Infectious diseases

Nail Technicians

one of the most shock and provoking concepts discovered among health and beauty treatments was introduced to me during a client visit The concept of having uniquely shaped or eye appealing toenails and fingernails. Now, for many of you reading that statement you’d probably be thinking “that’s no big deal”. Not very long ago this surfaced as a phenomenon during the Ahmaud Arbery case murder case the trials defense lawyer made an egreous comment about the victim’s toenails referring to them as dirty toenails. Although that case has already been tried and the assailants have been convicted our prayers for the entire family’s endurance and strength remains among us without ceasing. It wasn’t until this event occurred that my attention was drawn to recognize this as a phenomenon. A phenomenon, which I describe in titling this book The Attractive Nail Phenomenon.

The attractive nail phenomenon has been around for quite some time if you consider how important beauty and appearance are among society. And, and without stagnation it has been a part of our cultural descriptions of human behavior. The nail whether it is on your hands managed by a manicurist or at that into of your feet to be addressed by a pedicurist the nail, as an anatomic structure, is a bed of defense against a number of potential disease. Cancer can form underneath the nail bed of both the hand and feet, the form or natural shape of the nails can take on the appearance of what is described as clubbing or nail discoloration usually seen as either red yellow or white. A healthy nail is a defense that protects the body through areas of discharge such as the terminal phalanx of the digit usually a signal from internal organ injury. Historically, digital finger and toenails have served as a tool for protection and for our survival. As civilizations developed, it attained the additional function of adornment. Nail beautification is a big industry today, with various nail cosmetics available, ranging from nail hardeners, polishes, extensions, artificial/sculpted nails, and nail decorations. Adverse events may occur either during the
nail-grooming procedure or as a reaction to the individual components of the nail cosmetics. This holds true for both the client and the nail technician. Typically, any of the procedures
involves several steps and a series of products. Separate “nail-bars or salons” have been set up and dedicated to serve women and men interested in nail beautification, the phenomenon. Here the goal is to comprehensively inform and educate people about dermatology available and the services offered, the products used, and the possible/potential negative effects related to nail-grooming, nail cosmetics, and the phenomenology of having attractive nails.

Fungal Infections

& Abstract Research Summaries

Part 1

Fungal infections can affect any part of the skin, hair or nails. They can mimic many other conditions. Ringworm (tinea corporis) is not always ring shaped and not all annular rashes are due to ringworm. Fungal infections are usually scaly, unilateral and asymmetrical. If there is any suspicion of fungal infection, skin scrapings, plucked hairs or nail clippings may be sent for fungal staining and culture. It can take a month to culture a fungus in the laboratory. If there is a high index of suspicion of a fungal infection and treatment is required immediately (e.g. scalp ringworm, painful tinea cruris, etc) empirical treatment should be started and the patient reviewed in a 4 weeks when the results of fungal culture are available. Potent topical steroids dampen down the inflammatory response to the fungus but usually promote its spread, resulting in a more widespread, unilateral, diffuse, nonspecific rash that may not be easily identified as fungal in origin (Tinea incognito).

Part 2

By conforming to ingroup norms, individuals coordinate with other group members, preserve cohesion, and avoid costs of exclusion. Experimental studies have reported that increased concerns about infectious disease increases conformity. However, coordination with other group members has myriad benefits, most of which exist independent of pathogenic infection. Accordingly, a strong causal effect of perceived infection risks on conformity appears suboptimal. In line with this theoretical concern, results from four studies (N=1142) showed no support for the hypothesis that experimentally increasing perceived infection risk influences conformity. The findings suggest that associations between prevalence of infectious disease and conformity observed at the cross-cultural level are unlikely to arise from a fast-acting psychological mechanism that regulates conformity as a function pathogen avoidance motivations.

Part 3

The study aimed to develop and validate a tool to recognize the presence and to evaluate the level of self-neglect in community-dwelling older people. The cross-sectional study included 2,894 face-to-face interviews with randomly selected individuals from among the general population, social service users, and hospital patients. In addition, specially trained interviewers assessed the physical appearance and standards of living. Reliability, content, and construct validity were assessed. The Item Response Theory was used. The following scales were developed: the Self-Reported Self-Neglect Scale (SRSNS), the Objective Assessment of the Level of Self-Neglect–Physical Appearance (OALSN-PA) scale, concerning physical health risks based on the appearance of an individual, and the Objective Assessment of the Level of Self-Neglect–Standards of Living Arrangements (OALSN-SLA) scale, which assesses the physical and personal living conditions. The brevity of the scales makes them useful for the daily practice of health care and social care professionals.

