derm Flashcards
Acanthosis nigricans ass/w
Gastric cancer
Acquired ichthyosis ass/w
Lymphoma
Acquired hypertrichosis lanuginosa
Gastrointestinal and lung cancer
Polymorphic eruption of pregnancy
- Pruritic condition associated with last trimester
- Lesions often first appear in abdominal striae
- Management depends on severity: emollients, mild potency topical steroids and oral steroids
may be used
Pemphigoid gestationis
- Pruritic blistering lesions
- Often develop in peri-umbilical region, later spreading to the trunk, back, buttocks and arms
- Usually presents 2nd or 3rd trimester and is rarely seen in the first pregnancy
- Oral corticosteroids are usually required
Skin disorders associated with TB
- Lupus vulgaris (accounts for 50% of cases) * Erythema nodosum
- Scarring alopecia
Scrofuloderma: breakdown of skin overlying a tuberculous focus - Verrucosa cutis * Gumma
most common form of cutaneous TB seen in the Indian subcontinent
Lupus vulgaris
. The initial lesion is an erythematous flat plaque which gradually becomes elevated and may ulcerate later
Hypothyroidism skin
- Dry (anhydrosis), cold, yellowish skin
- Non-pitting oedema (e.g. hands, face)
- Dry, coarse scalp hair, loss of lateral
aspect of eyebrows - Eczema
- Xanthomata
Hyperthyroidism skin
Pretibial myxoedema: erythematous, oedematous lesions above the lateral malleoli
* Thyroid acropachy: clubbing
* Scalp hair thinning
* ↑ sweating
Erythema multiforme:
Target lesions (typically worse on peripheries e.g. Palms and soles)
* Severe = stevens-johnson syndrome (blistering and mucosal involvement)
Causes
* Idiopathic
* Bacteria: mycoplasma, Streptococcus
* Viruses: herpes simplex virus, Orf
* Drugs: penicillin, sulphonamides,
carbamazepine, allopurinol, NSAIDs,
oral contraceptive pill, nevirapine
* Connective tissue disease e.g.
Systemic lupus erythematosus
* Sarcoidosis
* Malignancy
Scarring alopecia
- Trauma, burns
- Radiotherapy
- Lichen planus
- Discoid lupus
- Tinea capitis*
- TB
Non-scarring alopecia
- ♂-pattern baldness
- Drugs: cytotoxic drugs, carbimazole,
heparin, oral contraceptive pill,
colchicine - Nutritional: iron and zinc deficiency
- Autoimmune: alopecia areata
- Telogen effluvium (hair loss following stressful period e.g. Surgery)
- Trichotillomania “hair loss from a patient’s repetitive self-pulling of hair”
Alopecia areata
a presumed autoimmune condition causing localised, well demarcated patches of hair loss. At the edge of the hair loss, there may be small, broken ‘exclamation mark’ hairs
Alopecia areata treatment
Hair will regrow in 50% of patients by 1 year, and in 80-90% eventually. Careful explanation is therefore sufficient in many patients. Other treatment options include:
* Topical or intralesional corticosteroids
* Topical minoxidil
* Phototherapy
* Dithranol
* Contact immunotherapy * Wigs
Shin lesions:
The differential diagnosis of shin lesions includes the following conditions:
* Erythema nodosum
* Pretibial myxedema
* Pyoderma gangrenosum
* Necrobiosis lipoidica diabeticorum
Erythema nodosum
Erythema nodosum
* Symmetrical, erythematous, tender, nodules which heal without scarring
* Most common causes are streptococcal infections, sarcoidosis, inflammatory bowel disease and
drugs (penicillins, sulphonamides, oral contraceptive pill)
Pretibial myxedema
Pretibial myxedema
* symmetrical, erythematous lesions seen in Graves’ disease
* shiny, orange peel skin
pyoderma gangrenosum
yoderma gangrenosum
* Initially small red papule
* Later deep, red, necrotic ulcers with a violaceous border
