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Senior - Derm 3 > 16 - Nails > Flashcards

16 - Nails Flashcards

1
Q

Anatomy of the nail

A

Nail Plate: Hard, translucent, dead keratin

Nail fold: surrounding skin and matrix

Matrix: Matrix epithelium synthesizes the nail plate

Lunula (white 1/2 moon): distal aspect of nail matrix, continuous w nail bed

Nail bed: consists of parallel longitudinal ridges w small blood vessels at their base

Hyponychium: short segment of skin lacking nail cover

Pic on slide 5

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2
Q

What is the MC effect of psoriasis on the nail?

A

Pitting (MC)

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3
Q

What effects does psoriasis have on the nail?

A

Pitting (MC)
Onchyolysis
Oil spots
Gross deformity (fragmentation, crubmling, and splinter hemorrhages)

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4
Q

What is onchyolysis?

A

Onycholysis is the painless separation of the nail from the nail bed.

This is a common problem. It can be a sign of skin disease, an infection or the result of injury, but most cases are seen in women with long fingernails.

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5
Q

Treatment for psoriasis?

A

Systemic:

  • cyclosporin
  • methotrexate
  • aceitretin

Topical

  • intralesional kenalog
  • calcipotriol ointment (vit D)
  • tazaroten gel (retinoid)
  • anthralin ointment (MOA UKN)
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6
Q

If a pt has nail lichen planus (LP)?

A

They prob have it elsewhere too

- 25% have it more places

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7
Q

MC findings for LP?

A

Longitudinal grooving and ridging

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8
Q

Inflammation of the matrix with LP may cause?

A

Adhesion of the proximal nail fold to the scarred matrix (pterygium unguis)

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9
Q

LP tx?

A

Self limiting but:

Local
- intralesional kenalog

Systemic
- oral prednisone

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10
Q

What types of drugs effect the nail?

A

Chemotherapy drugs are associated w variety of changes in the nail unit

Tetracycline abx can also do it

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11
Q

Tinea of the nails is aka?

A

Tinea unguium

- its is a type of onchomycosis

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12
Q

Presentation of tinea unguium?

A

May occur simultaneously w hand/foot tinea or alone

Thickened yellow nails
- may look like psoriasis too

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13
Q

How to confirm onchomycosis?

A

KOH and CX to confirm species before treating

Cx - crumbling debris from under distal edge

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14
Q

Patterns of infection for oncychomycosis?

A

Distal subungual onychomycosis

White superficial onchomycosis

Proximal subungual onchomycosis

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15
Q

Oral Treatment for onychomycosis?

A

Oral agents

  • Terbinafine (lamisil) 250mg q Day x 12 wks
  • itraconazole (sporanox) 200mg q day x 12 wks
  • fluconazole: 450 q week x 3 months
  • griseofulvin (Gris-PEG)
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16
Q

Preferred txt for onchomycosis?

A

Terbinafine

  • higher cure rate
  • slower relapse rate
  • not many drug interactions
  • results last >2 yrs
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17
Q

Topical tx for onychomycosis?

A

Ciclopirox nail lacquer (PENLAC)

  • for use w/o lunula involvment
  • complex implementation

Efinaconazole (jublia)
- shitty cure rate (16-53%)

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18
Q

Prevention for onchomycosis?

A 
Shoes/boots 
- protect toes from trauma
Dont pick nails
Rotate footwear
Clean socks
Shower shoes
Keep nails short
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19
Q

What is chronic exposure (in reference to nails)

A

Repeated water immersion or Frequent use of nail polish removers

Leads to brittle nails

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20
Q

Chronic exposure txt?

A 
Rehydrate the nail
Moisturizer/lubricant 
Protective gloves
Nail enamel weekly
B-complex vitamin (biotin B7)
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21
Q

Types of nail trauma

A 
Oncholysis
Nail biting
Hang nail 
Ingrown toenail 
Subungual hematoma
Habit-tic deformity
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22
Q

What is a hangnail?

A

Skin separation form lateral nai folds

- esp during winter months

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23
Q

Txt for hang nail?

A

Cut separated skin before it extends
Use moisturizers
Avoid repeated hand immersion in water

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24
Q

Txt for onycholysis?

