Department of Dermatology Lymphology Unit, CHRU Tours, Tours, France.
Br J Dermatol. 2011 Apr;164(4):765-70. doi: 10.1111/j.1365-2133.2010.10179.x.
Secondary lymphoedema is characterized by lymphatic stasis that is often the result of a lymph node lesion. At advanced stages it may cause trophic changes in the skin. However, the presence of changes in the nail unit has not been reported to date.
The aim of this study was to determine the presence of nail abnormalities in cases of secondary lymphoedema.
This was a prospective study, conducted on patients with unilateral secondary lymphoedema. A comparative clinical and dermoscopic examination and 20-MHz high-resolution ultrasound imaging of the affected limb and the contralateral limb were performed.
Thirty-three patients were included. On physical examination, hyperkeratosis of the lateral nail folds, friability of the nail surface, 'ragged' proximal nail folds and cuticle and apparent leuconychia were observed more frequently on the lymphoedematous limb. The ultrasound study of the nails of the thumb and the big toe did not reveal any differences in thickness of the different structures of the nail between the lymphoedema side and the opposite side. The nail matrix was longer on the lymphoedema side.
Our study showed mild changes in the nail unit compatible with the xerosis often associated with severe lymphoedema. However, the study also showed frequent evidence of 'ragged' cuticles, which in these patients at high risk of erysipelas are entry points for bacteria. This should be taken into account when counselling patients with limb lymphoedema in order to prevent erysipelas.
继发性淋巴水肿的特征是淋巴停滞，通常是由于淋巴结病变引起的。在晚期，它可能导致皮肤的营养变化。然而，迄今为止，尚未报道指甲单位发生变化。
本研究旨在确定继发性淋巴水肿病例中指甲异常的存在。
这是一项前瞻性研究，对单侧继发性淋巴水肿患者进行研究。对受累肢体和对侧肢体进行了比较临床和皮肤镜检查以及 20MHz 高分辨率超声成像。
共纳入 33 例患者。体格检查发现，受累肢体的侧甲皱襞过度角化、甲面易碎、近端甲皱襞和甲小皮参差不齐和明显的白甲更为常见。拇指和大脚趾的指甲超声研究未发现水肿侧和对侧指甲不同结构的厚度有任何差异。水肿侧的甲母质较长。
我们的研究显示指甲单位有轻微变化，与严重淋巴水肿常伴有的干燥有关。然而，研究还显示经常有参差不齐的甲小皮的证据，在这些高风险发生丹毒的患者中，这些甲小皮是细菌进入的入口。在为肢体淋巴水肿患者提供咨询时应考虑到这一点，以预防丹毒。