* Idiopathic in 50%, may also be seen in inflammatory bowel disease, connective tissue disorders
and myeloproliferative disorders
Necrobiosis lipoidica diabeticorum
Shiny, painless areas of yellow/red skin typically on the shin of diabetics
* Often associated with telangiectasia
Erythema nodosum overview
Inflammation of subcutaneous fat
* Typically causes tender, erythematous,
nodular lesions
* Usually occurs over shins, may also occur
elsewhere (e.g. Forearms, thighs)
* Usually resolves within 6 weeks
* Lesions heal without scarrin
Erythema nodosum causes
Causes
* Infection: streptococci, TB, brucellosis
* Systemic disease: sarcoidosis, inflammatory
bowel disease, Behcet’s
* Malignancy/lymphoma
* Drugs: penicillins, sulphonamides,
combined oral contraceptive pill
* Pregnancy
Pyoderma Gangrenosum futures
Typically on the lower limbs
* Initially small red papule
* Later deep, red, necrotic ulcers with a violaceous border
* May be accompanied systemic systems e.g. Fever, myalgia
Pyoderma Gangrenosum causes
- Idiopathic in 50%
- IBD: ulcerative colitis, crohn’s
- Rheumatoid arthritis, SLE
- Myeloproliferative disorders
- Lymphoma, myeloid leukemias
- Monoclonal gammopathy (IgA)
- Primary biliary cirrhosis
Pyoderma Gangrenosum causes
Management
* The potential for rapid progression is high in most patients and whilst topical and intralesional steroids have a role in management most doctors advocate oral steroids as first-line treatment
* Other immunosuppressive therapy, for example Cyclosporin and infliximab, have a role in
difficult cases
Seborrhoeic dermatitis causes
inflammatory reaction related to a proliferation of a normal skin inhabitant, a fungus called Malassezia (formerly known as Pityrosporum ovale).
Seborrhoeic dermatitis features
Features
* Eczematous lesions on the sebum-rich areas: scalp (may cause dandruff), periorbital, auricular and nasolabial folds
* Otitis externa and blepharitis may develop
Seborrhoeic dermatitis management
Scalp disease management
* Over the counter preparations containing zinc pyrithione (‘Head & Shoulders’) and tar (‘Neutrogena T/Gel’) are first-line
* The preferred second-line agent is ketoconazole
* Selenium sulphide and topical corticosteroid may also be useful
Face and body management
* Topical antifungals: e.g. Ketoconazole
* Topical steroids: best used for short periods
* Difficult to treat - recurrences are common
Malignant Melanoma: prognostic factor
invasion depth of a tumour (Breslow depth) is the single most important factor in determining prognosis of patients with malignant melanoma
Impetigo treatment
topical fusidic acid → oral flucloxacillin / topical mupirocin
Erythema ab igne
kin disorder caused by over exposure to infrared radiation. Characteristic features include erythematous patches with hyperpigmentation and telangiectasia. A typical history would be an elderly women who always sits next to an open fire (ovens)
If the cause is not treated then patients may go on to develop squamous cell skin cancer
Actinic keratoses features
premalignant skin lesion
- Small, crusty or scaly, lesions
- May be pink, red, brown or the same color as the skin
- Typically on sun-exposed areas e.g. Temples of head
- Multiple lesions may be present
Actinic keratoses Management options include
- Prevention of further risk: e.g. Sun avoidance, sun cream
- Fluorouracil cream: typically a 2 to 3 week course. The skin will become red and inflamed sometimes topical hydrocortisone is given following fluorouracil to help settle the inflammation
