Eckart Haneke

Inselspital, Universitätsspital Bern · Department of Dermatology

Chronic paronychia is a common condition mainly afflicting middle-aged women. It is usually due to long-standing and repeated irritation and contact with moisture. We observed a male farmer with chronic paronychia. Cow hair was found under the proximal nail fold of the right middle finger. Bacterial culture revealed Mycobacterium elephantis in addi...

This report describes the clinical, onychoscopic, nail clipping, and histopathologic features of a malignant onychopapilloma. A 71‐year‐old male presented to our outpatient clinic for a stable, asymptomatic lesion on his left middle finger that had been present for 2 years. Prior nail clipping histopathology showed nail plate thinning with subungua...

Background: Chronic paronychia is an inflammatory process of the nail folds lasting more than 6 weeks. Clinically, there is hypertrophy and retraction of the folds and absence of the cuticle. Treatment involves clinical measures and, when there is no response or the hypertrophy of the folds is very pronounced, surgical treatment is indicated. Post...

Introduction: Retronychia is a particular form of post-traumatic ingrown nail associated with repeated microtrauma of the underside of the proximal nail fold. It is caused by the nail embedding backward into the underside of the proximal nail fold, forming multiple generations of nail plate. Methods: The study aims to evaluate the results of a n...

Background: Severe nail lichen planus (NLP) does not respond well to treatment and is often poorly considered and described in detail. Objective: We sought to describe the characteristics of severe NLP. Methods: A retrospective data analysis was performed, including the photographic records of the most compromised nails of patients with NLP ov...

Background and objectives: The dermoscopic features of glomus tumors have only been described in a few case reports. The aim of this research was to define the clinical and dermoscopic features of subungual glomus tumors. Methods: Thirty-two patients with subungual glomus tumors were evaluated retrospectively. Results: On the photographs, long...

Chondromas are tumors due to proliferation of cartilage cells. Most arise from residual cartilage in the bone and cause chondromas within the bone, they are called enchondromas. Rarely, a chondroma may develop from cartilage cells between the periosteum and the bone, they are called parosteal chondromas. Even less common are soft tissue chondromas...

Background: The ABCDE rule systematizes warning signs for malignant melanoma (MM). Objectives: To evaluate whether the ABCDE signs are associated with early detection of MM. Materials & methods: Based on a retrospective study over 11.5 years, we assessed whether ABCDE signs are associated with early diagnosis of MM. Results: In total, 144 MM...

Toenail changes are extremely frequent. Onychomycoses were said to be the most frequent cause; however, recent examinations have shown that orthopedic foot and toe abnormalities are at least as frequent as fungal toenail infections. This has first been described as asymmetric gait nail unit syndrome and will be outlined in more detail here. Hallux...

Background: There are no proper management guidelines for nail apparatus melanoma (NAM). Objective: This study aimed to describe the clinical features, the presence of locoregional and distant metastases and disease-free and overall survival of NAM treated at our institution. Methods: A retrospective cohort review of patients with single, prim...

Nail abnormalities have been described in patients affected by alopecia areata and indicate a poor prognosis. Geometric pitting, punctate leukonychia, and trachyonychia are the most common signs. However, trachyonychia is not exclusive for alopecia areata, as it can be a clinical presentation of other disorders, such as lichen planus, psoriasis, an...

Cutaneous elastofibroma is part of the connective tissue nevus complex. Two subungual cases remotely similar to the one presented here have been described before. This patient presented with an unusual form of subungual elastofibroma of the big toe, which was surgically removed. Histopathology revealed a connective tissue tumor extremely rich in ve...

Nail disorders are common and ignored frequently by both patients and physicians due to asymptomatic nature. But they are cosmetically concerned and may manifest underlying systemic disease. This chapter illustrate and briefly discusses more than 100 nail problems we encounter in clinical practice. Customer can order it via https://www.springer.com...

This book focuses on the representation of dermatological diseases in pigmented skin, fills an important gap in the literature, and facilitates better dermatological diagnosis when dealing with patients of various ethnicities. It discusses over 400 diseases and their representations with the help of over 2000 high-quality images and illustrations....

Onychopapilloma is a fairly common lesion that is clinically typical enough to make the diagnosis. It is unique in that it stretches from the distal matrix all along the nailbed to the hyponychium. A case is described that developed pain eventually resulting in total excision. Histopathology revealed a malignant onychopapilloma. The differential di...

