Recognizing and diagnosing the most common nail diseases is essential, to be able to guide patients and provide appropriate treatment. However, uncommon nail disorders should not be neglected, in order to avoid inadequate treatment and above all to ensure that no severe underlying disorder, with severe prognosis, is overlooked.

Acrokeratosis paraneoplastica, also known as Bazex syndrome, is a relatively understudied yet clinically important dermatological condition that is inextricably associated with squamous cell carcinoma, predominantly of the upper respiratory and gastrointestinal tracts. Manifesting as unique psoriasis-like cutaneous lesions, Bazex syndrome functions as an early warning signal for underlying malignancies, underscoring the urgent need for its timely diagnosis and intervention. Notwithstanding its clinical relevance, the molecular and cellular mechanisms underpinning its pathogenesis are not fully understood. To address these gaps, this comprehensive literature review undertook a meticulous search across reputable databases such as EMBASE, MEDLINE/PubMed, and Web of Science. Our analysis ventures into multiple putative pathogenic pathways, including shifts in Th2 immune responses, aberrant secretion of growth factors, and immunological reactions to tumor-specific antigens. We also detail the clinical phenotypes of Bazex syndrome and their chronological linkage with the corresponding malignancies. Finally, the review evaluates the therapeutic effectiveness of various approaches, including but not limited to targeted cancer treatments, PUVA therapy, and topical corticosteroids. This synthesis aims to arm healthcare providers with a nuanced understanding of Bazex syndrome, facilitating more accurate diagnosis and tailored treatment paradigms.

Acrokeratosis paraneoplastica Bazex is a rare paraneoplastic skin manifestation, typically causing acral psoriasiform lesions. Patients usually show erythematous hyperkeratosis with yellowish, adherent scales on the hands and feet or other acral locations such as ears or nose. We herein report a case of Bazex syndrome in a male patient, who was previously diagnosed with hepatocellular carcinoma. Our case report highlights this rare condition as early diagnosis may impact the patient\'s course of tumor disease and prognosis.

UNASSIGNED: Acrokeratosis paraneoplastica of Bazex (APB) is a rare paraneoplastic dermatosis having definite association with malignancy, most commonly squamous cell carcinomas (SCC) of the upper aerodigestive tract. It is characterized by psoriasiform plaques involving the ears, nose, hands, and feet. Nail changes are commonly encountered, including onychauxis, subungual hyperkeratosis, xanthonychia, onycholysis, and onychorrhexis.
UNASSIGNED: We report the details of a 40-year-old male who presented with cutaneous changes involving both ears, palms, and soles and multiple nails, suggestive of APB. These typical changes were succeeded by an SCC of the lip.
UNASSIGNED: In 70% cases of APB, nail changes precede the diagnosis of the underlying neoplasm by up to 10 months, offering a good lead-time for early suspicion of malignancy. Our case highlights the importance of recognizing these changes early. An atypical location of malignancy (lower lip) and rare presentations, including painful acrokeratosis, melanonychia striata, and chloronychia, as seen in our case, should also be kept in mind.

Acrokeratosis paraneoplastica is a rare paraneoplastic skin disease in which there are erythematous violaceous, scaly plaques on the hands, feet, and acral locations. There is a relationship between various carcinomas of the aerodigestive tract and skin eruptions. These were the pioneering work done pertaining to a clinical entity that was showing some inter-relationship between a skin condition and carcinoma anywhere inside the body. Bazex syndrome is mostly associated with carcinomas of the upper aero-digestive tract, but other malignancies were also being reported. In this case, the patient was in advancing age with cachexic features along with liver and lung lesions which prompted us to investigate histologically for evidence of malignancy which came out to be negative. In our case, lungs showed features of pulmonary edema with normal histology. When we examined the liver, gross lesions were present but no evidence of malignancy was noted and the liver showed normal parenchyma histologically. Specimens taken from hand and foot showed hyperkeratosis along with bacterial colonies in the overlying epidermis. The spleen showed red pulp with congestion and hemorrhage. Similarly, sections from the kidneys were showing interstitial inflammation and congestion of blood vessels. Specimens from the brain and heart showed unremarkable histology.

Acrokeratosis paraneoplastica (Bazex syndrome) is a rare paraneoplastic dermatosis associated with internal malignancies. Clinical presentation is characterized by erythematous or violaceous scaly plaques involving the digits, nose, ears, palms, and soles. Nail changes commonly present concurrently with cutaneous manifestations. In this review, we characterize nail changes associated with acrokeratosis paraneoplastica. A total of 48 cases were analyzed. Nail findings were nonspecific, with the most common being nail plate thickening, onycholysis, subungual hyperkeratosis, longitudinal ridging, discoloration, and nail plate loss. In most patients, nail changes involved the majority of fingernails and toenails and most often appeared prior to the diagnosis of malignancy. The most common associated underlying malignancies were squamous cell carcinomas of the head and neck. A diagnosis of acrokeratosis paraneoplastica should be considered in patients with onychodystrophy involving multiple nails with accompanying atypical psoriasiform dermatoses. Screening for internal malignancies may significantly decrease morbidity and mortality for these patients.

Describing and listing all nail symptoms and signs in systemic disorders has already been widely detailed in dedicated textbooks. To be tutorial, this article described most common nails signs and the systemic disorders one may encounter in routine dermatologic consultation. Capsule summaries are presented for each section.

Bazex syndrome is a rare paraneoplastic dermatosis that precedes diagnosis of cancer. Awareness of this syndrome is important, as it allows early detection of underlying malignancy and may prevent misdiagnosis and delays in cancer treatment.

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UNASSIGNED: Some cutaneous manifestations can be the first presentation of an underlying malignancy. These so-called paraneoplastic syndromes can sometimes be very subtle or strongly resemble other benign cutaneous diseases.
UNASSIGNED: In this report, we want to emphasize the need for further investigation of eczema-like cutaneous presentations which develop at a later age and are recalcitrant to therapy. Exclusion of an underlying malignancy needs to be considered.
UNASSIGNED: A 53-year-old man with thickening of the skin, more pronounced on the hands, feet and face, was diagnosed with classic nodular sclerosing Hodgkin disease based on cutaneous presentation.
UNASSIGNED: After two rounds of chemotherapy (adriamycin, bleomycin, vinblastine and dacarbazine), the cutaneous symptoms had disappeared. After six rounds of chemotherapy and 14 months of follow-up, the patient is still in remission without recurrence of the cutaneous symptoms.
UNASSIGNED: Cutaneous symptoms recalcitrant to adequate treatment should raise suspicion and prompt further investigation to exclude an underlying malignancy. A multidisciplinary approach with the dermatology department can accelerate diagnosis and improve the patient\'s prognosis.
UNASSIGNED: Skin diseases can reflect internal manifestations or diseases.Vigilance, timely recognition and a multidisciplinary approach are important in a patient with atypical cutaneous manifestations.A paraneoplastic skin syndrome should be considered in persistent skin disease not responding to treatment and starting in middle-aged patients with B symptoms.