FAQ 36-4: Dermatology

EDITORIAL

Dear Colleagues,

The nail unit remains a critical yet often underappreciated component of clinical evaluation] reflecting localized disease, systemic pathology, and the effects of environmental, cosmetic and mechanical influences. This issue brings together a carefully curated collection of scholarly work that highlights the breadth, complexity and continued evolution of nail medicine and surgery.

This issue’s Feature Article, “Update on Toenail Onychomycosis,” synthesizes current diagnostic approaches and therapeutic strategies, reinforcing the importance of evidence-based management in the treatment of fungal nail disease. The Condensations and Commentaries section offers a diverse examination of nail health from multiple perspectives. Topics include the safety and potential health risks associated with nail products within the cosmetics industry, the diagnostic implications of biotin supplementation and its interference with allergy testing, and the role of ultrasound in evaluating cosmetic nail changes. Collectively, these contributions emphasize the expanding intersection between nail pathology, public health and diagnostic innovation.

Other topics explored include mechanical and activity-related nail disorders (through a focused discussion on runner’s toenail and the physiologic demands of marathon training), as well as infectious and systemic disease manifestations (through case-based and literature-supported reviews of nail changes in secondary syphilis and nail involvement in pemphigus). These articles underscore the importance of recognizing nail findings as valuable clinical indicators that may extend beyond the nail unit itself.

This issue also examines complex diagnostic and surgical challenges, including the evaluation and diagnosis of longitudinal melanonychia, advances in the surgical management of pincer nail deformity, and outcome-based analysis of ingrown toenail treatment using modified surgical techniques. Finally, an international, multi-institutional retrospective cohort study on the diagnosis and management of yellow nail syndrome further highlights the value of collaborative research in advancing understanding of rare but clinically significant conditions.

To complement the written content, this issue includes two Audio Lectures designed to enhance clinical learning and practical application. Our first lecture focuses on nail surgery techniques, while our second (presented by Jasmine Rana, MD) offers valuable insight into conservative management strategies within the nail unit for digital myxoid cysts (DMCs).

As Guest Editor, I am pleased to present this issue as a reflection of the growing sophistication and interdisciplinary nature of nail medicine. It is my hope that the articles and lectures contained herein will support clinical excellence, encourage thoughtful diagnosis, and inspire continued scholarly engagement in this evolving field.

Tracey C. Vlahovic,  DPM