Chander Grover

University College of Medical Sciences | UCMS · Department of Dermatology

b> Introduction: Giant cell tumor of tendon sheath (GCTTS), presenting as a subungual mass, is a diagnostic challenge and requires differentiation from other subungual tumors such as fibroma of tendon sheath and superficial acral fibromyxoma. Case Report: We describe a 32-year-old female patient with a relatively rare subungual presentation of GCTT...

This chapter discusses the latest therapeutic updates on acquired disorders of the nail unit, including onychomycosis, nail psoriasis, nail lichen planus, and brittle nail syndrome.

Background Psoriasis is a common chronic inflammatory disorder affecting all aspects of a patient’s life. Nail involvement is frequent, but little is known about its associated inflammatory biomarker profile, including similarities or differences from cutaneous disease. Aims We conducted this cross-sectional study to evaluate serum levels of infla...

Recent innovative strategies aimed at minimizing patient anxiety and optimizing comfort during nail surgery have significantly improved the experience for both patients and surgeons alike. Key considerations include meticulous attention to pain control and effective anesthesia administration both pre and post-surgery. Surgical techniques have been...

Trichostasis spinulosa is a disorder of hair follicles characterized by the retention of vellus telogen club hair, leading to the formation of comedo-like lesions. It usually presents over the face and is frequently asymptomatic. We report a 53-year-old female who presented with multiple itchy, discrete, bluish-black, 2–3 mm comedo-like follicular...

Background Tinea incognito presents with atypical, widespread, and recurrent lesions. Dermoscopy can aid its rapid diagnosis. Aim and Objectives This study aimed at assessing dermoscopic features and response to treatment in patients with tinea incognito. Materials and Methods An evaluation of 62 patients with tinea of glabrous skin (Group A (cas...

Onychomycosis (OM) is a difficult-to-treat condition, especially considering the limited armamentarium of antifungal drugs, need for prolonged treatment, and poor compliance. This problem is further confounded while treating OM in special populations such as children, elderly, immunosuppressed patients, pregnant or lactating women, and patients wit...

Introduction: Psoriasis is an autoimmune papulosquamous disorder characterized by erythematous plaques. There are various subtypes, of which follicular psoriasis (FP) is an underreported entity, presenting as scaly follicular papules. Only a few cases have been reported, with limited dermoscopy findings having been described. This report aims to r...

Introduction: Treatment of nail psoriasis is challenging. Systemic therapies may be difficult to justify, while topical therapies may be sup-optimal. Triamcinolone acetonide (TA) injections are recommended as first-line therapy in cases with less than 3 nails involved; however, limited studies are available. This study was conducted to evaluate th...

Background Onychomycosis (OM) is the most common nail disorder accounting for 40–50% of all onychopathies. Onychomycosis is caused by dermatophytes in majority, mostly Trichophyton ( T. ) rubrum followed by T. mentragrophytes var . interdigitale . However, there is a variation in the etiological profile with the subset of population, time, and geog...

Introduction: Nail unit infestation by scabies mites (ungual scabies) is uncommon. It usually presents with distal subungual lesions, leading to recurrent and persistent disease by acting as a reservoir of infection. Periungual involvement in scabies with nail loss is rare and may lead to severe nail damage. Case presentation: We report a 14-yea...

b> Introduction: Bony subungual growths arising on the digital tip are uncommon. Among these, subungual exostosis is a common cause. Case Presentation: We describe a 35-year-old-male patient with a rare occurrence of a fibro-osseus pseudotumor of the digit. It presents with reactive intramembranous ossification, with no continuity with the distal p...

Langer’s lines, lines of cleavage, and biodynamic excisional skin tension (BEST) lines have been defined for cutaneous surgery to ensure excisional wound closure with the least tension on any part of the body and minimize scarring. This article describes nail unit incision lines (NUIL) with a similar perspective. NUIL are followed by nail surgeons...

Background: Lichen planus (LP) is a chronic inflammatory disorder caused by an autoimmune attack by cytotoxic T-cells. The clinical course is variable, with episodes of remission and exacerbation. A clinicopathological scoring system for cutaneous LP is not available for effectively assessing disease severity and monitoring treatment response. Thi...

Introduction: Onychomatricoma is a fibroepithelial tumor derived from the nail matrix and onychodermis. Many clinical and histological variants have been described. Pigmented onychomatricoma is a rare variant which presents as longitudinal pachymelanonychia. Case presentation: We report the details of a 41-year-old female who presented with blac...

Dissecting cellulitis of scalp (DCS) is an uncommon inflammatory dermatosis, which can be difficult to diagnose in the absence of concomitant cutaneous markers. We present an interesting case of DCS in a 60-year-old male, with an onset after blunt trauma to head. The progression was fast and diagnosis could be achieved on multiple biopsies only. Th...

