1/
Hi #dermtwitter/#medtwitter! Our last (for now!) #tweetorial/#medthread on nails! This time it’s...

PEDIATRIC NAIL CONDITIONS!

Education from @naildisorders and the @jmervak team!

@societypedsderm @PeDRAResearch #medstudenttwitter #medtwitter #meded #FOAMed
2/
Beau’s lines (transverse ridge) and onychomadesis (nail shedding) common in kids! Often seen in a post-viral setting.

Common culprit = hand foot mouth disease!
3/
Congenital malalignment of the great toenails – lateral deviation of the first toenails. More common than you think. Start looking at more toes and you’ll see it! Can improve with time or persist. Risk for nail thickening or ingrown nails.

pc: sciencedirect.com/science/articl…
4/
Baby toes! Congenital hypertrophy of the nail fold describes an overgrowth of the nail fold covering the nail plate. Can treat with topical steroids if inflamed. Will improve by time of that first birthday smash cake!
5/
Chevron nails!

Normal variant…and quite beautiful! Diagonal ridging of the nails most commonly seen in elementary age kids and resolved by adulthood.

pc: onlinelibrary.wiley.com/doi/10.1111/pd…
6/
Punctate leukonychia! Small white spots on the nail plate due to minor trauma to the distal nail matrix. Should grow out with time!
7/
Trachyonychia!

Sometimes called “20 nail dystrophy” but does not have to involve all nails! Longitudinal ridging and roughness of the nail plate. Can be idiopathic in childhood or a sign of psoriasis or lichen planus. 50% will self resolve!

pc: journals.lww.com/co-pediatrics/…
8/
Congenital onychodysplasia of the index finger (COIF)!

Tiny nail plate of the second finger. No treatment needed. Classic xray shows bifurcation of the distal phalanx!

#radiology #pedsrads @pedsimaging

pc: doi.org/10.53347/rID-1…
sciencedirect.com/science/articl…
9/
Pachyonychia congenita, usually presents around 2-3 yo with thickened nails. Spectrum of genetic disorders presenting with thick yellow-brown nails, thick palms and soles, plantar pain.

PC: @pachyonychia
10/
Lichen striatus involving the nail! Look for the clues of linear papules leading up to the nail. Can see onycholysis, ridging, splitting, or “pseudo-growth” under the nail plate. Self resolves!

pc: sciencedirect.com/science/articl…
11/ Melanonychia in kids!

Most often due to congenital nevi or nail matrix nevi. Can look scary! Melanoma in kids is VERY rare, but always feel free to consult a (pediatric) dermatologist for their expert opinion.
12/12
In summary, most nail changes in kids are benign. Being able to explain to parents what they are seeing & what to expect will be so appreciated!

Hope all current/future #dermatologists & #pediatricians found this helpful!🙏@Nickles_Melissa for helping prepare this thread!

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More from @DrStevenTChen

27 Oct
1/
Join me for a quick #tweetorial/#medthread on:

Pearls for the #Dermatology Exam!

#MedEd #dermtwitter #medtwitter #medstudenttwitter #FOAMed

First a question - What do you think when someone asks for your help with a rash?
2/
Regardless how you answered, I hope to teach you something today! Let's start!

"In #dermatology, we don't do an H+P, we do a P+H."

The exam is perhaps most important. You can use it to narrow down your ddx! Then, you use your history to further work toward the right dx.
3/
"If there's scale, there probably is epidermal involvement."

Scale usually implies action in the epidermis. This doesn't rule out anything in the dermis or subcutis, but just that the pathology includes action up top.

Check out my #tweetorial on scale
Read 10 tweets
24 Oct
1/
Hi #dermtwitter! Back for another #tweetorial/#medthread on nails! Today we’re learning about:

ONYCHOMYCOSIS- nail fungus!
 
This is THE most common nail condition- so follow along!
Education from @naildisorders
#medstudenttwitter #medtwitter #meded #FOAMed
2/
Onychomycosis is more common in adults than kids.
Trauma, diabetes, immunosuppression, tinea pedis, psoriasis, and family history are some risk factors

Pro tip- check the feet for tinea pedis if you suspect onychomycosis!

@podiatrytoday
3/
Patients with onychomycosis present with nail discoloration (yellow to brown), onycholysis (nail separation), nail brittleness, or nail thickening.

The big toenail is most frequently affected.

Fingernail involvement without also have toenail involvement is uncommon.
Read 14 tweets
3 Oct
1/
Hi #dermtwitter! I'm working with @jmervak et al, who put together this amazing #tweetorial on

NAILS!

Specifically, findings in the setting of systemic diseases: let nails help your diagnosis!

Coordinated with @naildisorders

#medstudenttwitter #medtwitter #meded #FOAMed
2/
First things first, do you mind telling us who you are?
3/Let's begin: Beau’s lines! Transverse depression across the nail. Means the nail briefly stopped growing and started again.

Seen weeks after nail injury! Or, if it's seen on multiple nails, ask about febrile illness (like post #covid19) or stressors like SJS or chemotherapy.
Read 16 tweets
6 Feb
1/
Let's spend some time on a #dermtwitter #tweetorial on all things....

HERPES!

Even though there are 8 herpesviruses that infect humans, I'm going to focus on HSV1 and HSV2 today.

#medtwitter #medstudenttwitter #meded #FOAMEd
2/
You know how we say that everything could be sarcoid? Well, HSV-1/HSV-2 (which I'll refer to as herpes for this #thread) would be a close 2nd, ESPECIALLY on the inpatient service.

While HSV-1 is usually thought to be oral and HSV-2 genital, this certainly is NOT always true.
3/
The class exam finding for herpes is the "dew drop on a rose petal." In clinical speak, that would be a vesicle on an erythematous base. But often we don't see the vesicle intact.

For ex, the photo above shows intact vesicles, whereas here, we just see the resultant crust.
Read 16 tweets
2 Jan
1/
Let's kick off the new year with a #dermatology #tweetorial! I put together some tweets on

#MELANOMA

#MedEd #FOAMEd #medtwitter #dermtwitter #onctwitter

Let's start with a poll:

Among BOTH males and females in the US, how common is melanoma?
2/
Melanoma is the 6th most common malignancy (that's tracked) for BOTH men & women. Basal cell carcinoma is actually the MOST common cancer in the US, but we don't track it.

While melanomas are 6th, in certain groups (eg: women age 25-30), it is the #1 cause of cancer death! Image
3/
So melanoma is deadly, especially in certain age groups. But something peculiar is happening too. @AdeAdamson recently spoke at @MassGeneralNews about this interesting finding 👉 melanoma diagnosis is increasing, but melanoma death is decreasing.

Read 18 tweets
1 Nov 20
1/
While we're all doom-scrolling through Twitter, I thought I could help provide some distraction for #medtwitter, #dermtwitter & #medstudenttwitter.

A #Derm101 #tweetorial on the #dermatology exam:

REACTION PATTERNS!

AKA: "How a dermatologist approaches a rash!"
pc:@AADskin
2/
So what exactly is a reaction pattern? It's an organizational way to think about rashes so that we can bucket them. There are FIVE main reaction patterns:

1) Papapulosquamous
2) Eczematous
3) Dermal
4) Vascular
5) Vesicobullous

Which reaction pattern was that last photo?👆
3/
It's PAPULOSQUAMOUS! The name means it's papular (raised) with scale. The prototypical rash for these is psoriasis, which is that 1st photo! Notice how in darker skin, the erythema of psoriasis is harder to see!

Here's a whole #tweetorial I made:
Read 16 tweets

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