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Disappearing Nail Bed
Disappearing nail bed (DNB) is a condition characterized by irreversible epithelialization of the nail bed following long-standing onycholysis. This phenomenon can occur in fingernails and toenails. Factors implicated in the development of DNB include trauma, manicuring, and onychotillomania and dermatologic conditions like psoriasis and dermatitis. Specifically for the toenail, contributing factors also include increasing age, history of trauma, surgery, onychomycosis, and onychogryphosis. A grading system that stages the progression of onycholysis to DNB has been proposed to aid clinicians in the diagnosis and treatment ...
Source: Clinics in Podiatric Medicine and Surgery - September 17, 2021 Category: Podiatry Authors: Flavia Filisio, Shelby Busch, Delaney J.H. Wickramage, Russell Hill, Sushila Kabadi, Carolina Lordelo Van Pelt, Tracey C. Vlahovic Source Type: research

Pyoderma Gangrenosum
Pyoderma gangrenosum (PG), which most frequently affects the lower extremity, is a complicated disease state that results from a combination of inflammation, neutrophilic invasion, and genetic predisposition. There may also be certain comorbidities involved or it may be idiopathic. The many variations of PG mean that it often presents and responds differently to various treatments based on the specific case. Overall, there have been improvements in understanding the disease; however, further research should focus on finding better ways to predict and prevent this rapidly progressive, painful disease. (Source: Clinics in Po...
Source: Clinics in Podiatric Medicine and Surgery - September 17, 2021 Category: Podiatry Authors: Madeleine Barbe, Andrea Batra, Stephanie Golding, Olivia Hammond, Jacqueline C. Higgins, Amber O ’Connor, Tracey C. Vlahovic Source Type: research

Plantar Verruca and Dermoscopy
Traditionally, plantar warts or verrucae are often diagnosed by visual appearance and the lateral squeeze test. At times, these methods are not able to elucidate the difference between a plantar wart and a callus. The use of the dermatoscope can not only distinguish the difference between a wart and a callus, which ultimately helps to customize treatment plans to increase efficacy, but also be used to follow the therapeutic effects of treatment. The dermatoscope is a tool that can be used in the diagnosis of plantar verrucae and in assessment of the success of therapy. (Source: Clinics in Podiatric Medicine and Surgery)
Source: Clinics in Podiatric Medicine and Surgery - September 17, 2021 Category: Podiatry Authors: Adam Bhatti, Saakshi Chowdhary, Thomas Ferrise, Naga Govardhanam, Alexandra Parish, Yaakov Tropper, Tracey C. Vlahovic Source Type: research

The Penetrance of Topical Nail Therapy
The chemical composition and thickness of nails are obstacles for treatments of various nail diseases, such as onychomycosis. Topical medications are currently the preferred method of treatment because of reduced adverse systemic effects. However, penetration of the product from the nail plate into the nail bed continues to be an issue because of factors such as distance required to reach the target area, chemical barriers, and drug inactivation upon keratin binding. Beyond developing novel drugs, some studies have investigated mechanical and chemical methods to optimize drug delivery. The issue of nail diseases is still a...
Source: Clinics in Podiatric Medicine and Surgery - September 17, 2021 Category: Podiatry Authors: Kari Phan, Kushkaran Kaur, Kayla Wright, Son Tran, Benton Stewart, Michael Brown, Tracey C. Vlahovic Source Type: research

Biofilms and the Nail Unit
Recent studies have shown that a superficial fungal infection such as onychomycosis may form complex biofilms. Although most individuals susceptible to documented fungal biofilm infections are immunocompromised, physical damage to the nail or concurrent infection with other organisms is also a common risk factor in developing nail biofilm. The complex nature of the biofilm, which includes efflux pumps and the formation of a virulent extracellular matrix, helps it evade the immune system. Although there is no standardized treatment for fungal biofilms in onychomycosis, various studies using antimicrobials and lasers have sh...
Source: Clinics in Podiatric Medicine and Surgery - September 17, 2021 Category: Podiatry Authors: Corinna Castillo, Michael F. Masi, Austin Mishko, Alex Sheltzer, Alex Speer, Heather Tran, Tracey C. Vlahovic Source Type: research

Dermoscopy of Onychomycosis for the Podiatrist
This article discusses the technique and benefits of using a dermatoscope to improve patient care of this common disorder. (Source: Clinics in Podiatric Medicine and Surgery)
Source: Clinics in Podiatric Medicine and Surgery - September 17, 2021 Category: Podiatry Authors: Tracey C. Vlahovic, Michelle Garcia, Kevin Wotring Source Type: research

