{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T03:32:54Z","timestamp":1747193574333,"version":"3.40.5"},"reference-count":11,"publisher":"S. Karger AG","issue":"1","license":[{"start":{"date-parts":[[2020,12,16]],"date-time":"2020-12-16T00:00:00Z","timestamp":1608076800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.karger.com\/Services\/SiteLicenses"},{"start":{"date-parts":[[2020,12,16]],"date-time":"2020-12-16T00:00:00Z","timestamp":1608076800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.karger.com\/Services\/SiteLicenses"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Skin Appendage Disord"],"published-print":{"date-parts":[[2021]]},"abstract":"<jats:p>&lt;b&gt;&lt;i&gt;Introduction:&lt;\/i&gt;&lt;\/b&gt; Koenen tumors are benign, cutaneous manifestations of tuberous sclerosis. These are disfiguring, painful, and challenging to treat as they frequently recur. We report a case of long-standing, multiple Koenen tumors affecting all twenty nails in an elderly female who was successfully treated with a combination of topical sirolimus 1%, surgical excision, and electrofulguration. &lt;b&gt;&lt;i&gt;Case Report:&lt;\/i&gt;&lt;\/b&gt; A 57-year-old lady presented with multiple, asymptomatic periungual, and subungual tumors affecting all twenty nails since 27 years. Cutaneous examination revealed confetti macules, ash-leaf macule, and shagreen patch over trunk. Nail biopsy was compatible with Koenen\u2019s tumor. Computerized tomography of brain showed diffuse patchy sclerosis. The tumors were treated with topical sirolimus 1% ointment for 10 months with excellent regression. Electro\u00adfulguration for both great toenails and surgical excision of right thumbnail periungual fibroma was done. 1% sirolimus was advised after the surgical treatment. There were no adverse effects or recurrence of tumors over a 2-year follow-up. &lt;b&gt;&lt;i&gt;Discussion:&lt;\/i&gt;&lt;\/b&gt; Topical sirolimus 1% was effective in tumor regression and preventing new tumor formation. Larger tumors that interfered in daily chores were treated with excision and electrofulguration. Thus, a combination treatment for this rare presentation of tuberous sclerosis provided optimum results. <\/jats:p>","DOI":"10.1159\/000511743","type":"journal-article","created":{"date-parts":[[2021,1,20]],"date-time":"2021-01-20T09:48:59Z","timestamp":1611136139000},"page":"66-70","source":"Crossref","is-referenced-by-count":2,"title":["Multiple Koenen Tumors, a Rare Entity: Combination Treatment with 1% Topical Sirolimus Electrofulguration and Excision"],"prefix":"10.1159","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5873-2242","authenticated-orcid":false,"given":"Vishalakshi","family":"Viswanath","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jay D.","family":"Gupte","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niharika","family":"Prabhu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nilima L.","family":"Gour","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"127","published-online":{"date-parts":[[2020,12,16]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2010.03.002"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2009.01.021"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.4103\/0019-5154.91855"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.14964"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.4103\/0019-5154.174087"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.4103\/0019-5154.152516"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.4103\/ijdd.ijdd_34_18"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2017.04.005"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1159\/000455037"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2014.87"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-4725.2007.34024.x"}],"container-title":["Skin Appendage Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.karger.com\/Article\/Pdf\/511743","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.karger.com\/Article\/Pdf\/511743","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T16:10:02Z","timestamp":1745424602000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000511743"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,16]]},"references-count":11,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,1,19]]},"published-print":{"date-parts":[[2021,2,9]]}},"URL":"https:\/\/doi.org\/10.1159\/000511743","archive":["Portico"],"relation":{},"ISSN":["2296-9195","2296-9160"],"issn-type":[{"type":"print","value":"2296-9195"},{"type":"electronic","value":"2296-9160"}],"subject":[],"published":{"date-parts":[[2020,12,16]]}}}