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Hello Thanks for posting your query. I can understand your concern for a melanoma for these longitudinal dark lines on the nails of four fingers. But before labeling it as melanoma we have to rule out other possibilities. First of them is splinter hemorrhages which are longitudinal thin lines red or brown in color that occur beneath the nail plate. They are visible when capillaries within the epidermal ridges leak. They are found in local trauma psoriasis or localized fungal infection or endocarditis. Splinter hemorrhages are thought to be a more specific indicator of endocarditis if they are present proximally rather than distally on the nail plate. So considering your age endocarditis also should be ruled out which is an inflammation of the inner layer of the heart the endocardium. You should consult a physician and get it ruled out by getting a physical examination ECG or an ECHO done. Secondly it can be due to melanonychia which is a brown or black pigmentation of the nail plate caused by the presence of melanin commonly appearing as a longitudinal band on the nail plate. It can be due to four main causes which are simple melanocytic activation; increased activation (with a normal number) of melanocytes; benign melanocyte proliferations (lentigo nevus); and malignant melanocyte proliferation (melanoma). While the first three are benign fourth one which is melanoma is malignant. Now to rule out melanoma you need to get it examined from a dermatologist and get a physical examination done. In subungual melanoma it usually presents as a wide (>3mm) new or changing pigment band in a single nail. Dermoscopic examination may reveal more details showing pigmented lines of varying colour width and spacing and this examination can be done by a dermatologist. If melanoma is suspected then he may take biopsy samples and send the nail sample for histopathological examination. Hope that this information helps and hope that you get better soon. Wishing you good health. 15:20:57 olive 2014/12/9 15:20:57 Hello Thanks for posting your query. I can understand your concern for a melanoma for these longitudinal dark lines on the nails of four fingers. But before labeling it as melanoma we have to rule out other possibilities. First of them is splinter hemorrhages which are longitudinal thin lines red or brown in color that occur beneath the nail plate. They are visible when capillaries within the epidermal ridges leak. They are found in local trauma psoriasis or localized fungal infection or endocarditis. Splinter hemorrhages are thought to be a more specific indicator of endocarditis if they are present proximally rather than distally on the nail plate. So considering your age endocarditis also should be ruled out which is an inflammation of the inner layer of the heart the endocardium. You should consult a physician and get it ruled out by getting a physical examination ECG or an ECHO done. Secondly it can be due to melanonychia which is a brown or black pigmentation of the nail plate caused by the presence of melanin commonly appearing as a longitudinal band on the nail plate. It can be due to four main causes which are simple melanocytic activation; increased activation (with a normal number) of melanocytes; benign melanocyte proliferations (lentigo nevus); and malignant melanocyte proliferation (melanoma). While the first three are benign fourth one which is melanoma is malignant. Now to rule out melanoma you need to get it examined from a dermatologist and get a physical examination done. In subungual melanoma it usually presents as a wide (>3mm) new or changing pigment band in a single nail. Dermoscopic examination may reveal more details showing pigmented lines of varying colour width and spacing and this examination can be done by a dermatologist. If melanoma is suspected then he may take biopsy samples and send the nail sample for histopathological examination. Hope that this information helps and hope that you get better soon. Wishing you good health. 15:23:05 olive 2014/12/9 15:23:05 Hello Thanks for posting your query. I can understand your concern for the unsightly scars. Well these scars are due to post inflammatory hyperpigmentation. Hyperpigmentation occurs as brown macules or patches often with a poorly defined border irregular in outline and usually with little surface change. It is usually due to inflammatory conditions like infections or acne or trauma both of which were present in your case. It can either be epidermal or dermal melanosis. It is light brown to black with a lighter brown appearance if the pigment is within the epidermis (ie epidermal melanosis) and a darker gray to bluish appearance if lesions contain dermal melanin (ie dermal melanosis). In your case it looks more like epidermal melanosis. Regarding the treatment part it is quite tough for post inflammatory hyperpigmenttaion. Topical treatment is quite effective for epidermal hypermelanosis but none is proven effective for dermal hypermelanosis. Daily use of a broad-spectrum sunscreen (sun protection factor [SPF] 15 or greater) is very useful. Hence considering the topical treatment one is hydroquinone which you have already used. Apart from that tretinoin cream corticosteroids glycolic acid (GA) and azelaic acid are quite useful but please do not use them without medical guidance as they have potential side effects as well. Moreover a combination of topical creams and gels chemical peels and sunscreens may be necessary for significant improvement. Glycolic acid peels in combination with tretinoin and hydroquinone are an effective treatment of postinflammatory hyperpigmentation in dark-complexioned individuals. This is usually followed by topical steroids. But as mentioned before they are useful for epidermal hyperpigmentation. Other treatment options include use of trichloroacetic acid and gentle cryotherapy with liquid nitrogen But they can cause tissue necrosis and hence should be used with caution by a medical specialist. This is quite effective in individuals who are not dark skinned. Lastly fractional photothermolysis may be used after or in conjunction with ablative carbon dioxide laser resurfacing and this is quite effective for dermal melanosis. You can get the topical treatment prescribed by your dermatologist (one of them being hydroquinone which you were using) and if it fails then other treatment options can be tried. But treating post inflammatory hyperpigmentation requires patience and you should regularly follow up with your dermatologist. Hope that this information helps and hope that you get better soon. Wishing you good health.

2014-12-09 03:23:37

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