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生活中若沒了指甲，要比沒了頭髮更麻煩
Eckart Haneke
Hanake教授為德國知名的皮膚科醫師，專精於指甲疾病的診斷與治療，尤其是指甲手術。Hanake教授過去曾擔任德國皮膚科醫學會主席、歐洲指甲醫學會主席、歐洲皮膚外科醫學會主席、德國皮膚病理醫學會主席。目前是瑞士伯恩大學的客座教授，受邀在世界各盛大的醫學會中教育晚輩醫師指甲的知識。2017年05月，台灣也曾邀請Hanake教授來台為皮膚科醫學會演講，與台灣有很好的友誼。
The nails represent functionally and aesthetically very important cutaneous appendages. Although often seen as the little brother of hair and being of lesser importance life without nails is much harder than without hair. Wigs are available in all sizes and colours at virtually all prices but nothing similar can be bought even for a lot of money. Hair? can be hidden under a hat or scarf but the hands and fingers and their nails are virtually always visible.
不論是在功能或外觀上，指甲都是皮膚重要的延伸構造。雖然指甲常被認為比頭髮不重要，但生活中若沒了指甲是要比沒了頭髮更為麻煩。市面上有各種尺寸、顏色與價位的假髮，但不管花多少錢也買不到相似指甲的替代物。你可以用帽子或是頭巾來掩飾頭髮的問題，但手指上的指甲疾病是無法隱藏，一定會被看到的。
The nail starts developing with the formation of the limbs at the 8th to 9th week of gestation. Its development depends on the concerted action of many growth and signalling factors, and only one lacking or one false signal will make normal nail development impossible. Much research has concentrated on hair and it turned out that nail development is even more complex. It is not surprising that so many ectodermal dysplasia syndromes are associated with nail deformations.
指甲的生長開始於懷孕過程的第八到第九周，需要很多的生長與訊號因子的互相配合。倘若有任何一個因子缺乏或訊號出錯，指甲的生長便無法正常。有許多針對頭髮的研究發現，指甲的生長過程比頭髮複雜多了。因此不意外的，很多外胚層的發育障礙症候群都跟指甲有關連性。
Recent research has shown the close and intimate reltionship? of the musculo-skeletal system with the nail unit. Some rheumatologists now call the nail a musculo-skeletal appendage and explain part of the psoriatic nail changes with their close anatomic relationship with the bone and joint of the distal phalanx refuting the long-held anticipation of the nail changes as being immuno-mediated.
最近的研究顯示，指甲單元與肌肉骨骼系統有非常重要的關係。有些風濕免疫學的專家現在把指甲歸類為肌肉骨骼的附屬物，並認為部分乾癬性指甲的變化是因為指甲與遠端手指骨及關節的構造十分靠近，所以造成乾癬指甲變形。
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As a cutaneous appendage, the nail apparatus may react with the skin and demonstrate a number of nail changes, many of which are specific allowing the correct diagnosis to be made, but even more are less or non-specific and have to be seen with the corresponding dermatosis. When no accompanying skin lesions are present a correct diagnosis is even more difficult to reach and often requires a biopsy and expert histopathological diagnosis. This touches another difficult area: nail surgery.
指甲是皮膚的延伸構造，所以指甲也會被皮膚疾病影響而導致指甲的很多變化。很多指甲的疾病會有特殊且一致的改變，因此醫師很容易做出正確的診斷。但是更多的指甲疾病的外觀改變是不具特異性，因此需要搭配周遭皮膚的病變來做診斷。當沒有伴隨的皮膚疾病來幫助診斷時，醫師要做出診斷就更為困難了。為了解決這個難題，皮膚切片以及專業的皮膚病理診斷就顯得非常重要。當然，這裡又談到另一個困難的醫學領域???-指甲手術。
Nail surgery is an integral part of dermatologic surgery. Although many patients primarily consult surgeons because ?they can do everything“ even plastic and hand surgeons usually have only rudimentary knowledge of the nail’s biology, physiology, growth pattern, normal and pathologic anatomy and histopathology. Therefore, their foremost diagnostic-therapeutic approach is often nail avulsion, which by itself is almost never a treatment. It is self-evident that nail surgery requires in-depth knowledge of all aspects of the nail and it is the dermatologist who takes time and all efforts to learn this. Unfortunately, the huge number of mal-treated ingrown toenails with permanent mutilation of the bit toe gives strong evidence that this situation has not really changed to the better. And here we are at another important issue: function and aesthetics.
指甲手術是皮膚外科手術中重要的一環。雖然很多病人一開始去諮詢外科醫師，但即使是整形外科或是手外科的醫師，通常能提供的治療就是拔指甲。非常可惜的是，很多嵌甲被整片拔除後，在大腳趾甲留下不可回復的傷害。皮膚科醫師的養成訓練對指甲有深入的知識與了解，最能勝任執行指甲的手術。
Finger and toe nails have important functions for the protection of the distal phalanx, which in turn is a very important sensory organ, a most versatile tool and a weapon for defence and to scratch. For the great toe, the nail exerts counter-pressure for the soft tissue of the toe tip and thus prevents it from being heaped up and dorsally disclocated; thus the big toenail even adds to the safety of gait. Malformed finger nails are embarrassing and may cause considerable concern. In our world of youth and well-being, healthy good-looking nails are important features.
手腳指的指甲有多種重要功能，包括保護遠端指骨，同時指甲也是重要的感覺構造。指甲也可當作是防衛的武器與抓癢的工具。在我們行走踏地時，大腳趾的趾甲會施加一個反作用力在甲床組織上，避免甲床組織會因地板的作用力而往上移位，因此指甲也在穩定走路的安全機制扮演一個角色。另外，變形的手指甲是會引人注目且令人難為情的。在我們青春與身體健康情況時，健康美麗的指甲是重要的特徵。
Finally, the nails may reflect general health as was already mentioned by Hipokrates more then 2000 years ago when he noted that clubbed fingers were associated with serious pulmonary and heart problems.
最後，如醫學之父希波克拉底在超過兩千年所提到的，指甲可以反映我們整體的健康狀況。當時他指出杵狀指與嚴重的肺部和心臟問題有關。
An up-to-date nail book in Chinese is overdue. The authors are reputed experts in this field that unfortunately was a bit neglected for many years. I hope that this book will be a great success in all respects.
指甲領域已經被忽略很多年了，且目前專門針對指甲的中文書籍是過時的。這二位作者是這個領域的專家，我希望這本書將在各方面獲得很大的成功。
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