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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_141_библиотеки_им_акад_М_И_Перельмана
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52 Onychoschizia
Figs. 52.3–52.5 Onychoschizia
trimmed so they are not long. Using moisturizers or skin
softeners can help. There are reports on the supplementation
of vitamins (biotin), amino acids (cysteine), zinc, and iron,
but more research is needed. AHA and urea may also be
added to increase the water-binding capacity of the nail plate.
Various nail strengtheners are commercialized, but it is dif-
cult to nd reports on their medical effects. The effect of
the topical immunomodulator tacrolimus is being studied. I
told Ms. L to reduce the frequency of soaking her hands in
water and to apply moisturizer more frequently. I also prescribed an ointment to help with the healing and recommended regular visits.
52 Onychoschizia
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Figs. 52.6 and 52.7 Onychoschizia
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Figs. 52.8 and 52.9 Onychoschizia
Figs. 52.10 and 52.11 Onychoschizia
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Figs. 52.12 and 52.13 Proximal onychoschizia observed in atopic dermatitis
52 Onychoschizia
Fig. 52.14 Onychoschizia
Onychomadesis
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53
After our child had hand–foot–mouth disease, his ngernails and toenails changed strangely.
Mrs. P, who has been receiving skin care at our hospital
since giving birth, brought her 25-month-old child for treatment because the shape of the child’s ngernails and toenails
was strange. When I asked, “Hasn’t your child recently had
something like hand–foot–mouth disease?” She replied,
“Wow, how did you know that? He had a severe case of
hand–foot–mouth disease about 4weeks ago!” (Fig.53.1).
Onychomadesis refers to a disease in which the proximal
nail plate separates from the nail bed and nail matrix and
falls off due to temporary arrest of the function of the nail
matrix, which can be considered the root that makes the nail
plate. It is distinguished from onycholysis in that natural nail
shedding occurs from the proximal part of the nail, the area
where the nail matrix is located, and can affect both ngernails and toenails. In cases where such disorders affect the
replacement rate of nail matrix cells, it can also lead to thin-
Fig. 53.1 Onychomadesis that occurred after hand–foot–mouth
disease
ning of the nail plate or the formation of Beau’s lines. In
onychomadesis, the shedding of the nail appears as a crack
under the proximal part of the nail, leading to loss of the nail
surface near the nail matrix area. The form of such surface
ulcers usually does not invade deep layers, because it is a
lesion conned to the proximal part of the nail matrix. During
the incubation period of onychomadesis, transverse cracks
appear in the nail plate due to temporary but complete inhibition of nail growth for at least 1–2weeks, and when it reaches
its maximum size, it can be characterized as Beau’s lines.
However, the nail continues to grow as long as it is attached
to the underlying tissue and only stops growing when that
connection is lost. Onychomadesis is thought to occur when
there is inhibition of nail growth for more than 3weeks. Both
Beau’s lines and onychomadesis are triggered by temporary
functional stoppage of the nail matrix, but since onychomadesis is not a common disease, there are not many reports on
the conditions that cause onychomadesis. Severe systemic
diseases, vesicular dermatitis, drug eruption, chemotherapy,
radiation therapy, acute paronychia, chronic eczema around
the nails, alopecia areata, chilblain, lichen planus of the nail
matrix, habitual traumatic onychodystrophy, chronic graftversus- host disease, syphilis, severe psychological stress,
idiopathic or genetic cases, Kawasaki disease, etc. have been
reported, and since the rst report of Beau lines and onychomadesis in children suffering from hand, foot, and mouth
disease in 2000, many reports have followed. Recently, onychomadesis has been occasionally observed after COVID-19
infection. Diagnosis can be made by visually checking that
the nail plate is disconnected and divided into upper and
lower sections (Fig.53.2, 53.3, 53.4, 53.5, 53.6, 53.7, 53.8,
53.9, 53.10, 53.11, 53.12 and 53.13).
In onychomadesis, the base of the nail is completely pre-
served, so most of the changes in the nails are reported to be
temporary and naturally recover. Without any special treatment, it is known that the regrowth of the nails gradually
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024
J. Y. Jeong, Dermatology Diaries, https://doi.org/10.1007/978-981-97-1578-7_53
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Fig. 53.2 Onychomadesis
53 Onychomadesis
takes place usually after 6 weeks (within 1–4 months).
However, if there is some fundamental cause, treatment and
supportive care for it should be implemented. After hearing
the explanation about onychomadesis, she said, “Then I
don’t have to worry about anything?” I replied, “Yes! But I
will prescribe you with tacrolimus ointment, which can be
helpful. Please come back in 2 weeks.”
