16 - 91 - NAIL DISORDERS Flashcards
no terminal phalanx and no nail growth
Cooks syndrome or atelephalangia with anonychia
half-side index fingernail hypoplasia and a Y-shaped radiologic alteration of the distal phalanx is characteristic for what syndrome?
Iso-Kikuchi syndrome
Micronychia may be a sign of?
phenytoin and alcohol fetopathy and is a constant feature of congenital onychodysplasia of Iso-Kikuchi (COIF [congenital onychodysplasia of index finger] syndrome)
short wide nail, mostly of the thumb, which develops from the age of 12 years on and is the result of a premature ossification of the epiphysis of the distal phalanx
Racket nail
may develop in patients under chronic hemodialysis who develop a tertiary hyperparathyroidism with resorption of the bone of the terminal phalanx
Very short nails (brachyonychia)
most common color change of the nail
Leukonychia
It is caused by alterations in the keratinization of the nail plate with the nail cells being parakeratotic and/or having an eosinophilic cytoplasm in histologic sections.
Muehrcke lines are a pair of 2 whitish transverse lines and are said to be a sign of what?
hypalbuminemia
Erythronychia is the term for red nails. It may appear as red spots in the matrix (Fig. 91-6), 2 one or more longitudinal streaks in the distal matrix and nail bed
Multiple red bands are commonly caused by inflammatory conditions such as?
lichen planus
single red band may represent specific tumors such as?
onychopapilloma or Bowen disease
term for green nails.
Chloronychia
n almost all cases, it is caused by a colonization of the nail by Pseudomonas aeruginosa.
treatment of choice of P. aeruginosa colonization
soaking in diluted white vinegar, 2 or 3 times daily for 10 minutes, then brushing the fingers dry.
Household bleach for fingertip baths can be used undiluted or 1:1 diluted in water.
Glauconychia is described as discoloration of nail of what color?
This is caused by what?
Blue
Copper sulfate
makes the nail jet-black
Silver nitrate
Slate-gray to bluish nail matrix is a sign of?
argyria
lenticular labial, oral, and genital mucosal brown spots with melanonychias is characteristic for what syndrome?
Laugier-Hunziker-Baran syndrome
most frequent sign of nail melanoma
Longitudinal nail pigmentation
Hematomas occupying more than how many % of the nail field are commonly associated with a fracture of the distal phalanx?
> 50%
narrow red to almost black longitudinal lines in the distal nail bed and are caused by blood that is enclosed in the subungual keratin
Splinter hemorrhages
Oblique splinter hemorrhages may be a sign of?
trichinosis
Detachment of the nail from the distal nail bed
onycholysis.
cause of onycholysis semilunaris
Direct trauma resulting from overzealous nail cleaning
This is characterized by sharply delimited proximal margins that may look like a half moon.
exaggeration of nail bed and matrix hyperkeratosis
Onychogryposis
- It consists of innumerable stacks of keratin layers piled up one over the other, grows upward, is opaque and often has the shape of a ram’s horn
- There is usually no contact with the nail bed anymore and the nail pocket is extremely short. It is mainly seen in elderly, neglected, and debilitated individuals
bridging of the nail pocket by connective tissue, in most cases scars
Pterygium
It is very common in lichen planus (Fig. 91-20), but is occasionally seen in other conditions, such as bullous pemphigoid, but particularly also after trauma
When the nail plate does not separate correctly from the nail plate at the hyponychium and remains attached, a painful hyperkeratosis obliterates the distal groove
PTERYGIUM INVERSUM
This is quite common in acral scleroderma and Raynaud syndrome, but also may be idiopathic
temporary slowdown or even arrest of nail formation results in a transverse groove that runs parallel to the lunula border
BEAU LINES
result of a longer-lasting arrest of nail matrix proliferation that eventually results in a proximal gap in the nail and proximal onycholysis
Onychomadesis
give examples of causes of Beau lines
- Repeated Beau lines indicate repeated trauma, such as chemotherapy cycles.
- Equally distributed Beau lines hint at a general cause, whereas one-sided lines are seen after surgery of the extremity or a single-digit line at previous finger or toe surgery.
- A great many different causes are known, ranging from high fever to other serious diseases.
- Localized Beau lines and onychomadesis were also seen several weeks after hand-foot-and-mouth disease (coxcackievirus infection).