Part 4

Nail involvement is estimated to affect 80–90% of patients with psoriasis at some point in their lives and is often associated with severe disease. Patients with nail involvement experience pain, functional impairment and social stigma, with significant restriction of daily activities and quality of life. Nail psoriasis is also considered a risk factor for the development of psoriatic arthritis (PsA). Management of nail psoriasis is deemed challenging and as a result, it is often left untreated by physicians. Assessing the severity of nail disease can also be difficult in clinical practice. While the Nail Psoriasis Severity Index is used widely in trials, it is time-consuming and rarely used in the clinic, highlighting the need to develop a simplified disease severity score for nail psoriasis. All patients should be advised to keep their nails short, wear gloves for wet and dirty work, and regularly apply emollient to the nail folds and nail surface. Patients with mild nail psoriasis, without signs of severe cutaneous psoriasis or PsA, may benefit from topical treatment, while systemic treatment is indicated in patients with severe nail involvement. Evidence suggests that all anti-tumour necrosis factor (TNF)-α, anti-interleukin (IL)-17, and anti-IL-12/23 antibodies available for plaque psoriasis and PsA are highly effective treatments for nail psoriasis. This article aims to provide an up-to-date review of the therapeutic options currently available for the management of nail psoriasis in patients with or without skin psoriasis. Therapeutic options for the management of nail psoriasis in children will also be discussed.Part 5

Figure 3

Nail psoriasis is common, affecting up to 50% of patients with psoriasis, with a lifetime incidence of 80–90%.1 Nail involvement can be distressing for patients and causes a significant impairment in quality of life (QoL). The optimal treatment depends on patient and disease factors, and the hierarchy of treatments includes both topical and intralesional steroids, and systemic treatments, including biologic therapy (Table 1)

Part 6

Diagnostic, monitoring, response, predictive, risk, and prognostic biomarkers of disease are all widely studied, for the most part in biological fluids or tissues, but there is steadily growing interest in alternative matrices such as nails. Here we comprehensively review studies dealing with molecular or elemental biomarkers of disease, as opposed to semiological, pharmacological, toxicological, or biomonitoring studies. Nails have a long history of use in medicine as indicators of pathological processes and have also been used extensively as a matrix for monitoring exposure to environmental pollution. Nail clippings are simple to collect noninvasively as well as to transport and store, and the matrix itself is relatively stable. Nails incorporate, and are influenced by, circulating molecules and elements over their several months of growth, and it is widely held that markers of biological processes will remain in the nail, even when their levels in blood have declined. Nails thus offer the possibility to not only look back into a subject’s metabolic history but also to study biomarkers of processes that operate over a longer time scale such as the post-translational modification of proteins. Reports on ungual biomarkers of metabolic and endocrine diseases, cancer, and psychological and neurological disorders will be presented, and an overview of the sampling and analytical techniques provided.

Part 7

Health problems associated with essential trace metals can result from both inadequate (i.e., low intake) and excessive exposures (i.e., from environmental and/or occupational source). Thus, measuring the exposure level is a real challenge for epidemiologists. Among non-invasive biomarkers that intend to measure long-term exposure to essential trace metals, the toenail is probably the biological matrix with the greatest potential. This systematic review collects the current evidence regarding the validity of toenail clippings as exposure biomarker for trace metals such as boron, cobalt, copper, iron, manganese, molybdenum, selenium, silicon, vanadium and zinc. Special attention was paid to the time-window of exposure reflected by the toenail, the intraindividual variability in exposure levels over time in this matrix, and the relationship of toenail with other biomarkers, personal characteristics and environmental sources. Our search identified 139 papers, with selenium and zinc being the most studied elements. The variability among studies suggests that toenail levels may reflect different degrees of exposure and probably correspond to exposures occurred 3-12 months before sampling (i.e., for manganese/selenium). Few studies assessed the reproducibility of results over time and, for samples obtained 1-6 years apart, the correlation coefficient were between 0.26 and 0.66. Trace metal levels in toenails did not correlate well with those in the blood and urine and showed low-moderate correlation with those in the hair and fingernails. Available data suggests that for some elements (Se, Mn, Zn) toenail concentrations reflect long-term external exposures in fairly reproducible levels, while for other metals, this association has not yet been assessed. Among dietary factors, only toenail selenium showed clear associations with the intake of supplements or specific foods. The toenail levels could also represent occupational exposure, for instance, Mn exposure in welders. The scarcity of information on other essential trace elements, together with the great heterogeneity among studies makes the validation of the usage of toenails as biomarkers of exposure to these elements difficult. Standardization of sample collection, quality control, analytical techniques and reporting procedures might facilitate further research focused on the clear understanding of the significance of essential levels in this promising matrix and would enhance its utility in epidemiological research.

