in Montpellier, France. It needs confirmation with larger numbers of patients, a control arm, and blinded investigator assessment.

Dr. Blatiere noted that interest has been mounting in evaluating biologic agents for nail psoriasis. Favorable clinical experiences, albeit all of them open label, have recently been reported for the use of infliximab (J. Eur. Acad. Dermatol. Venereol. 2011;25:549-53); adalimumab (J. Eur. Acad. Dermatol. Venereol. 2010;24:530-4); ustekinumab (Arch. Dermatol. 2010;146:1315-6); and etanercept for nail psoriasis (J. Eur. Acad. Dermatol. Venereol. 2009;23:896-904).

But important questions remain about biologics for nail psoriasis, such as the appropriate duration of treatment, length of response, and whether they will help prevent psoriatic arthritis. And then there are the still incompletely answered questions regarding the long-term safety of the agents, as well as the issue of their considerable expense, Dr. Blatiere said.

She reported having no relevant financial disclosures.

LISBON – Pulsed dye laser therapy may be an attractive new option for treating nail psoriasis, according to Dr. Veronique Blatiere.

Nail psoriasis is challenging to treat because the psoriatic disease process damages the nails while they are still being formed. But Turkish investigators have reported positive results with three once-monthly pulsed dye laser (PDL) treatment sessions in a small uncontrolled patient series, Dr. Blatiere reported at the annual congress of the European Academy of Dermatology and Venereology.

Dr. Yasemin Oram and coworkers at the American Hospital in Istanbul, Turkey, reported on five patients with nail psoriasis treated using PDL. The laser therapy was applied at 595 nm with a pulse duration of 1.5 milliseconds, a beam diameter of 7 mm, and an energy fluence of 8-10 J/cm². A treatment session was continued until a purple discoloration appeared.

The hypothesized mechanism of action involves destruction of the abnormal vasculature, according to the investigators (Dermatol. Surg. 2010;36:377-81).

Nail bed lesions, particularly onycholysis and subungual hyperkeratosis, responded to PDL better than did nail matrix lesions. After three treatment sessions, the average Nail Psoriasis Severity Index (NAPSI) score for nail bed lesions dropped from 14.8 to 8.

While the Turkish report is certainly encouraging, it should be viewed as a proof of concept pilot study, said Dr. Blatiere of Saint Eloi University Hospital in Montpellier, France. It needs confirmation with larger numbers of patients, a control arm, and blinded investigator assessment.

Dr. Blatiere noted that interest has been mounting in evaluating biologic agents for nail psoriasis. Favorable clinical experiences, albeit all of them open label, have recently been reported for the use of infliximab (J. Eur. Acad. Dermatol. Venereol. 2011;25:549-53); adalimumab (J. Eur. Acad. Dermatol. Venereol. 2010;24:530-4); ustekinumab (Arch. Dermatol. 2010;146:1315-6); and etanercept for nail psoriasis (J. Eur. Acad. Dermatol. Venereol. 2009;23:896-904).

But important questions remain about biologics for nail psoriasis, such as the appropriate duration of treatment, length of response, and whether they will help prevent psoriatic arthritis. And then there are the still incompletely answered questions regarding the long-term safety of the agents, as well as the issue of their considerable expense, Dr. Blatiere said.

She reported having no relevant financial disclosures.

LISBON – Applying a fast-drying cyanoacrylate glue to the proximal nail fold once or twice weekly is an inexpensive and effective treatment for the habit-tic condition of onychotillomania.

Onychotillomania is often categorized as a compulsive psychiatric disorder. The same psychiatric medications employed in cases of obsessive-compulsive disorder, including selective serotonin reuptake inhibitors, are sometimes prescribed to good effect.

Gluing the problem nail – it is most often a thumbnail – can work, and at negligible cost, with low risk, and no risk of systemic side effects stemming from psychiatric medications, Dr. Veronique Blatiere said at the annual congress of the European Academy of Dermatology and Venereology.

©2009 Elsevier Inc. All rights reserved.

The likely mechanisms of benefit from the cyanoacrylate glue, such as Super Glue or Krazy Glue, are twofold: the built-up layer of glue creates a physical barrier that helps protect the proximal nail fold against the patient’s mindless repetitive picking, and, at the same time, the artificial layer promotes self-awareness of the tic habit, said Dr. Blatiere, a dermatologist at the University of Montpellier (France).

She credited the instant nail-gluing therapy to Dr. Daniel S. Ring, a Chesterfield, Mo., dermatologist who presented the approach in the Archives of Dermatology (2010;146:1222-3).

Dr. Ring described onychotillomania as a common condition given little attention in most dermatologic textbooks. Onset is typically in adulthood, and patients frequently bring up the problem as an "oh, by the way" afterthought during an office visit scheduled for another reason.