- Topical diclofenac: may be used for mild AKs. Moderate efficacy but much fewer side-effects
- Topical imiquimod: trials have shown good efficacy
- Cryotherapy
- Curettage and cauter
Skin & DM: Necrobiosis lipoidica
o Shiny, painless areas of yellow/red/brown skin typically on the shin o Often associated with surrounding telangiectasia
Skin & DM: Infection
o Candidiasis
o Staphylococcal
Skin & DM
Neuropathic ulcers
* Vitiligo
* Lipoatrophy
* Granuloma annulare
LICHEN
* Planus:
Purple, Pruritic, Papular, Polygonal rash on flexor surfaces. Wickham’s striae over
surface. Oral involvement common
LICHEN Sclerosus
itchy white spots typically seen on the vulva of elderly women
Lichen Planus causes
Is a skin disorder of unknown etiology; most probably being immune mediated
Features
* Itchy, papular rash most common on the
palms, soles, genitalia and flexor surfaces
of arms
* Rash often polygonal in shape, ‘white-lace’
pattern on the surface (wickham’s striae)
* Koebner phenomenon seen
* Mucous membrane involvement
* Nails: thinning of nail plate, longitudinal
ridging
Lichenoid drug eruptions - causes: * Gold
* Quinine * Thiazides
LICHEN Sclerosus
Was previously termed lichen sclerosus et atrophicus. It is an inflammatory condition which usually affects the genitalia and is more common in elderly ♀s. Lichen sclerosus leads to atrophy of the epidermis with white plaques forming
Features
* Itch is prominent
A biopsy is often performed to exclude other diagnoses
Management
* Topical steroids and emollients
* ↑ risk of vulval cancer
Scabies features
Features
* Widespread pruritus
* Linear burrows on the side of fingers, interdigital webs and flexor
aspects of the wrist
* In infants the face and scalp may also be affected
* Secondary features are seen due to scratching: excoriation, infection
Scabies causes
mite Sarcoptes scabiei and is spread by prolonged skin contact. It typically affects children and young adults.
Scabies management
Management
* Permethrin 5% is first-line
* Malathion 0.5% is second-line
* Give appropriate guidance on use (see below)
* Pruritus persists for up to 4-6 weeks post eradication
The BNF advises to apply the insecticide to all areas, including the face and scalp, contrary to the manufacturer’s recommendation. Patients should be given the following instructions:
- Apply the insecticide cream or liquid to cool, dry skin
- Pay close attention to areas between fingers and toes, under nails, armpit area, creases of the
skin such as at the wrist and elbow - Allow to dry and leave on the skin for 8–12 hours for permethrin, or for 24 hours for malathion,
before washing off - Reapply if insecticide is removed during the treatment period, e.g. If wash hands, change
nappy, etc - Repeat treatment 7 days later
Psoriasis: type 1
Type 1
* Presents < 40 years old
* Positive family history
* Associated with HLA-CW6
Psoriasis: type 2
- Presents > 50 years old
- No family history
Psoriasis: features
- Red, scaly plaques
- Scalp, extensor surfaces elbows/knees, sacrum
- Nail signs: pitting, onycholysis
- Arthritis
Factors may exacerbate psoriasis:
Trauma
* Alcohol
* drugs: β blockers, lithium,
antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors
* Systemic steroids withdrawal
Psoriasis cause
Abnormal T cell activity stimulates keratinocyte proliferation (rather than an actual primary keratinocyte disorder)
* Mediated by type 1 helper T cells
Psoriasis management
opical
* Simple emollients
* Coal tar: probably inhibit DNA synthesis
* Topical corticosteroids: particularly flexural disease.