Introduction: Onychomycosis is a chronic nail fungal infection resulting in nail damage and a decreased quality of life. Chemical avulsion of the nail with urea and bifonazole -removes fungally infected debris, increasing antifungal treatment efficacy and penetration. Previous clinical ob-servations describe patients who applied their urea and -bi...

A case of adult onset longitudinal melanonychia caused by a compound nevus is described. Longitudinal melanonychias are mainly caused by melanocytic activation (hypermelanosis), lentigo (benign melanocytic hyperplasia), nevus and melanoma. Nevi are more commonly seen in children than adults; however, melanocytic activation, atypical melanocytic pro...

Background: Ultrasonography has demonstrated a shortening of the distance between the origin of the nail plate and the base of the distal phalanx in retronychia. The aim of this study was to analyze the clinical and ultrasonographic features of retronychia. Methods: We evaluated the clinical findings in 18 patients with retronychia, along with t...

Background Longitudinal melanonychia (LM) can present a diagnostic challenge and dermoscopy is of utmost importance in its evaluation and differential diagnosis of LM. Objective This report aimed to describe an unusual dermoscopic pattern in a group of patients that presented with LM. Methods The clinical course and features of 5 patients that pr...

Lichen planus is a benign inflammatory disorder of unknown etiology that may affect the skin, mucosae, scalp and nails. When the nails are affected, it may lead to permanent destruction with severe functional and psychosocial consequences. Therefore, prompt diagnosis and early treatment are essential, even in mild cases. There are currently no guid...

Onychocryptosis, or ingrown toenail, is a frequent, painful condition affecting young individuals. Controversies still exist regarding its etiopathogenesis and treatment options, including conservative and surgical techniques. The choice of treatment method depends on the stage of disease as conservative measures are mostly effective in early stage...

Yellow nail syndrome (YNS) is a rare, but relatively well characterized triad of slow growing yellow nails, lymphedema of the distal portions of the upper and lower limbs as well as chronic infection of the respiratory tract and/or pleural effusion. The most characteristic features of this syndrome are the nail changes that allow the diagnosis to b...

Nail apparatus melanoma (NAM) is a rare dermatologic malignancy. Its prognosis is poor because it is often diagnosed late. However, progression and survival of NAM patients have only been studied among small populations. Early biopsy could help to identify suspicious lesions at a less invasive stage. While surgery is generally seen as the treatment...

The Schamroth sign can be used for the detection of nail clubbing and is associated with pulmonary and cardiovascular diseases. This case illustrates a patient with sudden nail clubbing and positive Schamroth sign without any other abnormal clinical or laboratory findings. Radiological workup revealed a pleural tumor, histologically confirmed as a...

Objectives: Onychomycoses in temperate climates are most commonly due to dermatophytes, particularly Trichophyton rubrum. Non-dermatophyte nail infections are much less frequent, and their diagnosis requires a careful and repeated search for a potential dermatophyte that may have been overgrown in culture. Materials/patients/methods: A series of...

Cogan syndrome and lichen planus represent two autoimmune disorders. Cogan syndrome is a very rare type of ANCA-negative vasculitis affecting the eyes and vestibulocochlear system. It has been associated with other autoimmune disorders, none of them showing any lichenoid inflammation. We herein report the first case of a patient that suffered from...

Divided or kissing nevi are a rare clinical variant of congenital melanocytic nevi developing in adjacent areas of the skin that undergo cleavage during embryogenesis. Penile lesions are even rarer, with only few cases described in the literature. Typically, they present as two opposing dark colored macular or papular lesions on the glans and prepu...

The term retronychia originated in 1999 (1) and a first series of cases was published in 2008. (2) A disturbance in the continuous longitudinal nail growth (3) leads to an upward and backward nail displacement with posterior embedding. Several nail plates pile up beneath the proximal nail fold (PNF) generating paronychia and granulation tissue. Rep...

Subungual metastases (SM) represent a very rare event, in which malignant cells spread from a primary tumor to the nail unit, ie specifically the nail plate and the tissue around it. They account for 1% of acral metastases and usually occur in well‐known cancer patient, signalling a progression of the disease. They may rarely be the presenting sign...

Nail involvement in psoriasis is common, and the severity of it does not always parallel the intensity of cutaneous disease. We created a consensus group, of which the aim was to provide practical recommendations for the treatment of nail psoriasis in patients without skin psoriasis or with mild skin lesions with no indication for a systemic treatm...

