Tırnak Sağlığı ve Hastalıklarında D Vitamini
Özet
D vitamininin tırnak sağlığı ve hastalıklarındaki rolünü kapsamlı bir şekilde inceleyen bu çalışma, tırnak ünitesinin yaşam boyu mitotik aktivite gösteren dinamik yapısını ele almaktadır. Tırnağın büyüme hızı ve sertliği D vitamini, kalsiyum ve çeşitli minerallerle doğrudan ilişkilidir. A ve D vitamini eksikliklerinin tırnaklarda kuruluk, kırılganlık, yumuşama (hapalonişi) ve longitudinal melanonişiye yol açabildiği bildirilmiştir. D vitamininin hücresel farklılaşma, immün regülasyon ve antiproliferatif etkileri sayesinde başta tırnak psoriasisi olmak üzere akrodermatitis kontinua Hallopeau, trakiyonişi, porokeratoz, periungual siğiller ve onikotillomani gibi çeşitli tırnak hastalıklarının tedavisinde topikal veya intralezyonel olarak kullanıldığı belirtilmektedir. Özellikle tırnak psoriasisinde kalsipotriol, kalsitriol ve takalsitol gibi D vitamini analoglarının tek başına ya da kortikosteroidler ve sistemik tedavilerle kombine edilerek subungual hiperkeratoz, onikoliz ve renk değişikliklerinde başarılı sonuçlar verdiği yapılan klinik çalışmalarla ortaya konmuştur. Sonuç olarak D vitamini, kalsiyum metabolizmasının ötesinde tırnak hastalıklarının tedavisinde gelecek vadeden bir seçenektir.
Examining the role of vitamin D in nail health and diseases, this study addresses the dynamic structure of the nail unit showing lifelong mitotic activity. The growth rate and hardness of nails are directly associated with vitamin D, calcium, and various minerals. It has been reported that vitamin A and D deficiencies can lead to dryness, brittleness, softening (hapalonychia), and longitudinal melanonychia in nails. Thanks to its cellular differentiation, immune regulation, and antiproliferative effects, vitamin D is used topically or intralesionally in the treatment of various nail diseases, primarily nail psoriasis, as well as acrodermatitis continua of Hallopeau, trachyonychia, porokeratosis, periungual warts, and onychotillomania. Clinical studies have demonstrated that vitamin D analogs such as calcipotriol, calcitriol, and tacalcitol, used alone or combined with corticosteroids and systemic treatments, yield successful results in subungual hyperkeratosis, onycholysis, and discoloration, especially in nail psoriasis. In conclusion, beyond calcium metabolism, vitamin D is a promising option in the management of nail disorders.
Referanslar
Rich P. Nail surgery. In Bolognia JL, Jorizzo JL, Rapini RP (Eds.), Dermatology, 2nd ed. 2006: 2260. Mosby, New York.
Haneke E. Surgical anatomy of the nail apparatus. Dermatol Clin. 2006;24:291.
Geyer AS, Onumah N, Uyttendaele H, Scher RK. Modulation of linear nail growth to treat diseases of the nail. J Am Acad Dermatol. 2004;50(2):229-34.
Haneke E. Surgical anatomy of the nail apparatus. In Richert B, Di Chiacchio N, Haneke E (Eds), Nail Surgery 2011: 1. Informa Healthcare.
de Berker DA, André J, Baran R. Nail biology and nail science. Int J Cosmet Sci. 2007;29(4):241-75.
Wang, Etienne; de Berker, David; Christiano, Angela M. Biology of Hair and Nails. In Bolognia JL, Schaffer JV, Cerroni L (Eds.), Dermatology 4th ed. 2018: 1144-61. Elsevier, China.
Zook EG. Anatomy and physiology of the perionychium. Hand Clin. 2002;18(4):553-9.
Rich P, Scher RK. Nail anatomy and basic science. In: An Atlas of Diseases of the Nail, Parthenon Publishing, New York 2003: 7.
Piraccini B.M. Nail Disorders Due to Dermatological Diseases. In Nail Disorders Springer, Milano. 1th ed.2014: 75-93. Springer, London https://doi.org/10.1007/978-88-470-5304-5_7
Parashar B, Yadav V, Maurya B, Sharma L. Natural therapy of fungal nail disease: review. Pharma Innovation. 2012;1(4):46-60.