- Trauma,** cosmetic manipulations, onychophagia, and onychotillomania** are other causes and explain why the fingernails are predominantly affected
small depressions in the nail surface resulting from minute foci of abnormal keratinization in the apical matrix
Pits
This produces small mounds of parakeratosis that tend to break away from the nail when this emerges from under the proximal nailfold
Large surface defects are typical for pustular psoriasis and are called
elkonyxis
differentiate the pits seen from psoriasis vs atopic dermatitis and alopecia areata
Pits are the most frequent sign of nail psoriasis where they are deep and of regular size, whereas those developing in alopecia areata and atopic dermatitis are more shallow and less-well delimited
rough nails
Trachyonychia
Multiple longitudinal fissures, often associated with nail thinning and ridges
onychorrhexis
lamellar splitting of the nail at its free end
Onychoschizia
t is usually confined to fingernails and occurs much more often in women than in men, pointing to the importance of environmental factors, such as frequent water contact that results in hydration and dehydration of the nail, which leaks cementing lipoproteins out.
Proximal ingrowing of the nail
retronychia
It is caused by a single strong or repeated minor trauma to the nail that eventually results in a backward movement of the nail plate.
Overcurvature of the nails
pincer nails
The most common variant shows a distally increasing curvature, but it may also remain at the same degree (tile nail) or exhibit sharp lateral bends
most common type of ingrown nails
distal–lateral ingrowing of the edge of the big toenail
how do pits form on the nails
They are thought to arise from tiny psoriatic lesions in the apical matrix leading to parakeratosis that breaks off leaving these hole-like lesions.
When the parakeratosis remains it is seen as an ivory-colored spot in the proximal third of the nail plate
Infection with what HPV types is the most common cause for viral warts of the nail unit
HPV types 1, 2, 3, 4, and 7
most cases of trachyonychia are caused by what condition?
atopic dermatitis
Trachyonychia is the term for rough nails and a hallmark of the so-called 20-nail dystrophy. In author’s experience, most cases are caused by atopic dermatitis, although psoriasis, alopecia areata, and nail lichen planus were also found as the underlying disorder.
nail lichen planus most frequently affects what part of the nail?
proximal matrix
Matrix involvement leads to longitudinal ridging and splitting until the distal nail plate breaks away and a pterygium develops
end stage of ungual lichen planus
Postlichen atrophy
Muehrcke lines are 2 parallel white bands in the middle of the nail bed that do not move out and are seen in what condition?
severe hypoalbuminemia
chewing of the nails
onychophagia
picking of the periungual skin
perionychotillomania
nails are virtually rubbed away
onychoteiromania
nail is pulled out in pieces
onychotillomania
cutting device is used to remove all the nail
onychotemnomania
frankly psychotic behavior; the patients bite on their nails in the lunula or proximal nail bed region to produce pain
has been successfully used in a number of obsessive-compulsive disorders, including autoaggressive nail conditions
N-acetyl cysteine in a dose of 1800 to 2400 mg/day
Drug than can cause Permanent nail loss
Bleomycin
drug that can cause Granulation tissue formation on the nail
Reverse Transcriptase Inhibitors (indinavir)
shows painful callus-like palmar and plantar hyperkeratoses, monstrous thickening of the subungual hyperkeratosis that is covered by a horseshoe-like nail usually of normal thickness, oral leukokeratosis with no potential for malignant degeneration, natal teeth, and vellus hair cysts
pachyonychia congenita
longitudinal brownish to dirty-yellow lesion under the nail that shines through the plate
Onychocytic Matricoma
Onychopapilloma arises from what part of the nail
distal matrix
- It is a fibroepithelial neoplasm originating from the matrix. The nail is thickened, funnel-shaped, yellow, striated, and may show splinter hemorrhages
- Dermatoscopy shows that the tunnels contain capillaries that may run a long distance distally in the nail; in rare cases they remain patent, and may cause bleeding upon nail trimming
Onychomatricoma
Multiple ungual fibrokeratomas, so-called Koenen tumors, are a sign of what disease?
tuberous sclerosis
Multiple ungual fibrokeratomas are called?
Koenen tumors
Patients usually present with the complaint of an extremely painful digit tip. Clinical examination reveals a violaceous red spot under the nail of a finger, from which a reddish line may sometimes extend distally
Glomus Tumor
most frequent malignant neoplasm of the nail
SCC
Bowen disease may clinically resemble a flat agglomeration of warts. Paronychia may be associated. Melanonychia is a feature in dark-skinned persons and association with what HPV?
HPV56
Other high-risk HPV are HPV16, HPV18, and HPV35, but many more were found, hinting at a possible genitodigital transmission
numerical increase in melanin-producing cells
matrix lentigo
nest-like agglomeration of melanocytes in the matrix; most are seen in children and are junctional
matrix nevus
most common sites of acral melanoma
Thumbs, big toes, index fingers, and middle fingers