Patients typically display parallel transverse ridges running from the proximal nail fold to the distal nail plate along with a lack of cuticle. These changes result from years of picking at the cuticle or pushing it back.

In his report, Dr. Ring described two cases in detail and mentioned 10 others successfully treated with glue. The affected nails typically normalized after 3-6 months of weekly gluing.

Dr. Blatiere said that instant-drying cyanoacrylate glues may also be worth investigating for the treatment of chronic paronychia.

However, she noted that a potential hazard of applying this therapy for months at a time is development of an allergic contact dermatitis to the acrylate.

Neither Dr. Ring nor Dr. Blatiere reported having any financial conflicts.

LISBON – Applying a fast-drying cyanoacrylate glue to the proximal nail fold once or twice weekly is an inexpensive and effective treatment for the habit-tic condition of onychotillomania.

Onychotillomania is often categorized as a compulsive psychiatric disorder. The same psychiatric medications employed in cases of obsessive-compulsive disorder, including selective serotonin reuptake inhibitors, are sometimes prescribed to good effect.

Gluing the problem nail – it is most often a thumbnail – can work, and at negligible cost, with low risk, and no risk of systemic side effects stemming from psychiatric medications, Dr. Veronique Blatiere said at the annual congress of the European Academy of Dermatology and Venereology.

©2009 Elsevier Inc. All rights reserved.

The likely mechanisms of benefit from the cyanoacrylate glue, such as Super Glue or Krazy Glue, are twofold: the built-up layer of glue creates a physical barrier that helps protect the proximal nail fold against the patient’s mindless repetitive picking, and, at the same time, the artificial layer promotes self-awareness of the tic habit, said Dr. Blatiere, a dermatologist at the University of Montpellier (France).

She credited the instant nail-gluing therapy to Dr. Daniel S. Ring, a Chesterfield, Mo., dermatologist who presented the approach in the Archives of Dermatology (2010;146:1222-3).

Dr. Ring described onychotillomania as a common condition given little attention in most dermatologic textbooks. Onset is typically in adulthood, and patients frequently bring up the problem as an "oh, by the way" afterthought during an office visit scheduled for another reason.

Patients typically display parallel transverse ridges running from the proximal nail fold to the distal nail plate along with a lack of cuticle. These changes result from years of picking at the cuticle or pushing it back.

In his report, Dr. Ring described two cases in detail and mentioned 10 others successfully treated with glue. The affected nails typically normalized after 3-6 months of weekly gluing.

Dr. Blatiere said that instant-drying cyanoacrylate glues may also be worth investigating for the treatment of chronic paronychia.

However, she noted that a potential hazard of applying this therapy for months at a time is development of an allergic contact dermatitis to the acrylate.

Neither Dr. Ring nor Dr. Blatiere reported having any financial conflicts.

LISBON – Applying a fast-drying cyanoacrylate glue to the proximal nail fold once or twice weekly is an inexpensive and effective treatment for the habit-tic condition of onychotillomania.

Onychotillomania is often categorized as a compulsive psychiatric disorder. The same psychiatric medications employed in cases of obsessive-compulsive disorder, including selective serotonin reuptake inhibitors, are sometimes prescribed to good effect.

Gluing the problem nail – it is most often a thumbnail – can work, and at negligible cost, with low risk, and no risk of systemic side effects stemming from psychiatric medications, Dr. Veronique Blatiere said at the annual congress of the European Academy of Dermatology and Venereology.

©2009 Elsevier Inc. All rights reserved.

The likely mechanisms of benefit from the cyanoacrylate glue, such as Super Glue or Krazy Glue, are twofold: the built-up layer of glue creates a physical barrier that helps protect the proximal nail fold against the patient’s mindless repetitive picking, and, at the same time, the artificial layer promotes self-awareness of the tic habit, said Dr. Blatiere, a dermatologist at the University of Montpellier (France).

She credited the instant nail-gluing therapy to Dr. Daniel S. Ring, a Chesterfield, Mo., dermatologist who presented the approach in the Archives of Dermatology (2010;146:1222-3).

Dr. Ring described onychotillomania as a common condition given little attention in most dermatologic textbooks. Onset is typically in adulthood, and patients frequently bring up the problem as an "oh, by the way" afterthought during an office visit scheduled for another reason.

Patients typically display parallel transverse ridges running from the proximal nail fold to the distal nail plate along with a lack of cuticle. These changes result from years of picking at the cuticle or pushing it back.

In his report, Dr. Ring described two cases in detail and mentioned 10 others successfully treated with glue. The affected nails typically normalized after 3-6 months of weekly gluing.

Dr. Blatiere said that instant-drying cyanoacrylate glues may also be worth investigating for the treatment of chronic paronychia.

However, she noted that a potential hazard of applying this therapy for months at a time is development of an allergic contact dermatitis to the acrylate.

Neither Dr. Ring nor Dr. Blatiere reported having any financial conflicts.