Part 8

Background: A unique syndrome affecting young adults of unexplained hearing loss often associated with uncorrectable poor visual acuity and lower extremity numbness is endemic in Dar es Salaam. This study characterized the hearing loss, associated it with other symptoms, and gathered information on potential causes.

Methods: Forty-seven patients (23 men, 24 women) <40 years old with a symptom consistent with the syndrome, negative syphilis test, and no head injury history were recruited from Muhimbili National Hospital. 18 controls (10 men, 8 women) were recruited from the same neighborhoods as patients. Hearing ability and cochlear outer hair cell function (distortion-product otoacoustic emissions (DPOAEs)) were assessed, as were visual acuity and color vision. Peripheral neuropathy was evaluated using the Michigan Neuropathy Screening Instrument (MNSI), and physical examination. Blood C-reactive protein levels and toenail trace metal concentrations were measured. Environmental exposures were elicited using a questionnaire. Patients with at least two of the following signs were defined as having the syndrome: poor hearing with normal DPOAEs, vision not correctable to better than 20/30, or a MNSI score greater than 4.

Results: 29 participants met the case definition. CRP levels did not differ between groups but manganese, cobalt and tin levels were each greater in the cases than controls. No other environmental exposure differences were noted.

Conclusions: Toenail manganese, cobalt, and tin levels were higher in those with the syndrome. These metals are potential neurotoxins suggesting a possible environmental origin for this unique and debilitating syndrome.

Part 9

Figure 1

Dermatology supplements, often marketed as “skin, hair, and nail” supplements, are becoming increasingly popular. However, many consumers lack an understanding of the science of dietary supplements or the specifics of the supplement industry. While certain supplements at the right dose in the right population may prove beneficial, the evidence is sparse for many supplements. In addition, the use of some supplements has resulted in serious adverse effects. From a regulatory standpoint, the US FDA recognizes dietary supplements as foods. This distinction has multiple ramifications, including the fact that manufacturers do not need to prove efficacy, safety, or quality prior to sale. Therefore, physicians and consumers must evaluate each supplement ingredient and formulation individually. This article outlines an evidence-based approach to assess dermatology supplements. As a starting point, all supplements should be evaluated for PPIES: purity, potency, interactions, efficacy, and safety.

Background and objective Dietary supplements advertised to “boost collagen” or for “skin, hair, and nail” health are becoming increasingly popular, despite a lack of evidence to support their use. These products are not regulated by the United States (U.S.) Food and Drug Administration (FDA), and hence there is no centralized database listing current products. The goal of this study was to document and examine the labeling and marketing methods of these products. Methods Supplements including the words “glow,” “beauty,” “skin,” “hair,” or “nails” on the label were included in the sample. Seven stores within a 3-mile radius were included. Results A total of 176 unique supplements were identified. It was found that most products lacked independent testing; many utilized outdated daily values (DVs) of nutrients. Some had confusing dosing instructions, and most products made health-related marketing claims. Conclusion Dermatologists and primary care providers should be aware of the marketing claims commonly made by these products. Patients should be educated that these claims are generally not verified by independent testing agencies, the U.S. FDA, or by high-quality randomized control trials.

Part 10

Figure 2

Skin, hair, and nail supplements, sometimes referred to as “beauty supplements” or “ingestible skin care,” are a large and growing industry. These products may contain vitamins and minerals, sometimes in very high doses. They may also contain herbs, hormones, microbes, or animal derivatives such as fish oils and collagen powders. Dietary supplements are regulated as foods, not as drugs, by the US Food and Drug Administration (FDA). Therefore, manufacturers do not need to provide any proof of safety, efficacy, or quality prior to sale. This is of serious concern, as many adverse effects due to supplement components have been reported. The potential risks cover multiple categories. These include acute toxicities, such as choking, as well as chronic toxicities, such as increased risk of diabetes. Teratogenicity and interactions with drugs and laboratory testing have been documented in research studies. Other risks include potentially increased risk of cancer with long-term use, allergic reactions, and others. It is vital that physicians educate their patients on these risks. As no post-marketing surveillance programs are required for supplements, our understanding of supplement risks is incomplete. Physicians should be wary of these risks and encourage further research and regulation.

Part 11

corynebacteriaceae - Keyword Search - Science Photo Library

Background: The human skin microbiome is represented by bacteria, fungi, viruses, and mites.