The clinical differential diagnosis of many tumors in the nail area is difficult. The nail plate both covers the lesions and may influence the pattern of invasion. Most benign tumors cause nail and sometimes bone deformation due to chronic pressure on the matrix and/or on the distal phalanx. Tumors involving the proximal nail fold can cause pressur...

Nail surgery is often feared by patients because of the pain, both during anesthesia and post op. Potential dystrophic sequellae frighten the practionner. A good knowledge of the techniques of anesthesia, nail anatomy and surgical procedures are a prerequisite for a successful nail surgery with almost no pain and minimal scarring. Any dermatolologi...

Linked article: This is a commentary on C. Delvaux et al., pp. 2025–2030 in this issue. To view this article visit https://doi.org/10.1111/jdv.15037

We conducted a retrospective study aiming to assess the risk, and associated risk factors, of developing subsequent skin cancers after having a first diagnosis of skin cancer. We included all patients with biopsy-proven skin cancer attending a dermatology clinic between July 2007 and July 2017. We assessed the frequency of new skin cancers, as well...

Filler injections belong to the most frequently performed noninvasive beautifying procedures. When done correctly they are generally well tolerated. However, a number of factors, such as poor filler quality, and particularly host as well as user dependent filler reactions may lead to unwanted effects. These may be early, late, or delayed events wit...

Introduction: Lentigo maligna (LM) is a rare form of in situ melanoma, frequently seen as a large patch in elderly patients. The aim of this study was to assess clinical and dermoscopic features of LM. Material and methods: A retrospective study of LM patients presenting to our center between July 2007 and July 2017 was performed. Demographic da...

Onychomycosis is often held to be the most difficult‐to‐treat cutaneous mycosis. The tenacity of the disease contributes to the frustration in treating it along with the relatively rare long‐term cures, high rate of relapses and re‐infections, and the difficulties in prophylaxis. A number of different mold species have been frequently isolated from...

The term melanonychia denotes a brown or black nail, not the pigment itself. There are many reasons for a brown nail, many different patterns of melanonychia (longitudinal, transverse, diffuse, etc.), and a number of diagnoses. Longitudinal melanonychia (LM) always derives from a focus of melanin-producing melanocytes in the matrix and is due to me...

Background: Plantar fibromatosis or Ledderhose disease is characterized by a benign fibroblastic proliferation of the plantar fascia. It is an illness with unknown etiology and a complex treatment in its most intense manifestation. Objective: The authors describe a surgical option for extensive cases where conservative treatments are not success...

Eckart Haneke1–4 1Department of Dermatology, Inselspital, University of Bern, Bern, Switzerland; 2Dermatology Practice Dermaticum, Freiburg, Germany; 3Centro de Dermatología Epidermis, Instituto CUF, Porto, Portugal; 4Department of Dermatology, University Hospital, Gent, Belgium Abstract: Psoriasis is the skin disease that most frequently affects t...

Epidermal nevi (EN) are hamartomas of the skin that result from mosaic post-zygotic mutations. There are several variants of EN, the verrucous epidermal nevus (VEN) being the most common. EN can be further subdivided into epidermolytic and nonepidermolytic, important since in contrast with nonepidermolytic EN, epidermolytic EN occurs sporadically (...

Melanonychia is the most common and earliest visible sign of a subungual melanoma. Melanonychia may be due to melanocyte hyperfunction, lentigines, nevi or malignant melanomas of the nail matrix. Whereas functional melanonychia is grayish, melanonychia due to lentigines and nevi usually causes a clear brown to sometimes even black nail color. The d...

The nail apparatus is an integral part of the functional unit of the digital tip. Although overall uncommon, all cells and tissues occurring in this area can give rise to neoplastic lesions. Given the special anatomical location, such tumors frequently show morphological and symptom‐related differences compared to similar lesions located elsewhere...

Zusammenfassung Der Nagelapparat ist Teil der Funktionseinheit Finger‐ bzw. Zehenspitze. Alle von den hier vorkommenden Zellen und Geweben ausgehenden Tumoren können beobachtet werden, wenn sie auch insgesamt selten sind. Die besondere anatomische Lage führt dazu, dass sie morphologisch und symptomatologisch oft unterschiedlich sind im Vergleich zu...

p>Subungual melanoma is a rare variant of acral lentiginous melanoma that often has a poor prognosis compared with other types of melanoma. The aim of the present study is to report a case of a patient with recurrence of subungual melanoma treated with imiquimod 5%, which presented a total regression of the lesion and no recurrence for 4 years. J...

