FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 360:2108-2116 May 14, 2009 Number 20 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

	Full Text PDF PDA Full Text  Full Text Audio PowerPoint Slide Set CME Exam Supplementary Material Purchase this article Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations.

A 68-year-old man reports changes in his left big toenail. It has been discolored distally for the past 2 years. It has become thickened and difficult to cut and is painful when the man is walking in certain shoes. He is otherwise well. On physical examination, the nail appears thickened, has crumbling yellow material beneath, and is more discolored distally than proximally. . . . [Full Text of this Article]

The Clinical Problem

Strategies and Evidence

Treatment

Topical Therapy

Systemic Therapy

Combined Topical and Systemic Therapy

Débridement

Areas of Uncertainty

Guidelines

Conclusions and Recommendations

Source Information

From the Bristol Dermatology Centre, Bristol Royal Infirmary, University Hospitals Bristol, Bristol, United Kingdom.

An audio version of this article is available at NEJM.org.

Address reprint requests to Dr. de Berker at the Bristol Dermatology Centre, Bristol Royal Infirmary, University Hospitals Bristol, Bristol BS2 8HW, United Kingdom, or at david.deberker@uhbristol.nhs.uk.

HOME  |  SUBSCRIBE  |  SEARCH  |  CURRENT ISSUE  |  PAST ISSUES  |  COLLECTIONS  |  PRIVACY  |  TERMS OF USE  |  HELP  |  beta.nejm.org Comments and questions? Please contact us. The New England Journal of Medicine is owned, published, and copyrighted © 2009 Massachusetts Medical Society. All rights reserved.