Educational Blog

Overview: Green Nail Syndrome

2020-09-16T14:05:33-04:00

Green nail syndrome (GNS) is the most common bacterial infection of the nail unit. OUR PATHOLOGY SERVICES | PHYSICIAN RESOURCES | INSTRUCTIONAL VIDEOS | ORDER LAB SUPPLIES | FIND AN ACCOUNT MANAGER Green nail syndrome (GNS) is the most common bacterial infection of the nail unit. Both the upper and lower extremities may be affected in GNS, but is uncommonly reported as a primary cause of onychodystrophy. The causative organism, Pseudomonas aeruginosa, is a gramnegative bacteria which is ubiquitous in nature favoring warm and moist environments with reservoirs in soil, water, plants and animals. Infection of the nail [...]

Overview: Green Nail Syndrome2020-09-16T14:05:33-04:00

Web Space Dermatophytosis

2020-09-16T14:58:33-04:00

By Adi Pajazetovic, DPM, Kalani Parker, DPM Tinea pedis resistant to treatment may require systemic antifungals History A 67-year-old male with no known significant past medical history presented to clinic with an itchy dermatitis like lesion within his left fourth web space. Lesion has been present for an undefined length of time. Physical Examination Patient presented with an eczematous/tinea like lesion within the left fourth web space along with maceration to the area. Diagnostic Testing A shave biopsy was performed and a submission of a skin fragment measuring 0.3 x 0.3 x 0.1 cm was received [...]

Web Space Dermatophytosis2020-09-16T14:58:33-04:00

Molluscum Contagiosum

2020-09-16T14:55:55-04:00

By Courtney McClurkin, DPM; Andrew Olson, DPM Molluscum contagiosum can be confused with a variety of different skin pathologies History A 25 year old male with no known significant past medical history presents with a pigmented lesion to plantar aspect of his left foot present for an undetermined period of time. Physical Examination A raised red and black 3mm lesion is seen on the plantar aspect of left foot. Diagnostic Testing A 2mm punch biopsy was performed with clinical concern to rule out melanoma. Histological Findings Typical histological features of molluscum contagiosum were identified including [...]

Molluscum Contagiosum2020-09-16T14:55:55-04:00

Erythema Elevatum Diutinum

2020-09-16T15:07:09-04:00

By Desiree Dalcherone, DPM; Laura Fernandez, DPM; Pooja Srivastava, DPM Lesions are usually asymptomatic, but some cases might present with itching and pain History Patient is a 29 year old male with past medical history of Crohn’s disease, presenting with a one year history of progressively worsening, painful nodules to his bilateral legs and feet. A punch biopsy of skin was taken from the nodule present to the patient's plantar-medial left hallux. Physical Examination Multiple nodules were present on bilateral legs and feet. Click on image to enlarge Click on image to enlarge [...]

Erythema Elevatum Diutinum2020-09-16T15:07:09-04:00

Onychomycosis

2020-09-16T14:40:59-04:00

By Steven Goldstein, DPM; Basem Halaka, DPM; David Vance, DPM; Jason Weslosky, DPM There are multiple tests that can be performed to evaluate for the presence of fungi History The patient is a 62 year old male with a 2 year history of thickened, elongated, and yellow discolored nails of the hallux bilateral. The nails appear dystrophic with evidence of subungual debris. The patient does not admit to any significant trauma to the nails but does admit to uncomfortable rubbing of the bilateral hallux nails in his shoes. The patient does not have any other contributing medical history. [...]

Onychomycosis2020-09-16T14:40:59-04:00

Blastomycosis

2020-09-16T14:41:15-04:00

By Morgan Baxter, DPM, Aron Block, DPM, Lillian Youhkana, DPM Blastomycosis is a type of fungal infection that can be acquired from inhaling fungal spores History A 53 year old healthy male presents to clinic with concerns of a rash involving raised bumps for about a month. He thought it was a cluster of warts, but has not had any relief with over the counter topical medications. He does mention that about a month ago, he was raking leaves barefoot. The bumps are not painful but have started to leak and have not gone away. He resides in [...]

Blastomycosis2020-09-16T14:41:15-04:00

DNA-based Onychomycosis Detection Correlates Better to Histopathology than does Fungal Culture

2020-09-16T13:35:20-04:00

Onychomycosis is a prevalent disease of the nail. Traditional methods for diagnosis include direct microscopy with potassium hydroxide (KOH microscopy) and fungal culture. OUR PATHOLOGY SERVICES | PHYSICIAN RESOURCES | INSTRUCTIONAL VIDEOS | ORDER LAB SUPPLIES | FIND AN ACCOUNT MANAGER Traditional methods for diagnosis include direct microscopy with potassium hydroxide (KOH microscopy) and fungal culture. Other techniques using histochemical staining have higher sensitivity, but cannot identify genus or species of the infecting agent. PCR assays are sensitive, specific, and capable of genus and species level identification. We describe a real-time PCR assay for 15 different fungi that [...]

DNA-based Onychomycosis Detection Correlates Better to Histopathology than does Fungal Culture2020-09-16T13:35:20-04:00

Biopsy Planning and Post-Biopsy Tissue Handling : A Synopsis

2017-11-24T19:22:22-05:00

Introduction As a general rule, the podiatic profession is notorious for its underutilization of cutaneous and soft tissue biopsy techniques. In some instances, such under-use may be attributed to trepidation stemming from a lack of familiarity with the biopsy techniques themselves; however, I believe this is not the preeminent cause. In my experience, the most common reason that many podiatric clinicians don’t use biopsy techniques to their fullest is a degree of insecurity regarding when to use witch biopsy and what to do with them once the biopsy has been performed. In most offices, the support staff is ill prepared [...]

Biopsy Planning and Post-Biopsy Tissue Handling : A Synopsis2017-11-24T19:22:22-05:00

Cutaneous Biopsy Techniques in the Management of Chronic Wounds

2017-11-24T19:32:38-05:00

Many clinicians rely exclusively on clinical acumen when determining how to manage chronic wounds. Though an ulcer’s clinical features may be fairly indicative of its etiology, in some instances, such is not the case. Even among the most characteristic‐appearing ulcerations, masqueraders do exist. Ruling out the possibility of an unsuspected neoplastic or inflammatory condition could be necessary for the successful management of chronic wounds. In this context, cutaneous biopsy techniques may be invaluable; however, their utility does not necessarily end here. There are three common clinical settings in which a biopsy may be used in the management of a chronic wound. [...]

Cutaneous Biopsy Techniques in the Management of Chronic Wounds2017-11-24T19:32:38-05:00

Needle Aspiration Biopsy

2020-09-16T14:02:12-04:00

Needle aspiration biopsy is amongst the most underutilized diagnostic procedures of those available. This technique may be effectively used to rule out high‐grade malignancies when faced with nonspecific subcutaneous masses, in particular, those masses that resemble ganglion cysts. I once had three different medico‐legal cases under consultative review at one time, all of which were centered on patients who had non‐specific ganglion‐like masses. In each instance, the patient actually harbored a high‐grade sarcoma, and in each case, they were followed into their grave by their clinician with the errant diagnosis of “ganglion”. It is not overtly surprising that neoplasms masquerading [...]

Needle Aspiration Biopsy2020-09-16T14:02:12-04:00
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