Psoriasis is a chronic and recurrent inflammatory skin disease with a worldwide prevalence of approximately 1 to 3% causing significant distress and morbidity in the affected patients.1,2,3 Skin manifestations are the most characteristic findings of psoriasis, however, nail psoriasis is often overlooked despite its common occurrence.1,2 Nail involv...

Background: Frontal fibrosing alopecia (FFA) is a primary scarring alopecia characterized by frontotemporoparietal hairline recession with associated clinical findings crucial for diagnosis and which may be linked to severity and prognosis. Objective: To evaluate clinical-trichoscopic-histological features of a series of FFA cases comparing with pu...

Glomus tumor is a rare benign vascular hamartoma derived from the modified smooth muscle cells of the glomus body. Paroxysmal pain is the leading symptom. A 78-year-old woman presented at our clinic with a 50-year history of a slow growing painful purple blue tender nodule under the right fourth finger nail. Dermoscopy and magnetic ressonance confi...

Background: Bowen disease is the most frequent nail malignancy, usually seen as a verrucous plaque of the nail in men. Objective: To characterize the affected patient population, the clinical manifestations, the diagnostic delay and diagnostic steps, and presence of human papilloma virus (HPV) infection. Methods: We retrospectively evaluated a...

Der „Nagel” besteht aus der Matrix, der von ihr gebildeten Nagelplatte, dem Nagelbett, den lateralen und proximalen Nagelwällen, dem Hyp- und Eponychium sowie der Kutikula. Die histologische Untersuchung des Nagelorgans wird nur von relativ wenigen Labors routinemäßig durchgeführt. Sie setzt ebenso wie die richtige Nagelbiopsie Grundkenntnisse der...

Six cases of vascular compromise after hyaluronic injection are reported. Clinical symptoms realized a Nicolau syndrome, which is characterized by immediate pain, livedoid pattern and a few days later by the appearance of scabs and skin necrosis. This type of complication is rare, but may be dramatic and injectors must be aware of that. A thorough...

Fillers belong to the most frequently used beautifying products. They are generally well tolerated, but any one of them may occasionally produce adverse side effects. Adverse effects usually last as long as the filler is in the skin, which means that short-lived fillers have short-term side effects and permanent fillers may induce life-long adverse...

A rudimentary accessory or double nail of the little toe is not rare, although only described three times before. Most cases are accidentally detected and only few patients seek help because they have discomfort or pain. Some have a positive family history, but most patients cannot give any information concerning heredity. Clinically, the nail of t...

The subungual melanoma is considered a rare subtype of melanoma. It emerges in the ungual matrix, however can involve all components of the nail apparatus. This tumor is often underdiagnosed, which leads to a delay in proper treatment, resulting in a poorer prognosis. The final diagnosis should be confirmed by histology. Conservative surgery in the...

Retronychia represents proximal ingrowth of the nail that occurs when the nail embeds backwards into the proximal nail fold. It is suspected when there is a persistent paronychia, particularly in the setting of trauma. Important clinical criteria for diagnosis are inflammation of the proximal nail fold, granulation tissue emerging from under the na...

The nail unit is the largest and a rather complex skin appendage. It is located on the dorsal aspect of the tips of fingers and toes and has important protective and sensory functions. Development begins in utero between weeks 7 and 8 and is fully formed at birth. For its correct development, a great number of signals are necessary. Anatomically, i...

Acquired periungual fibrokeratomas are benign fibrous tissue tumors and are considered as the topographical variant of acquired digital fibrokeratoma. They usually present as solitary tumors. In some instance, the entity may appear in multibranched fashion. The main histopathologic features consist of acanthosis, thick collagen bundles mainly orien...

The more modern, radiowave surgery allows cutting to be done almost without thermal damage. Electrosurgery is the destruction or removal of tissue using electrical energy and provides a rapid, cost-effective treatment for many skin lesions. There are now many different electrosurgical devices available in various countries. The modern devices gener...

Histopathology is the most important method in dermatopathology which requires good biopsy specimens for diagnosis. In most European countries, biopsies are daily routine procedures for virtually all dermatologists. Poor biopsy specimens hinder the diagnostic process and there are many pitfalls in performing biopsies.