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Related Concept Videos

Accessory Structures of the Skin: Nails01:05

Accessory Structures of the Skin: Nails

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Nails are one of the important accessory structures of the skin. They are hard, protective structures that cover the dorsal surface of the distal phalanges of fingers and toes. Nails are composed of specialized keratinized cells and serve various functions, including protection, sensation, and manual dexterity.
The main components of a nail include the following.
Nail Plate: The nail plate is the visible portion of the nail that extends beyond the fingertips or toes. It is a hard, translucent...
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Papillary Dermis01:11

Papillary Dermis

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Dermis
The dermis might be considered the "core" of the integumentary system, as distinct from the epidermis and hypodermis. It contains blood and lymph vessels, nerves, and other structures, such as hair follicles and sweat glands. The dermis is made of two layers of connective tissue that comprise an interconnected mesh of elastin and collagenous fibers, produced by fibroblasts.
Papillary Layer
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Types of Membrane Protrusions01:28

Types of Membrane Protrusions

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The protrusion of the cell surface is an initial step for several cellular processes, including cell migration, phagocytosis, and neurite outgrowth. These membrane protrusions are a result of cytoskeletal rearrangement. The most  widely observed cell protrusions include lamellipodia, pseudopodia, filopodia, microvilli, invadopodia, and podosomes. These protrusions can be of two types — static or dynamic.
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Endocarditis II: Clinical Features of Infective Endocarditis01:25

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Endocarditis can present various clinical features depending on the causative organism and the patient's underlying health conditions. Initially, the clinical features of infective endocarditis develop gradually, presenting with nonspecific symptoms that can be easily mistaken for other illnesses.General SymptomsEarly symptoms of infective endocarditis are fever, chills, weakness, malaise, fatigue, and weight loss. These symptoms reflect the systemic nature of the infection and the body's...
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Pinching-off of Coated Vesicles01:32

Pinching-off of Coated Vesicles

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Vesicle budding is orchestrated by distinct cytosolic proteins such as adaptor proteins, coat proteins, and GTPases. To initiate vesicle budding, membrane-bending proteins containing crescent-shaped BAR domains bind to the lipid heads in the bilayer and distort the membrane to form a protein-coated vesicle bud. Adaptors proteins such as AP2 for clathrin-coated vesicles can nucleate on the deformed membrane. Finally, coat proteins such as clathrin or COPI and COPII assemble into a coat forming...
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Skin Cancer01:30

Skin Cancer

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Skin cancer is a type of cancer that occurs when there is an abnormal growth of skin cells, usually triggered by damage to the DNA within the skin cells. It is primarily caused by exposure to ultraviolet (UV) radiation from the sun or artificial sources like tanning beds. Skin cancer is the most common type of cancer worldwide, and its incidence continues to rise.
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Related Experiment Video

Updated: Oct 26, 2025

Technique of Conjunctival Biopsy and Direct Immunofluorescence for Diagnosing Mucous Membrane Pemphigoid
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Technique of Conjunctival Biopsy and Direct Immunofluorescence for Diagnosing Mucous Membrane Pemphigoid

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Uncommon Nail Involvement during Bullous Pemphigoid.

Anissa Zaouak1, Soumaya Gara1, Samy Fenniche1

  • 1Department of Dermatology, Research Unit "Genodermatosis and Cancer" LR12SP03, Habib Thameur Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.

Skin Appendage Disorders
|July 26, 2021
PubMed
Summary

Bullous pemphigoid (BP), a common autoimmune blistering disease, can rarely cause nail loss and onycholysis. This case highlights persistent nail changes despite high-dose steroid treatment in a BP patient.

Keywords:
Bullous pemphigoidDermoscopyNail disorder

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Last Updated: Oct 26, 2025

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Area of Science:

  • Dermatology
  • Immunology
  • Pathology

Background:

  • Bullous pemphigoid (BP) is the most common autoimmune blistering disease, characterized by autoantibodies against BP180 and BP230 antigens.
  • These antigens are crucial components of junctional adhesion complexes located at the skin's basement membrane zone.
  • Clinical manifestations typically involve tense blisters on urticarial plaques, but nail involvement is infrequently documented.

Observation:

  • A 72-year-old woman with diagnosed Bullous pemphigoid presented with secondary nail loss affecting both thumbs and the left middle finger.
  • Dermoscopic examination revealed onycholysis of the fourth left finger, exhibiting a characteristic 'roller-coaster' appearance of the proximal border.
  • The patient's nail atrophy was permanent, persisting despite high-dose systemic steroid therapy.

Findings:

  • This case illustrates a rare presentation of Bullous pemphigoid with significant and permanent nail abnormalities, including nail loss and onycholysis.
  • The ineffectiveness of high-dose steroid therapy suggests that nail changes in BP may follow a distinct pathogenic course or possess unique resistance.
  • Dermoscopy proves valuable in characterizing the specific nail changes associated with BP, such as the 'roller-coaster' sign in onycholysis.

Implications:

  • The findings underscore the importance of monitoring for and recognizing nail changes in Bullous pemphigoid patients, as they can be severe and treatment-resistant.
  • Further research is warranted to elucidate the specific mechanisms underlying nail involvement in BP and to develop targeted therapeutic strategies.
  • This case contributes to the limited literature on nail apparatus involvement in BP, emphasizing the need for comprehensive dermatological evaluation in affected individuals.