Background Nail involvement in psoriasis is common and may be an indicator not only of disease severity, but also of the presence of psoriatic arthritis. However, the relationship of nail psoriasis with enthesitis remains under-explored. Aims This study was conducted to evaluate the clinical, onychoscopic (nail dermatoscopic) and ultrasonographic...

Onychomycosis (OM) is the commonest cause of dystrophic nails, responsible for upto 50% of cases. Apart from significantly damaging the nails, quality of life, and self.image of the sufferer, it also acts as a reservoir of fungal infections carrying important implications for emerging recalcitrant dermatophytoses. Treatment of OM is based on guidel...

Pincer nail is a deformity characterized by excessive transverse curvature of nail, progressively increasing along its longitudinal axis. The curvature is greatest at the distal end, leading to an ingrown nail, producing pain, discomfort, and significant cosmetic alteration. It is a severe variant of ingrown nail, often attributed to causes such as...

Intralesional injections of triamcinolone acetonide are widely used to successfully treat several inflammatory nail conditions. This procedure is well described in adults, but less frequently reported in children and teenagers, being largely considered too invasive and fear-provoking for pediatric patients. Our report shows how this procedure is fe...

A 2-year-old girl was brought to the pediatric outpatient clinic with complaints of recurrent diarrhea, poor growth and rash over the abdomen for the past few months. Examination revealed generalized lymphadenopathy, mild hepatosplenomegaly and brownish, itchy lesions over the lower abdomen extending upto the genital area (Fig. 1). The child had be...

Background Though diabetes mellitus (DM) is a well-recognised risk factor for onychomycosis (OM), the epidemiology of OM in diabetic patients remains largely unexplored, especially from the Indian subcontinent. Aims and objectives To estimate the prevalence of OM in diabetic patients, to identify and analyse risk factors, and correlate the severit...

Retronychia is an uncommon type of ingrown nail characterized by ingrowing of the proximal nail plate into the proximal nail fold (PNF), inciting cycles of inflammation. The condition can be symptomatic due to swelling and inflammation of the PNF, but most often it is noticed because of a proximal thickening of the nail plate and the failure of nai...

Nail in women assumes special importance, due to the aesthetic appeal and regular use of nail cosmetics and beautification procedures. Also, women are more prone to certain nail disorders like brittle nails and chronic paronychia due to increased household work and parlor activities. In this chapter physiologic changes in women nail, nail cosmetics...

We have seen that radiological techniques like digital x-ray, high-frequency ultrasonography (USG), computed tomography (CT), and magnetic resonance imaging (MRI) have their unique roles in assessing a complex anatomical structure like the nail unit. Broadly speaking, USG and MRI help evaluate soft tissue components well; while, radiographs and CT...

As we were on the road to recovery from the coronavirus disease-19 (COVID-19) pandemic, the world is waking up to yet another potential adversary. Monkeypox (or human monkeypox) caused by monkeypox virus (an orthopox virus) is fast emerging in more than 80 countries worldwide, where it has never been historically reported. We in India, have already...

Vulvar disorders represent a diverse group of cutaneous disorders in which vulva can be involved in isolation, or as part of a more generalized disease process. At times, these disorders can be challenging to diagnose, both for the gynecologists and the dermatologists; however, a systematic approach is always helpful to arrive at a diagnosis or diff...

Introduction: Acrokeratosis paraneoplastica of Bazex (APB) is a rare paraneoplastic dermatosis having definite association with malignancy, most commonly squamous cell carcinomas (SCC) of the upper aerodigestive tract. It is characterized by psoriasiform plaques involving the ears, nose, hands, and feet. Nail changes are commonly encountered, incl...

The nail unit is a unique skin appendage, capable of mounting only a limited number of reaction patterns to a variety of insults. This makes it difficult to diagnose many nail conditions based on clinical features alone. Thus, diagnostic modalities have an important role to play in nail disorders. Emphasis is placed on non-invasive diagnostic metho...

Introduction: Irritant contact dermatitis affecting the nail unit may lead to nail matrix damage and onychomadesis, which may initially be subclinical, becoming overt later. We describe a patient who developed these changes after using a chemical pesticide. Case presentation: A 52-year-old woman presented with discoloration of the nails of both...

To estimate and compare serum VEGF levels before and after vitamin D supplementation in vitamin D deficient PCOS patients. The present study was conducted in Department of Obstetrics and Gynaecology in collaboration with Department of Biochemistry at University College of Medical Sciences (UCMS) and Guru Teg Bahadur Hospital (GTBH), Delhi from Nove...

Background: Various nail manifestations have been reported with COVID-19; mostly in the form of isolated reports. Objective: This cross-sectional study was carried out to assess nail changes in hospitalized patients with moderate to severe COVID-19. Methods: Nail findings in 43 adults being treated for COVID-19, were evaluated after obtaining...

