16: Systemic Nail Manifestations - Mahoney Flashcards
black streak common in african americans
melanonychia
- looks like melanoma: if diagnosis uncertain, remove nail and perform superficial shave biopsy of lesion. submit both shave and nail for pathology.
absence of nail
anonychia
- could be due to alopecia areata and nail-patella syndrome
why do nails become more brittle with age?
normal aging loses H2O in the form of vapor and nail growth rate decreases
distal end of matrix is high compared with proximal end
clubbing
- loss of the normal angle betwen nail and the posterior nail fold
positive schamroth’s test
clubbing
two index fingers are put nail to nail and there is loss of normal diamond-shaped recess
most common cause clubbing nails ****
bronchiogenic CA
white nail / terry’s nail indicates …
hepatic cirrhosis
paired, narrow white bands that run parallel with the lunula and are separated from one another and from the lunula by areas of normal pink nail
Muehrcke’s lines
- due to hypoabluminemia
puntate or striped white bands associated with arsenic poisoning
Mee’s lines
white nail plate
leukonychia
what could a blue-green nail be?
- pseudomonas
- subungual hematoma
red half moons indicate …
congestive heart failure
blue half moons indicate …
hepato-lenticular degeneration (Wilson’s disease)
“half-and-half” nail with proximal nail bed white and distal half red, pink or brown indicates …
renal disease and azotemia
ABCDEF of subungual melanoma
African-american, native American, Asian
band is brown-black, breath is greater than 3 mm, border is irregular
Change is rapid in size or growth rate
Digit is most commonly the hallux
Extension into surrounding skin (Hutchinson’s sign)
Family or personal history of melanoma or dysplastic nevus syndrome
describe yellow nail syndrome
nails cease, or almost cease, to grow and some months later take on a yellow color
- remain smooth but may be excessively curved
- bronchiectasis, bronchitis, pleural effusion cause
subungual hemorrhage
bleeding of nail bed
“spoon-shaped” nail
- concave dorsally, distal end depressed below normal level due to anoxia and atrophy of distal connective tissue
koilonychia
* associated with iron deficiency anemia
onycholysis
separation of nail from its bed
- can be partial or total and due to many causes
“parrot beaking” indicates …
- scleroderma, normal, or TB
- nails look like a beak curving around the atrophic soft tissue of the tips of the toe
most common reason pitting nails
psoriasis
- pits are due to retention of nuclei (parakeratosis) in parts of the nail keratin
- these areas weaker than surrounding normal keratin and may be shed leaving pits on nail surface
cuticle appears to grow forward on the nail plate and the nail is split into two portions
pterygium formation
- results from fusion of epidermis of the dorsal nail fold to the nail bed and matrix
- associated with lichen planus ***
loosening of nail at base vs. separation from nail bed
onychomadesis
onycholysis
splinter hemorrhages are classically associated with …
subacute bacterial endocarditis
- longitudinal, thin black lines of hemorrhaging below the nails
“inverted fir tree”
slightly off-centered split with feather y cracks extending laterally from the split
median nail dystrophy
identify
habit tic
single transverse depression
beau’s line
- disability which temporarily interferes with the rate of growth of the nail (ex: chemo)
describe psoriatic nail
- most common disease associated with pitting
- partial onycholysis starting at free edge
- opaque, discolored, irregular, thickened, pustular
- formation of hyperkeratosis at free edge
- over curvature
- arthropathy
describe eczematic nail
- most common is atopic or contact dermatitis which leads to atrophic changes
- irregular ridges across nail
- pitting
- subungual hemorrhage
- gross hypertrophy and onycholysis occur less frequently
most common nail change with lichen planus
longitudinal ridging with slight depressions on surface and thinning and pterygium formation
keratoderma blenorrhagicum lesions
reiter’s syndrome
- cant see, cant pee, cant climb a tree
nail changes associated with scleroderma
parrot beaking
- changes primarily due to impaired peripheral circulation
cuticle broken with hemorrhagic leisons in the area
SLE
patches of erythema with telangectasia over the posterior nail folds
erythema over toe joints
dermatomyosistis
describe the nails …
pemphigus/epidermolysis bullosa
sarcoidosis
scabies
- shedding of nails with nail bed scarring
- thickened, irregular with damage to distal phalanx
- thickened and opaque
nail changes due to chemo
- beau’s lines
- pigmentary changes
- onychomadesis
- transverse leukonychia
these drugs cause …
zidovudine/retrovir
tetracycline and doxycycline
minocycline
lithium
chloroquine
accutane
- longitudinal brown or blue-brown lines or diffuse coloration of entire nail
- photosensitive onycholysis
- blue-gray pigmentation of nail bed of longitudinal pigmented lines
- transverse brown bands with leukonychia
- blue/balck or blue/brown pigmentary changes
- fibromas
cardiovascular and hematologic disease
- splinter hemorrhages
- red lunula
GI disease
- terry’s nail
- blue half moons
- brown nails of hyperbilirubinemia
- chronic hepatitis may cuase splinter hemorrhages, clubing and white nails
renal disease
- half and half nail / lindsay’s nail
- anonychia
- longitudinal ridging
- koilonychia
- muehrcke’s lines
- increased in red color in renal adenocarcinoma due to increased erythropoeitin
pulmonary disease
- yellow nail syndrome
- clubbing
endocrine disease
- longitudinal pigmented bands in addison’s disease
- short, wide, thick, flat nails in acromegaly
- proximal nail bed telangiectasia with yellow nails in diabetes
- brittle nails with longitudinal sulci in hypothyroidism
