Although both HMS and PLS share the common pathogenomic features of PPK and severe periodontitis6,7 and are allelic variants of cathepsin C gene mutations6,8, a number of additional findings are reported in HMS including onychogryphosis (curved nails), arachnodactyly (spider fingers/ elongated and slender shaped fingers and toes), acro-osteolysis (tappered pointed distal phalangeal ends due to osteolysis), pes planus (flat foot), occasionally hyperkeratotic psorisiform lesions with an erythematous background on the extensor surfaces of elbows and knees9,10,11,12 and rarely destructive arthritis of the wrists and shoulder joints.
Extra oral examination revealed abnormality of the skin in the form of keratoderma on the palmo plantar aspects of hands and feet (Fig 3), keratosis of the dorsal surface of hands and feet (Fig 4) and erythematous psorisiform keratotic lesions on the extensor surfaces of both elbows and knees (Fig 5), both of which appeared first when he was 2 years old; nail abnormalities in the form of onychogryphosis (curved nails) (Fig 6) and transverse grooves (Fig 7); finger abnormalities in the form of arachnodactyly (elongated fingers/ spider fingers).
In addition to these common oro-cutaneous features; other features like acro-osteolysis, onychogryphosis, arachnodactyly, pes planus and acro-osteolysis are only present in HMS.
Nail plate thinning predisposes to brittle nails and nail plate thickness predisposes to onychogryphosis and pachyonichia.
In onychogryphosis, the nail plate is thickened and uplifted since one side of the matrix grows faster than the other side (Fig.
Animals were classified as symptomatic (showing clinical signs of leishmaniasis, such as weight loss, cachexia, dermatologic alterations, onychogryphosis, lymphadenopathy, or kerato conjunctivitis) or asymptomatic (no clinical signs).
6% (8/143) of the animals presented suggestive clinical signs of canine visceral leishmaniasis, such as cachexia, skin lesions on the tips of the ears, alopecia, hyperkeratosis, lymphadenopathy, weight loss (most common clinical sign), and onychogryphosis.
2009), hepatosplenomegaly, onychogryphosis
(ALBUQUERQUE et al.
3,4) A surveillance study of 25,000 patients with onychogryphosis
showed 23% were over the age of 60 years (4).