Use of Biologics in the Treatment of Moderate-to-Severe Plantar Psoriasis
Psoriasis is a common inflammatory disorder with potentially severe systemic and dermatologic consequences. As traditional treatments for this condition fail, biologics are emerging as the next promising therapy for moderate-to-severe cases, especially for the lower extremity. This review examines current research on monoclonal antibodies that target specific cytokines including interleukin-23 (IL-23), IL-12, tumor necrosis factor alpha, and IL-17 involved in pathologic inflammatory processes. (Source: Clinics in Podiatric Medicine and Surgery)
Source: Clinics in Podiatric Medicine and Surgery - September 17, 2021 Category: Podiatry Authors: Josh Ekladios, Jason Jolliffe, Shalin Panchigar, Rafay Qureshi, Ankita Shete, Jason Wellner, Tracey C. Vlahovic Source Type: research

Shoe Dermatitis
Shoe dermatitis is a type of contact dermatitis precipitated by allergens or irritants found in shoes. Potassium dichromate, commonly used in leather processing, is one of the most prevalent agents responsible for shoe dermatitis; however, it is not the only one. Shoe dermatitis caused by an allergen or an irritant may affect a person of any age, sex, or ethnicity. Numerous treatments exist for shoe dermatitis, the most simple yet important being avoidance of causative agents. Pharmaceutical agents commonly used are emollients, humectants, and topical corticosteroids. In more severe cases, topical calcineurin inhibitors an...
Source: Clinics in Podiatric Medicine and Surgery - September 17, 2021 Category: Podiatry Authors: Victoria Adeniran, Asher Cherian, Jin O. Cho, Ciesco Febrian, Eui T. Kim, Tymoteusz Siwy, Tracey C. Vlahovic Source Type: research

Plantar Psoriasis
Plantar psoriasis negatively affects the quality of life for patients due to its weight-bearing location. Most therapeutic studies for psoriasis focus on total body surface changes and rarely report specific effects of the plantar and palmar areas. This review focuses on therapeutic options for plantar psoriasis ranging from topical therapy to phototherapy to biological therapy. Treatment should be approached as a stepwise gradient beginning with topicals and progressing to systemics. As always, review of the patient ’s severity of condition, health status, and impact on quality of life is needed to individualize therapy...
Source: Clinics in Podiatric Medicine and Surgery - September 17, 2021 Category: Podiatry Authors: Michael Romani, Garrett Biela, Kalen Farr, Ryan Lazar, Marcus Duval, Victoria Trovillion, Tracey C. Vlahovic Source Type: research

Cutaneous Manifestations of the Diabetic Foot
This article reviews skin disorders found on the lower extremity that are associated with diabetes mellitus. (Source: Clinics in Podiatric Medicine and Surgery)
Source: Clinics in Podiatric Medicine and Surgery - September 17, 2021 Category: Podiatry Authors: Sam Gorelik, Alexander Leos, Amida Kuah, Salil Desai, Ahmad Namous, Alexandru Onica, Tracey C. Vlahovic Source Type: research

Lower Limb Lymphedema
Unilateral or bilateral lower limb lymphedema is a chronic and progressive phenomenon that occurs for several reasons. From a podiatric perspective, this condition may result after a trauma, a surgical procedure, a neoplasm, or a primary condition that impairs lymph vessel function. Even though no gold standard exists, early intervention and management of lower limb lymphedema with active exercise and compression than with compression therapy alone. (Source: Clinics in Podiatric Medicine and Surgery)
Source: Clinics in Podiatric Medicine and Surgery - September 17, 2021 Category: Podiatry Authors: Adam Abboud, Jared Blum, Zarnab Butta, Elizabeth Ferber Lindvig, Nishani Kuruppu, Sonya Wali, Tracey C. Vlahovic Source Type: research

Plantar Melanoma
Melanoma accounts for more than 100,000 new cancer cases each year, and a minority (3% –15%) involve the foot and ankle. Case studies and isolated data set analyses report infrequent plantar melanomas, with these tumors more commonly encountered in non-whites. The absolute incidence of plantar melanoma is approximately the same in all races, but it is a more common type of cutaneous melanoma in non-white populations. Plantar melanoma is more prevalent in women, potentially a result of increased inflammation from uncomfortable shoes. When presenting on the plantar surface of the foot, features atypical of classic cutaneou...
Source: Clinics in Podiatric Medicine and Surgery - September 17, 2021 Category: Podiatry Authors: Michael An, Lev Blekher, Meng Liu, Matthew Pitre, Ryan Shaner, Daryl Silva, Tracey C. Vlahovic Source Type: research

Podiatric Dermatology
CLINICS IN PODIATRIC MEDICINE AND SURGERY (Source: Clinics in Podiatric Medicine and Surgery)
Source: Clinics in Podiatric Medicine and Surgery - September 17, 2021 Category: Podiatry Authors: Tracey C. Vlahovic Source Type: research

Copyright
ELSEVIER (Source: Clinics in Podiatric Medicine and Surgery)
Source: Clinics in Podiatric Medicine and Surgery - September 17, 2021 Category: Podiatry Source Type: research

Contributors
THOMAS J. CHANG, DPM (Source: Clinics in Podiatric Medicine and Surgery)
Source: Clinics in Podiatric Medicine and Surgery - September 17, 2021 Category: Podiatry Source Type: research