Background: Tuberculosis (TB) has been one of the most challenging infectious diseases globally. Cutaneous tuberculosis (CTB) accounts for 0.5-2% of extrapulmonary TB and is often missed owing to its varying morphology and paucibacillary nature. Methods: In this retrospective analytical study, we share our 22-year experience to describe the clin...

Cutaneous adverse drug reactions (CADRs) are the most common pediatric adverse drug reactions. CADR can range in severity from very mild, self-limited reactions like maculopapular rash to severe life-threatening ones like Stevens–Johnson syndrome-Toxic Epidermal Necrolysis (SJS-TEN). An understanding of these reactions is essential to avoid unneces...

In dermatology, “pseudo” is often used as a prefx for entities resembling another standard condition, either morphologically or histopathologically. Correspondingly, “pseudotumor” is a term encompassing dermatological conditions which are not true proliferations, but either have a clinical resemblance to a known tumor (e.g., Pseudokaposi’s sarcoma...

Lichen planus is a multifaceted disease of complex etiopathogenesis. Nails are involved in up to 10% of patients with lichen planus. Although most cases are mild, serious consequences may occur due to rapid progression of the disease, the high risk of scarring, and the resulting irreversible damage to the nail structure. Permanent damage of at leas...

Ever since the beginning of COVID-19 pandemic, mucocutaneous manifestations started being noticed and are still being documented. Many of these have been described with the prefix “COVID” and may occur due to the infection (e.g., COVID rash), use of personal protective equipment in healthcare workers (e.g., COVID hand dermatitis) or extensive use o...

White piedra is a superficial fungal infection of hair caused by Trichosporon species. It presents clinically as white nodules encasing the hair shafts and may lead to increased fragility. It can usually be differentiated easily from clinically similar conditions based on clinical and microbiologic features. We report a case of white piedra of scal...

In dermatology, the word “molluscum” is used as a prefix for infective and non-infective conditions. The term is used to describe soft papules or nodules with or without central umbilication, which is not a necessary qualification. This article attempts to summarise the conditions in dermatology with the epithet “molluscum” and discuss them in brie...

Chronic mucocutaneous candidiasis is an immunodeficiency state, inherited or acquired, characterized by recurrent and/or persistent candidiasis of skin, nails, and mucous membranes. Woolly hair is a congenital structural anomaly of scalp hair, characterized by light-colored, short, extremely kinky, and thin hair due to premature termination of anag...

Nail fold is one of the most accessible sites for studying changes in the microcirculation in various microangiopathies. The characterization of changes in microvasculature can provide useful clues towards the diagnosis and prognosis of a disease. The diagnostic utility of nail fold capillaroscopy has improved and expanded over the past couple of d...

Familial hypercholesterolemia is a rare genetic disease, although it is amongst the commonest dyslipidemias. It characterized by raised cholesterol levels and normal triglyceride levels. Childhood presentation of familial hypercholesterolemia can cause early atherosclerotic plaque deposition in arteries and a markedly increased risk of coronary hea...

COVID-19 pandemic has challenged and overwhelmed most healthcare institutions and healthcare workers, across the world. Despite being unprepared for this pandemic, frontline workers have worked relentlessly to provide the much-needed care to these patients. Doctors from different branches of medicine, including dermatologists, came forward and play...

Pterygium is an irreversible scarring of the nail matrix resulting in a split nail. The deformity is most often post-traumatic, though it can be the end result of aggressive inflammatory diseases involving the nail matrix like nail lichen planus, graft versus host disease, or autoimmune bullous disorders like cicatricial pemphigoid. It is thought t...

Background Lichen scrofulosorum (LS) represents immunologic reaction to the Mycobacterium tuberculosis antigen and presents with subtle, asymptomatic, grouped follicular papules over the trunk and shows good therapeutic response to antitubercular drugs. Objective To study the clinical and epidemiological characteristics of patients diagnosed with...

Salient nail unit changes serve as pointers toward systemic disease. On similar lines, salient nail changes are associated with pigmentary disorders, and can help toward diagnosis. Nail changes form a part of various physiologic pigmentary changes including racial pigmentation, pregnancy, or neonatal period. At the same time, a number of nail chang...

Background Subungual glomus tumor is a relatively uncommon entity with varied clinical presentations which may lead to diagnostic delays. Onychoscopy can be used as an evaluation tool in routine intraoperative evaluation of glomus tumors. Objectives and methods With an aim to characterize the onychoscopic features of subungual glomus tumors, we an...

Introduction: Ungual warts are common fibroepithelial tumours of the nail unit caused by human papillomavirus. Although various treatment modalities are available, their management is challenging due to high potential for recurrence and treatment-related nail dystrophy. Objective: This study evaluates the efficacy and safety of intralesional ble...