tag:blogger.com,1999:blog-9870114.post2632162495681340337..comments2024-03-10T08:41:32.400+00:00Comments on VIRTUAL GRAND ROUNDS IN DERMATOLOGY 2.0: Nail Dystrophy in an Eight Year-Old GirlHumane Medicine Huihttp://www.blogger.com/profile/07113291188306363130noreply@blogger.comBlogger11125tag:blogger.com,1999:blog-9870114.post-81575793195868467452011-05-02T16:13:25.127+00:002011-05-02T16:13:25.127+00:00Oh !! I have the same problem , I have visited ma...Oh !! I have the same problem , I have visited may Doctors and they said me just lies, one of them said me said m you have Onycholysis , it is a loosening of the exposed portion of the nail from the nail bed, usually beginning at the free edge and continuing to the lunula.!!cheap viagrahttp://www.xlpharmacy.com/noreply@blogger.comtag:blogger.com,1999:blog-9870114.post-5836215837191703632010-04-14T04:08:15.988+00:002010-04-14T04:08:15.988+00:00This comment has been removed by a blog administrator.yenhttps://www.blogger.com/profile/14471191304245154347noreply@blogger.comtag:blogger.com,1999:blog-9870114.post-38388435412792669302010-04-11T22:11:32.750+00:002010-04-11T22:11:32.750+00:00I'm a dermatology resident in Oregon and have ...I'm a dermatology resident in Oregon and have shared this case with one of my pediatric dermatology attendings, who agrees that this looks like Acrodermatitis continua of Hallopeau. He has had success with topical steroids, Dovonex, and Protopic - if no response to these would consider narrow band UVB or Excimer laser before going on to a systemic medication like MTX.Julianne Mannnoreply@blogger.comtag:blogger.com,1999:blog-9870114.post-2588288124952603682010-04-08T20:57:42.869+00:002010-04-08T20:57:42.869+00:00I agree with Dr Pahwa completely - confirm with bi...I agree with Dr Pahwa completely - confirm with biopsy, then dapsone, failing that, methotrexate.Dr. Stephen Stonehttps://www.blogger.com/profile/11999118015030901461noreply@blogger.comtag:blogger.com,1999:blog-9870114.post-80151220476594968392010-04-07T19:40:16.968+00:002010-04-07T19:40:16.968+00:00I have not treated this condition in a child. In a...I have not treated this condition in a child. In adults most will respond to a strong topical steroid such as Diprosone OV or Clobetasol but there are intermittent flares and most patients require continuous use to keep the condition at bay. Tacrolimus topically BD can be used to prevent flares. In a recalcitrant case at this age Methotrexate would be my next choice. Some of my colleagues recommend methotrexate soaks but I would use it orally in small weekly doses to try to control the condition. Pediatric rheumatologists use it a lot in children with rheumatoid and psoriatic arthritis and the children usually cope very well with fewer issues than adults.Dr Ian McCollhttps://www.blogger.com/profile/01609385802531645972noreply@blogger.comtag:blogger.com,1999:blog-9870114.post-39455886283644079882010-04-07T17:18:10.999+00:002010-04-07T17:18:10.999+00:00Dear All
My approach would be:
1. Do a 3 mm punch...Dear All<br /> My approach would be:<br />1. Do a 3 mm punch biopsy, to confirm the diagnosis.<br />2. After confirming it as Acrodermatitis continua,<br />3. I have experience with Tab. Dapsone 1- 2 mg/kg body weight per day, in children. Start only after getting G6PD levels done. Monitor Hemogram, liver function tests.<br />4. Apply topical Halobetasol cream at night.<br />There after one can think of Methotrexate and biologics. <br />All the best<br /> DR Manish Pahwa<br /> New DelhiAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-9870114.post-52837382771847561182010-04-07T16:05:32.515+00:002010-04-07T16:05:32.515+00:00A colleague with a special interest in nail disord...A colleague with a special interest in nail disorders sent this comment: "Thank you for for the pics. They really look like Acrodermatitis continua of Hallopeau. However, before embarking on any potentially harmful therapies I would recommend a biopsy. A 3 or 4 mm punch is easily tolerated even by a child and is, in the long run, much better than a long-term, potentially hazardous treatment.<br /><br />I would also hesitate to give MTX to a child and have no own experience with thalidomide. A TNF-alpha blocker might be an option is abd when the comination of a vitamin D derivative with a potent setroid fails.Humane Medicine Huihttps://www.blogger.com/profile/07113291188306363130noreply@blogger.comtag:blogger.com,1999:blog-9870114.post-50058285771442679162010-04-07T16:04:40.462+00:002010-04-07T16:04:40.462+00:00Why don't you try topical Tazarotene 0.1% in t...Why don't you try topical Tazarotene 0.1% in this child.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-9870114.post-60070916735595351932010-04-07T14:37:36.173+00:002010-04-07T14:37:36.173+00:00I would consider xrays to rule out bone changes or...I would consider xrays to rule out bone changes or arthritis. This may also guide tx. Consider low dose mtx (2.5mg/wk) or anti-TNF drugs. Continuing topical clobetasol and perhaps considering Cordran tape are other thoughts.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-9870114.post-35551316012824124882010-04-07T14:11:30.633+00:002010-04-07T14:11:30.633+00:00I find Dr Ashok Sharma's comments useful. Thi...I find Dr Ashok Sharma's comments useful. This is a difficult case to manage. There is no long term effective treatment. Of all the topical treatments, I favour tacrolimus ointment 0.1%. If it is troublesome, I would consider oral acetretin but there is long term adverse effects that need to be considered especially to skeletal and bone changes. Cyclosporin or methotrexate may be a better option. Courses of oral antibiotics may be helpful. When the clinical trials of biologics eg usetekinumab and infliximab are available, then perhaps we may consider them too.Henry Foonghttps://www.blogger.com/profile/02804592640968503188noreply@blogger.comtag:blogger.com,1999:blog-9870114.post-8018279946138405512010-04-07T13:21:13.703+00:002010-04-07T13:21:13.703+00:00I can well understand the concern of the parents. ...I can well understand the concern of the parents. <br />The clinical pictures do suggest Acrodermatitis continua(although I would like to see a picture of the palm also).<br />I have noted the tried therapies. I have used Protopic oint (tacrolimus) and Daivobet oint (calcipotriol and betamethasone) for a couple of my cases with appreciable result (skin shows improvement over about 6-8 weeks with nails showing some improvement over about 4-6 months). It is a difficult condition to manage in all age groups.Severely dystrophic nails in my cases have never shown a complete recovery to normal-like nail plates. <br />For cases with multiple nail involvement (as in the present case), biologics like etanercept may hold some promise. I am contemplating trying etanercept for some of the cases I see in future.Ashok K. Sharmanoreply@blogger.com