Seshadri D, De D. Nails in nutritional deficiencies. Indian J Dermatol Venereol Leprol. 2012;78(3):237-41.
Cashman MW, Sloan SB. Nutrition and nail disease. Clin Dermatol. 2010;28(4):420-5.
Yost JM. Nail reactions to antibiotics, antimalarials, and other medications. In Rubin AI, Jellinek NJ, Daniel CR, Scher RK (Eds.), Scher and Daniel's nails: Diagnosis, Surgery, Therapy 4th ed. 2018: 453-91. Springer Nature, Cham, Switzerland.
Yesil Y, Kuyumcu ME, Ozturk ZA, et al. The relationship between metabolic bone diseases and fingernail calcium levels in the elderly. Eur. Geriatr. Med. 2012;3:341–4.
Aşkın Ö, Üstünbaş Uzunçakmak TK, Neval A, Yalçın T. Vitamin deficiencies/hypervitaminosis and the skin. Clin Dermatol. 2021, https://doi.org/10.1016/j.clindermatol. 2021.05.010
Iizuka H. Psoriasis. In Krieg T, Bickers DR, Miyachi Y (Eds.), Therapy of Skin Diseases: A worldwide perspective on therapeutic approaches and their molecular basis 1th ed. 2010: 194-205. Springer-Verlag Berlin Heidelberg.
Singal A, Kayarkatte MN. Trachyonychia. In Singal A, Neema S, Kumar P, (Eds.), Nail Disorders: A Comprehensive Approach 1st ed. 2019: 221-8. CRC Press. /Taylor & Francis, New York, NY.
Abdo HM. Marvelous Response of Severe Onychotillomania to Treatment with Local Steroid Injection plus Topical Calcipotriol/Betamethasone Dipropionate Combination. Skin Appendage Disord. 2020;6(3):158-61.
Jakhar D, Kaur I, Misri R. Intralesional vitamin D3 in periungual warts. J Am Acad Dermatol. 2019;80(5):e111-e112.
Kechichian E, Ezzedine K. Vitamin D and the Skin: An Update for Dermatologists. Am J Clin Dermatol. 2018;19(2):223-35.
Hadeler E, Mosca M, Hong J, et al. Nail Psoriasis: A Review of Effective Therapies and Recommendations for Management. Dermatol Ther. 2021;11(3):799-831.
Shehadeh W, Matz H, Ellenbogen E, et al. Pulse-Dye Laser Followed by Betamethasone-Calcipotriol and Fractional Ablative CO2-Laser-Assisted Delivery for Nail Psoriasis. Dermatol Surg. 2021;47(4):e111-e116.
Sarma N. Evidence and Suggested Therapeutic Approach in Psoriasis of Difficult-to-treat Areas: Palmoplantar Psoriasis, Nail Psoriasis, Scalp Psoriasis, and Intertriginous Psoriasis. Indian J Dermatol. 2017;62(2):113-22.
Rigopoulos D, Baran R, Chiheb S, Daniel CR 3rd, et al. Recommendations for the definition, evaluation, and treatment of nail psoriasis in adult patients with no or mild skin psoriasis: A dermatologist and nail expert group consensus. J Am Acad Dermatol. 2019;81(1):228-40.
Fogh K, Kragballe K. Recent developments in vitamin D analogs. Curr Pharm Des. 2000 Jun;6(9):961-72.
Fogh K, Kragballe K. New vitamin D analogs in psoriasis. Curr Drug Targets Inflamm Allergy. 2004 Jun;3(2):199-204.
Márquez Balbás G, Sánchez Regaña M, Umbert Millet P. Tacalcitol ointment for the treatment of nail psoriasis. J Dermatolog Treat. 2009;20(5):308-10.
Jiaravuthisan MM, Sasseville D, Vender RB, et al. Psoriasis of the nail: anatomy, pathology, clinical presentation, and a review of the literature on therapy. J Am Acad Dermatol. 2007;57(1):1-27.
Petrow W. Calcipotriol: ein topisches Therapeutikum zur Behandlung der Nagelpsoriasis. Acta Derm Venereol. 1994;21: 396–400.
Tosti A, Piraccini BM, Cambiaghi S, Jorizzo M. Nail lichen planus in children: clinical features, response to treatment, and long-term follow-up. Arch Dermatol. 2001;137:1027-32.