Aims: Every human being possess their own unique skin microbiome because intrinsic and environmental factors have a significant impact on the quality and quantity of microorganism. Every site of the body is a separate microbial niche.

Patients: The feet are one of the most unique and heterogeneous microbial niches of human body with areas that differ by skin thickness, anatomical features, distribution of sweat glands, pH, and the availability of oxygen.

Results: Healthy skin of the foot is inhabited by Corynebacteriaceae, Micrococcaceae, Propionibacteriaceae, Actinobacteria, Clostridiales, Lactobacillaceae, Streptococcaceae, Enterobacteriaceae, Moravellaceae, Neisseriaceae, Pastereullaceae, and Proteobacteria. The most common fungi present on the feet are Malassezzia, Cryptococcus, Aspergillus, Rhodotorula, Epicoccum, Saccharomyces, Candida, Epidermophyton Microsporum, and Trichophyton.

Conclusions: The disturbance of the foot microbiome causes dysbiosis and may lead to pitted keratolysis, fungal, and viral infections or even to protothecosis.

Healthy Therapeutics

Part 1

Several types of cutaneous fungal infections can affect the population worldwide, such as dermatophytosis, cutaneous candidiasis, onychomycosis, and sporotrichosis. However, oral treatments have pronounced adverse effects, making the topical route an alternative to avoid this disadvantage. On the other hand, currently available pharmaceutical forms designed for topical application, such as gels and creams, do not demonstrate effective retention of biomolecules in the upper layers of the skin. An interesting approach to optimise biomolecules’ activity in the skin is the use of nanosystems for drug delivery, especially solid lipid nanoparticles (SLN) and nanostructured lipid carriers (NLC), which in the past decade has shown advantages like increased adhesiveness, great occlusive properties and higher biomolecule deposition in stratum corneum when designed for topical application. Considering the demand for more effective therapeutic alternatives and the promising characteristics of SLN and NLC for topical application, the present study sought to gather studies that investigated the potential of using SLN and NLC for the treatment of cutaneous fungal infections. Studies demonstrated that these nanosystems showed optimisation, mostly, of the effectiveness of biomolecules besides other biopharmaceutical properties, in addition to offering potential occlusion and hydration of the applied region.

The aim of this study was to describe the safety and effectiveness associated with phenol matricectomy in patients with diabetes. To date, the medical literature is devoid of information regarding the use of chemical toenail matricectomies performed on patients with diabetes. Sixty-six consecutive patients with diabetes and ingrown toenails were evaluated. The procedure was performed on 57 of these patients. The results demonstrate a 5% regrowth rate, no significant complications, and limited risk in this patient population.

Phenol (also called carbolic acid) is an aromatic organic compound with the molecular formula C6H5OH. It is a white crystalline solid that is volatile. The molecule consists of a phenyl group (−C6H5) bonded to a hydroxy group (−OH). Mildly acidic, it requires careful handling because it can cause chemical burns.

Part 2

Background. In the last decades, phenol cauterization has been widely used with high success rates for the treatment of ingrowing toenails. However, unpredictable tissue damage and prolonged healing time are the disadvantages of this technique. Sodium hydroxide is an alternative chemical agent that causes less tissue damage.

Objective. In this study, long-term results and postoperative morbidity of two sodium hydroxide chemical matricectomy procedures carried out by different application times have been investigated.

Methods. A total of 156 partial chemical matricectomy procedures were performed with 10% sodium hydroxide in 60 patients divided into two groups. The first group (80 nail sides) received a 2-minute application of sodium hydroxide, whereas the second group (76 nail sides) received a combination of curettage of the lateral matrix area and 1-minute application of sodium hydroxide. Postoperative pain, drainage, and tissue damage were evaluated 2 days after the operation and at three more visits with weekly intervals. Long-term success rates of the methods were evaluated on the 6th month and at a further visit with a mean time of 16.83±2.18 months (range, 13 to 20).

Results. Partial matricectomy with 10% sodium hydroxide was found to be 100% successful in both of the groups (P>0.05). Postoperative pain and tissue damage were either absent or minimal in the great majority of the patients with no statistical difference between the two groups (P>0.05). On the 2nd day, more patients in the first group experienced mild drainage than the patients in the second group (P=0.001), but in the following control visits, this difference disappeared.

Conclusion. Matricectomy with 10% sodium hydroxide, either applied for 2 minutes or 1 minute combined with curettage, is equally effective in the treatment of ingrowing toenails with high success rates and minimal postoperative morbidity.