16 - Nails Flashcards by michael english

Anatomy of the nail

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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What is the MC effect of psoriasis on the nail?

Pitting (MC)

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What effects does psoriasis have on the nail?

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

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What is onchyolysis?

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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Treatment for psoriasis?

Systemic:

cyclosporin
methotrexate
aceitretin

Topical

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

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If a pt has nail lichen planus (LP)?

They prob have it elsewhere too

- 25% have it more places

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MC findings for LP?

Longitudinal grooving and ridging

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Inflammation of the matrix with LP may cause?

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

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LP tx?

Self limiting but:

Local
- intralesional kenalog

Systemic
- oral prednisone

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What types of drugs effect the nail?

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

Tetracycline abx can also do it

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Tinea of the nails is aka?

Tinea unguium

- its is a type of onchomycosis

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Presentation of tinea unguium?

May occur simultaneously w hand/foot tinea or alone

Thickened yellow nails
- may look like psoriasis too

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How to confirm onchomycosis?

KOH and CX to confirm species before treating

Cx - crumbling debris from under distal edge

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Patterns of infection for oncychomycosis?

Distal subungual onychomycosis

White superficial onchomycosis

Proximal subungual onchomycosis

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Oral Treatment for onychomycosis?

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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Preferred txt for onchomycosis?

Terbinafine

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

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Topical tx for onychomycosis?

Ciclopirox nail lacquer (PENLAC)

for use w/o lunula involvment
complex implementation

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

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Prevention for onchomycosis?

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

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What is chronic exposure (in reference to nails)

Repeated water immersion or Frequent use of nail polish removers

Leads to brittle nails

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Chronic exposure txt?

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

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Types of nail trauma

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

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What is a hangnail?

Skin separation form lateral nai folds

- esp during winter months

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Txt for hang nail?

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

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Txt for onycholysis?

Removal of separated nail

Ingrown toenail rundown?

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

Causes of ingrown toenail?

Poorly fitting shoes Bad nail care Acute trauma

Txt for ingrown nail?

Partial/full nail removal | - phenol may prevent recurrence

What is a subungual hematoma?

Trauma to nail plate - immediate bleeding - pain - self limiting

Sever subungual hematoma txt?

Trephination ASAP Field expedient method - heated paperclip to melt a small hole - you can also use an 18g needle

What is habit-tic deformity?

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

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

Psychiatric d/o | - OCD

Txt for habit-tic deformity

Stop being crazy

What are pincher nails?

Inward folding of lateral edges - painful - prob 2/2 shoe compression

Txt for pincher nails?

Removal | Shoes w wider toebox

What is acute paronychia

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

Acute paronychia follows?

Trauma Nail biting Manipulation

Txt for acute paronychia?

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

What is chronic paronychia

Chronic inflammation of proximal nail fold - sig contact irritant exp is maj cause Gets colonized with candida

What fingers are involved w chronic paronychia?

Typically its many or all of them

Txt for chronic paronychia?

Avoid exposures Tx underlying inflammation/infection Fluconazole if bad

How does one get pseudomonas in their nail?

Onycholysis exposes a damp, macerated space | - leads to growth of pseudomonas

Describe pseudomonas nail

Nail plate turns green-black in color

Txt for pseudomonas nail?

Mix of - chlorine bleach - water Or - vinegar Or - ciprofloxacin if severe/txt failure

What are beau’s lines

Transverse depressions of all nails - appears at base of lunula - weeks after stressful event

Prognosis and txt of beaus lines?

Nothing, they grow out normally

What is yellow nail syndrome?

Rare syndrome Nail plate becomes - curved - yellow Usually involves all nails

When does yellow nail syndrome occur

Seen before, during, or after A respuratory disease AIDS pts

Txt for yellow nail syndrome?

May spontaneously resolve Vitamin E (oral or topical) helps

What causes finger clubbing?

``` Normal variant Heart disease Lung disease Colitis Thyroid disease ```

What is lovibonds angle?

A method of measuring the nail to determine if a finger qualifies as “clubbing” >180* is pos 160* is normal

Txt for clubbing?

Nothing its permanent

What is koilonychia?

Spoon nails

What are spoon nails?

Lateral elevation and central depression of nail plate - may be normal - may be IDA

Txt for spoon nails?

Treat the anemia

What are mee’s lines?

Transverse white line in the nail plate

What causes mee’s lines

``` Sepsis Renal failure Arsnec poisoning Hepatic failure CHF Chemo ```

Txt for mee’s lines?

Txt: Underlying problem Nail grows out w nail and resolves

what do you call a sleeping bull?

A bulldozer