Kawasaki disease is characterized by fever for ≥ five days, bilateral bulbar conjunctival injection without exudate, polymorphous rash changes in the extremities, oral mucosal changes, and cervical lymphadenopathy. We report a 20-month-old boy with Kawasaki disease who had onychomadesis affecting the fingernails and toenails bilaterally. To our knowledge, there were three reported cases of onychomadesis associated with Kawasaki disease, to which we add another one. We suggest keeping in mind the possibility of onychomadesis as a nail sequela of Kawasaki disease.
We describe a 6-year-old boy with an asymptomatic linear eruption on the left index finger with mild erythema of the proximal nail fold, nail dystrophy, and subungual hyperkeratosis of the nail. A diagnosis of nail lichen striatus was made. The child was successfully treated with a topical corticosteroid. Because of its rarity, nail lichen striatus is often under-recognized. Physicians should be familiar with the nail involvement in individuals with lichen striatus so that an accurate diagnosis can be made and unnecessary investigations and treatment avoided.
Hidrotic ectodermaldysplasia was found, to our knowledge, for the first time in a Chinese family in Malaysia, and it affected 15 members in five generations. The disease, which is transmitted as a non-sex-linked autosomal dominant trait, presumably originated from southern China. All 15 members had the typical nail, hair, and skin lesions, and we observed three different types of nail defects. Scalp alopeica was more extensive in the female members while keratoderma of the palms and soles was more notable in the male members. The nail and skin lesions also became severer with age. Except for the infectious eczematoid dermatitis present in the propositus, none had other skin or systemic disorders. All were relatively healthy and had normal life expectancies;
Once believed to be a rare disease in developed countries, recent data suggest that there is a surge in incidence of congenital syphilis in many developed countries. Diagnosis of congenital syphilis can be difficult because more than two-thirds of affected infants are asymptomatic at birth, and signs of symptomatic infants may be nonspecific or subtle. On top of this, some affected infants may have atypical presentations. Familiarity with the diverse presentations is essential to diagnosis. We report a 2-week-old male infant with congenital syphilis whose cutaneous manifestations included diffuse, erythematous keratoderma with desquamation and fissures on his hands and feet, multiple linear scaly fissures at the angles of his mouth, and onychauxis of the fingernails and toenails To our knowledge, diffuse, erythematous keratoderma of the hands and feet and thick nails have not been reported previously in congenital syphilis.
Onychomycosis is the infection of nail apparatus by dermatophytes, yeasts or non-dermatophyte moulds and is responsible for 50% of all nail disorders. A five year retrospective study was conducted at Universiti Kebangsaan Malaysia to identify the common pathogens responsible for onychomycosis and to describe the epidemiology of the affected patients. A total of 278 abnormal nails were cultured, out of which 231 were positive for fungus. Females constituted 50.2% (n=116) while males 49.8% (n=115). The majority (51.9%, n=120) were between ages 50-69 years. The Malay ethnic group was most commonly affected (44.2%, n=102) followed by Chinese (33.8%, n=78), Indians (18.2%, n=42) and other ethnic groups (3.8%, n=9). The most common fungal element isolated was non-dermatophyte moulds (45.4%, n=105) followed by yeast (34.6%, n=80) and dermatophytes (1.3%, n=3). Aspergillus spp. was the commonest (59.8%,n=81) non-dermatophyte mould, while Candida spp. was the commonest yeast (74.3%, n=89) isolated. In this study, non-dermatophyte moulds are the most common microorganisms implicated to cause onychomysosis. Treatment for non-dermatophyte mould is challenging as the current available antifungal agents are more effective against dermatophytes and yeasts.