Figs. 53.3 and 53.4 Onychomadesis after hand–foot–mouth disease
Figs. 53.5 and 53.6 Onychomadesis observed in the ngernails
53 Onychomadesis
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Figs. 53.7 and 53.8 Onychomadesis of the ngernails after hand–foot–mouth disease
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Figs. 53.9 and 53.10 Onychomadesis observed in the toenails
Figs. 53.11 and 53.12 Onychomadesis after COVID-19 infection
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Fig. 53.13 Onychomadesis with onycholysis
53 Onychomadesis
Tinea Manus, Tinea Manuum
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54
I’ve had athlete’s foot for a long time, but recently my left
hand has become itchy and white scales have formed in
every crease of my palm (Fig.54.1).
Mr. P, a man in his 50s, has had athlete’s foot since he was
young, but it got better when he applied athlete’s foot ointment and then got worse when left untreated. One day, he
came for a consultation because only his left hand was itchy,
the skin was thickening, and white powdery scales were
forming in every crease of his palm, but his right hand was
ne. When I asked, “Are you left-handed?” he replied, “Yes!
How did you know?”
Tinea manuum (tinea manus) is an infection of the skin
caused by dermatophytes on the hand, accounting for about
5% of all tinea infections, making it much less common than
athlete’s foot. The hand has a thick stratum corneum, so it
appears similar to tinea pedis, but unlike tinea pedis, interdigital and vesicular forms are rare, and most are hyperkeratotic. Clinically, the characteristic is that the scales of the
hand used more often are concentrated in the creases of the
skin. There is minimal hyperkeratosis on the palm, more
prominent in the creases. Also, you can see scale patches on
the sides and back of the ngers. Itching may be complained
of, and if there is a secondary infection or ssure, pain may
occur. On the back of the hand, it appears ring-shaped like
tinea corporis. If left untreated for a long time, tinea unguium
can occur. A case showing a characteristic distribution of
lesions is when hyperkeratotic tinea manuum occurs unilaterally on the hand used more often and hyperkeratotic tinea
pedis is present on both feet, which is called “two feet–one
hand syndrome” (Fig.54.2).
Tinea manuum can be conrmed by characteristic clinical
ndings, KOH test, and culture test. Clinically, when tinea
manuum occurs on the back of the hand, it appears ringshaped like tinea corporis, but the palms show a very characteristic arrangement of ne white scales, concentrated in the
crease and skin folds and furrows. The cause of this unique
Fig. 54.1 Typical form of tinea manuum Fig. 54.2 Two feet–one hand syndrome
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024
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scale arrangement pattern is not clear, but it is thought to be
due to the tendency of dermatophytes to proliferate in moist
environments such as skin furrows. Therefore, it has recently
been reported that using dermoscope to conrm the presence
of white scales located in the palm skin folds may be useful
in differential diagnosis from other diseases affecting the
palm (Figs. 54.3, 54.4, 54.5, 54.6, 54.7, 54.8, 54.9,54.10,
54.11, 54.12 and 54.13).
In cases where a patient with tinea manuum has tinea
unguium, tinea pedis, and tinea cruris, they should be treated
together to prevent recurrence of tinea manuum. Topical
antifungal agents should be used for at least 1week after the
lesion has disappeared. Apply beyond the edge of the expanding lesion to a minimum range of 3 cm, twice a day for
4weeks. Due to the thick stratum corneum, failure of topical
antifungal treatment is common, so oral antifungals are used
54 Tinea Manus, Tinea Manuum
Fig. 54.5 Athlete’s foot and right hand tinea manuum
Fig. 54.3 Characteristic aspect of tinea manuum where ne white
scales are concentrated in skin folds
Fig. 54.4 10× magnied image of tinea manuum showing a “frosty
eld furrow” shape
Fig. 54.6 Toenail tinea unguium and right hand tinea manuum
Fig. 54.7 Tinea manuum
54 Tinea Manus, Tinea Manuum
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Fig. 54.8 Tinea manuum
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in cases of extensive lesions, non-response to topical antifungals, and chronic recurrent tinea. Especially when accompanied by tinea unguium, it is impossible to cure tinea manuum
with only topical agents, so oral antifungals should be used.
After hearing the detailed explanation, Mr. P leaves the
clinic, determined to cure this damn athlete’s foot this time.
Figs. 54.9 and 54.10 Tinea manuum observed on the palm and back of the hand
Figs. 54.11 and 54.12 Tinea unguium and tinea manuum
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