Rigopoulos D, Ioannides D, Prastitis N, Katsambas A. Nail psoriasis: a combined treatment using calcipotriol cream and clobetasol propionate cream. Acta Derm Venereol. 2002;82(2):140.
Feliciani C, Zampetti A, Forleo P, et al. Nail psoriasis: combined therapy with systemic cyclosporin and topical calcipotriol. J Cutan Med Surg. 2004;8(2):122-5.
Zakeri M, Valikhani M, Mortazavi H, et al. Topical calcipotriol therapy in nail psoriasis: a study of 24 cases. Dermatol Online J. 2005;11(3):5–9.
Tzung TY, Chen CY, Yang CY, et al. Calcipotriol used as monotherapy or combination therapy with betamethasone dipropionate in the treatment of nail psoriasis. Acta Derm Venereol. 2008;88(3):279-80.
Rigopoulos D, Gregoriou S, Daniel Iii CR, et al. Treatment of nail psoriasis with a two-compound formulation of calcipotriol plus betamethas.one dipropionate ointment. Dermatology. 2009;218(4):338-41.
Tan ES, Oon HH. Effective treatment of severe nail psoriasis using topical calcipotriol with betamethasone dipropionate gel. Indian J Dermatol Venereol Leprol. 2016;82(3):345-7.
Saki N, Hosseinpoor S, Heiran A, et al. Comparing the Efficacy of Triamcinolone Acetonide Iontophoresis versus Topical Calcipotriol/Betamethasone Dipropionate in Treating Nail Psoriasis: A Bilateral Controlled Clinical Trial. Dermatol Res Pract. 2018;2018:2637691.
Gregoriou S, Sidiropoulou P, Tsimpidakis A, et al. Treatment of nail psoriasis with calcipotriol/betamethasone dipropionate foam versus pulse dye laser: an unblinded, intra-patient, left-to-right prospective study. J Eur Acad Dermatol Venereol. 2020;34(9):e519-e520.
Usmani N, Wilson C. A case of nail psoriasis treated with topical calcitriol. Clin Exp Dermatol. 2006;31(5):712-3.
Kole L, Cantrell W, Elewski B. A randomized, double-blinded trial evaluating the efficacy and tolerability of vectical ointment (calcitriol 3 mcg/g ointment) when compared to betamethasone diproprionate ointment (64 mg/g) in patients with nail psoriasis. J Drugs Dermatol. 2014;13(8):912-5.
Khare S, Trivedi T. Correlation between Vitamin-D and Calcium levels with severity of nail involvement in psoriasis: An observational study from Northern India. Panacea J Med Sci. 2020;10(2):162-6.
Sotiriadis D, Patsatsi A, Sotiriou E, et al. Acrodermatitis continua of Hallopeau on toes successfully treated with a two-compound product containing calcipotriol and betamethasone dipropionate. J Dermatolog Treat. 2007;18(5):315-8.
Piraccini BM, Fanti PA, Morelli R, Tosti A. Hallopeau’s acrodermatitis continua of the nail apparatus: A clinical and pathological study of 20 patients. Acta Derm Venerol. 1994;74:65–7.
Piquero-Casals J, Fonseca de Mello AP, Dal Coleto C, et al. Using oral tetracycline and topical betamethasone valerate to treat acrodermatitis continua of hallopeau. Cutis. 2002;70:106–8.
Chowdhury MM, Motley RJ. Treatment of acrodermatitis continua of Hallopeau with oral propylthiouracil and methotrexate. Clin Exp Dermatol. 2001;26:657–60.
Harland CC, Kilby PE, Dalziel KL. Acrodermatitis continua responding to cyclosporin therapy. Clin Exp Dermatol. 1992;17:376–8.
Behrens S, von Kobyletzki G, Hoffmann K, et al. PUVA-bath photochemotherapy in Hallopeau’s acrodermatitis continua suppurativa. Hautarzt. 1997;48: 824–7.
Tsuji T, Nishimura M. Topically administered fluorouracil in acrodermatitis continua of Hallopeau. Arch Dermatol. 1991;127:27–8.
Kuijpers AL, van Dooren-Greebe RJ, van de Kerkhof PC. Acrodermatitis continua of Hallopeau: Response to combined treatment with acitretin and calcipotriol ointment. Dermatology. 1996;192:357–9.
Wilsmann-Theis D, Hagemann T, Dederer H, et al. Successful treatment of acrodermatitis continua suppurativa with topical tacrolimus 0.1% ointment. Br J Dermatol. 2004;150:1194–7.
