The nail is a specialized keratinous skin appendage that grows approximately 2 to 3 mm per month, with complete replacement achieved in 6 to 9 months. Although this structure can be easily overlooked, nail disorders comprise approximately 10% of all dermatologic conditions. This contribution first provides an overview on the basic anatomy of the nail that will delineate between the nail unit (eg, hyponychium, nail bed, proximal nail fold, and matrix) and anatomic components not part of the nail unit (eg, lateral nail folds, nail plate, and eponychium). The function of each nail structure will also be presented. The chemical profile of the normal nail plate is reviewed with a discussion of its keratin content (hair type keratin vs epithelial type keratin), sulfur content, and mineral composition, including magnesium, calcium, iron, zinc, sodium, and copper. The remainder will focus on nail manifestations seen in states of malnutrition. Virtually every nutritional deficiency can affect the growth of the nail in some manner. Finally, the discussion will include anecdotal use of nutritional and dietary supplements in the setting of brittle nail syndrome as well as a brief overview of biotin and its promising utility in the treatment of nail disorders.
"Our data are in agreement with literature data on nail protein glycation obtained in stratum corneum, nails (Bakan & Bakan 1985) and hair (Masuta et al. 1989; Seven et al. 1993; Kobayashi & Igimi 1996). The increase in reference values upon ageing may be explained by the slower growth rate of nails (Cashman & Sloan 2010), by altered chemical composition of nail proteins (Dittmar et al. 2008) and by the increasing reference range for serum glucose upon ageing (Ghasemi et al. 2011). The sensitivity obtained in the present study for glycated nail proteins was better than that of the trivial assessment of urinary glucose (van der Sande et al. 1999). "
[Show abstract][Hide abstract] ABSTRACT: To assess glycation of nail proteins as a tool in the diagnosis of diabetes.
Glycation of nail proteins was assessed using a modified photometric nitroblue tetrazolium-based assay, which provides information about average glucose values of the last 6-9 months. Analysis is possible on 10 mg of nail clippings with a within-run coefficient of variation (CV) of 11%. The analyte is extremely stable. The reference range for glycated nail protein (0.55-3.60 μmol/g nail) increases upon ageing.
In diabetics (n = 112), values for glycated nail protein are significantly higher (median: 4.07 μmol/g nail, IQR: 2.37-6.89 μmol/g nail, P < 0.0001) than in non-diabetics (n = 116). ROC analysis shows an AUC of 0.848 (specificity 93.1%; sensitivity 68.9%).
This affordable method is a simple alternative for diagnosing diabetes in remote areas as the pre-analytical phase (including all processes from the time a laboratory request is made by a physician until the sample is ready for testing) is extremely robust.
Tropical Medicine & International Health 10/2013; 19(1). DOI:10.1111/tmi.12218 · 2.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The human nail can be afflicted by several disease states. Approximately 50% of all problems result from fungal infections, and brittle nail syndrome affects approximately 20% of the population. For the topical treatment of nail diseases, however, it is a prime requirement that the active ingredient is capable of penetrating into and diffusing though the nail plate. Experimental techniques for investigation of the penetration and distribution of chemicals into and through the nail plate have demonstrated that it is possible to deliver drugs to the nail following topical application. This research has led the development of newer more effective topical products and regimens for treatment of onychomycoses and other nail diseases. In this chapter, nail structure and chemical composition will be discussed together with an overview of the permeation of molecules through the nail plate, and this will be followed by a review of selected clinical studies designed to determine the efficacy of topical treatment for nail diseases.
[Show abstract][Hide abstract] ABSTRACT: Manicures can result in nail damage via instrumentation, nail polish, nail polish removers, and artificial nails. We report nail weakness, brittleness, and thinning in five subjects after the application of a new manicure system called gel polish and removal with acetone and manual peeling. All subjects complained that the polish was very difficult to remove and that their nails became much thinner after the procedure. Pseudoleukonychia and onychoschizia lamellina were noted on examination. One subject underwent ultrasound and reflectance confocal microscopy (RCM) measurements of nail plate before and after the gel polish application, which showed thinned nail plate (0.063 vs. 0.050 cm and 0.059 vs. 0.030 cm, respectively). Overall, we call attention to the adverse effects of gel polish manicures in five subjects. In addition, our case illustrates potential utility of ultrasound and RCM in measuring nail plate thickness.
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