A

Removal of separated nail

25
Q

Ingrown toenail rundown?

A

Large toe (usually)
Nail pierces nail fold and becomes FOB
Swelling, pain, purulent drainage

26
Q

Causes of ingrown toenail?

A

Poorly fitting shoes
Bad nail care
Acute trauma

27
Q

Txt for ingrown nail?

A

Partial/full nail removal

- phenol may prevent recurrence

28
Q

What is a subungual hematoma?

A

Trauma to nail plate

  • immediate bleeding
  • pain
  • self limiting
29
Q

Sever subungual hematoma txt?

A

Trephination ASAP

Field expedient method

  • heated paperclip to melt a small hole
  • you can also use an 18g needle
30
Q

What is habit-tic deformity?

A

Caused by biting or picking a section of proximal nail fold of thumb w index fingernail

Defect Consists of
- longitudinal band of horizontal grooves w yellow discoloration

31
Q

If you see habit-tic deformity the pt may suffer from?

A

Psychiatric d/o

- OCD

32
Q

Txt for habit-tic deformity

A

Stop being crazy

33
Q

What are pincher nails?

A

Inward folding of lateral edges

  • painful
  • prob 2/2 shoe compression
34
Q

Txt for pincher nails?

A

Removal

Shoes w wider toebox

35
Q

What is acute paronychia

A

Bright red swelling of proximal and lateral nail fold
- rapid onset

Small abscess

36
Q

Acute paronychia follows?

A

Trauma
Nail biting
Manipulation

37
Q

Txt for acute paronychia?

A

Drainage of abscess
Antistaphylococcal abx

The way i’ve seen it treated is gently seperate the skin from the nail w an 18g needle, get a little puss out and squeeze the shit out of it
- the pt is not usually happy

38
Q

What is chronic paronychia

A

Chronic inflammation of proximal nail fold
- sig contact irritant exp is maj cause

Gets colonized with candida

39
Q

What fingers are involved w chronic paronychia?

A

Typically its many or all of them

40
Q

Txt for chronic paronychia?

A

Avoid exposures
Tx underlying inflammation/infection

Fluconazole if bad

41
Q

How does one get pseudomonas in their nail?

A

Onycholysis exposes a damp, macerated space

- leads to growth of pseudomonas

42
Q

Describe pseudomonas nail

A

Nail plate turns green-black in color

43
Q

Txt for pseudomonas nail?

A

Mix of

  • chlorine bleach
  • water

Or
- vinegar

Or
- ciprofloxacin if severe/txt failure

44
Q

What are beau’s lines

A

Transverse depressions of all nails

  • appears at base of lunula
  • weeks after stressful event
45
Q

Prognosis and txt of beaus lines?

A

Nothing, they grow out normally

46
Q

What is yellow nail syndrome?

A

Rare syndrome

Nail plate becomes

  • curved
  • yellow

Usually involves all nails

47
Q

When does yellow nail syndrome occur

A

Seen before, during, or after A respuratory disease

AIDS pts

48
Q

Txt for yellow nail syndrome?

A

May spontaneously resolve

Vitamin E (oral or topical) helps

49
Q

What causes finger clubbing?

A 
Normal variant
Heart disease
Lung disease
Colitis 
Thyroid disease
50
Q

What is lovibonds angle?

A

A method of measuring the nail to determine if a finger qualifies as “clubbing”

> 180* is pos
160* is normal

51
Q

Txt for clubbing?

A

Nothing its permanent

52
Q

What is koilonychia?

A

Spoon nails

53
Q

What are spoon nails?

A

Lateral elevation and central depression of nail plate

  • may be normal
  • may be IDA
54
Q

Txt for spoon nails?

A

Treat the anemia

55
Q

What are mee’s lines?

A

Transverse white line in the nail plate

56
Q

What causes mee’s lines

A 
Sepsis
Renal failure
Arsnec poisoning 
Hepatic failure
CHF
Chemo
57
Q

Txt for mee’s lines?

A

Txt: Underlying problem

Nail grows out w nail and resolves

58
Q

what do you call a sleeping bull?

A

A bulldozer

Senior - Derm 3 (7 decks)

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