Piraccini BM, Tosti A, Iorizzo M, Misciali C. Pustular psoriasis of the nails: treatment and long-term follow-up of 46 patients. Br J Dermatol. 2001;144(5):1000-5.
Brill TJ, Elshorst-Schmidt T, Valesky EM et al. Successful treatment of acrodermatitis continua of Hallopeau with sequential combination of calcipotriol and tacrolimus ointments. Dermatology. 2005;211(4):351-5.
Brunasso AM, Lo Scocco G, Massone C. Recalcitrant acrodermatitis continua of hallopeau treated with calcitriol and tacrolimus 0.1% topical treatment. J Eur Acad Dermatol Venereol. 2008;22(10):1272-3.
Gordon KA, Vega JM, Tosti A. Trachyonychia: a comprehensive review. Indian J Dermatol Venereol Leprol 2011;77:640-5.
Sakata S, Howard A, Tosti A, Sinclair R. Follow up of 12 patients with trachyonychia. Australas J Dermatol. 2006;47:166-168.
Park JM, Cho HH, Kim WJ, et al. Efficacy and Safety of Calcipotriol/Betamethasone Dipropionate Ointment for the Treatment of Trachyonychia: An Open-Label Study. Ann Dermatol. 2015;27(4):371-5.
Schissel DJ, Elston DM. Topical 5-fluorouracil treatment for psoriatic trachyonychia. Cutis. 1998;62:27-8.
Halkier-Sørensen L, Cramers M, Kragballe K. Twenty-nail dystrophy treated with topical PUVA. Acta Derm Venereol. 1990;70:510-1.
Khoo BP, Giam YC. A pilot study on the role of intralesional triamcinolone acetonide in the treatment of pitted nails in children. Singapore Med J. 2000;41:66-8.
Brazzelli V, Martinoli S, Prestinari F, Borroni G. An impressive therapeutic result of nail psoriasis to acitretin. J Eur Acad Dermatol Venereol. 2004;18:229-30.
Piérard GE, Piérard-Franchimont C. Dynamics of psoriatic trachyonychia during low-dose cyclosporin A treatment: a pilot study on onychochronobiology using optical profilometry. Dermatology. 1996;192:116-9.
Pawar M. Onychodystrophy due to porokeratosis of Mibelli: a rare association. Acta Dermatovenerol Alp Pannonica Adriat. 2017;26(2):51-2 .
Kohara Y, Takeo T, Oshima Y, et al. Linear porokeratosis with nail dystrophy. Eur J Dermatol. 2011;21(4):625-6.
Chen HH, Liao YH. Onychodystrophy in congenital linear porokeratosis. Br J Dermatol. 2002;147(6):1272-3.
Kono M, Yokoyama N, Ogawa Y, et al. Unilateral generalized linear porokeratosis with nail dystrophy. J Dermatol. 2016;43(3):286-7
Aktaş H, Ergin C, Demir B, Ekiz Ö. Intralesional Vitamin D Injection May Be an Effective Treatment Option for Warts. J Cutan Med Surg. 2016;20(2):118-22.
Muse ME, Stiff KM, Glines KR, et al. A review of intralesional wart therapy. Dermatol Online J. 2020;26(3):13030/qt3md9z8gj.
Egawa K, Ono T. Topical vitamin D3 derivatives for recalcitrant warts in three immunocompromised patients. Br J Dermatol. 2004;150(2):374-6.
Elmas ÖF, Atasoy M, Akdeniz N, Özyurt K. A recalcitrant case of facial verruca plana successfully treated with topical calcipotriol alone. Dermatol Ther. 2020;33(4):e13664.
Labandeira J, Vázquez-Blanco M, Paredes C, et al. Efficacy of topical calcipotriol in the treatment of a giant viral wart. Pediatr Dermatol. 2005;22(4):375-6.
Kareem IMA, Ibrahim IM, Mohammed SFF, Ahmed AA. Effectiveness of intralesional vitamin D3 injection in the treatment of common warts: single-blinded placebo-controlled study. Dermatol Ther. 2019;32(3):e12882.
Sidiropoulou P, Sgouros D, Theodoropoulos K, et al. Onychotillomania: A Chameleon-Like Disorder: Case Report and Review of Literature. Skin Appendage Disord. 2019;5(2):104-7.