Mild steroids are useful in facial psoriasis
* Calcipotriol: vitamin D analogue which ↓ epidermal
proliferation and restores a normal horny layer
* Dithranol: inhibits DNA synthesis, wash off after 30
mins, SE: burning, staining
Flexural psoriasis * emollients
* topical steroids
Psoriasis Phototherapy
Phototherapy
* Narrow band ultraviolet B light (311-313nm) is now
the treatment of choice
* Photochemotherapy is also used - psoralen +
ultraviolet A light (PUVA)
* Adverse effects: skin ageing, squamous cell cancer
(not melanoma)
Scalp psoriasis
Calcipotriol lotion
* Steroid lotion + shampoo
* Combination shampoo:
betamethasone with vitamin D
analogues
* Coconut oil compound
shampoos (combination of coal
tar, salicylic acid and sulphur) * Tar shampoo
Systemic therapy psoriasis
- Methotrexate: useful if associated joint disease
- Biological agents: infliximab, etanercept and adalimumab, Ustekinumab (IL-12 and IL-23
blocker) is showing promise in early trials. - Cyclosporin
- Systemic retinoids
Guttate psoriasis
s more common in children and adolescents. It may be precipitated by a streptococcal infection (tonsillitis) 2-4 weeks prior to the lesions appearing
Features
* Tear drop papules on the trunk and limbs
Guttate psoriasis Management
- Most cases resolve spontaneously within 2-3 months
- There is no firm evidence to support the use of antibiotics to eradicate streptococcal infection
- Topical agents as per psoriasis
- UVB phototherapy
- Tonsillectomy may be necessary with recurrent episodes
Toxic Epidermal Necrolysis (TEN) features
Features
* Systemically unwell e.g. Pyrexia, tachycardic
* Positive Nikolsky’s sign: the epidermis
separates with mild lateral pressure
Drugs known to induce TEN
Phenytoin Sulphonamides Allopurinol Penicillins Carbamazepine NSAIDs
Keloid scars
Predisposing factors
* More common in young, black, male adults, rare in the elderly
* Common sites (in order of decreasing frequency): sternum, shoulder, neck, face, extensor
surface of limbs, trunk
* Keloid scars are less likely if incisions are made along relaxed skin tension lines*
keloid Treatment
Treatment
Treatment
* Early keloids may be treated with intra-lesional steroids e.g. Triamcinolone
* Excision is sometimes require
Acanthosis nigricans: describes symmetrical, brown, velvety plaques that are often found on the neck, axilla and groin
Causes
* Internal malignancy (esp. Gastrointestinal)
* Insulin-resistant diabetes mellitus
* Obesity
* Acromegaly
* Cushing’s disease
* Hypothyroidism
* Polycystic ovarian syndrome
* Familial
* Prader-Willi syndrome
* Drugs: oral contraceptive pill, Nicotinic acid
Eczema:
UK Working Party Diagnostic Criteria for Atopic Eczema An itchy skin condition in the last 12 months
Plus three or more of
* Onset below age 2 years*
* History of flexural involvement**
* History of generally dry skin
* Personal history of other atopic disease***
* Visible flexural dermatiti
Eczema: Management:
Topical steroids
* moderate: Clobetasone butyrate 0.05%
* potent: Betamethasone valerate 0.1%
* very potent: Clobetasol propionate 0.05%
Pompholyx
is a type of eczema which affects both the hands (cheiropompholyx) and the feet (pedopompholyx). It is also known as dyshidrotic eczema
Features
* Small blisters on the palms and soles
* Pruritic, sometimes burning sensation
* Once blisters burst skin may become dry and crack
Pityriasis rosea
Overview
* Cause unknown, herpes hominis virus 7 (HHV-7) is a possibility
* Tends to affect young adults
Herald patch (usually on trunk)
* Followed by erythematous, oval, scaly
patches which follow a characteristic distribution with the longitudinal diameters of the oval lesions running parallel to the line of Langer. This may produce a ‘fir-tree’ appearance
Pityriasis rosea treatment
Self-limiting, usually disappears after 4-6 weeks
Pityriasis Versicolor,
also called tinea versicolor, is a superficial cutaneous fungal infection caused by Malassezia furfur (formerly termed Pityrosporum ovale)
Features
* Most commonly affects trunk
* Patches may be hypopigmented, pink or
brown (hence versicolor)
* Scale is common
* Mild pruritus
Pityriasis Versicolor,Predisposing factors
Predisposing factors
* Occurs in healthy individuals
* Immunosuppression
* Malnutrition
* Cushing’s
Pityriasis Versicolor, Management
Topical antifungal e.g. Terbinafine or selenium sulphide
* If extensive disease or failure to respond to topical treatment then consider oral itraconazole
Acne Rosacea is a chronic skin disease of unknown aetiology
features
Features
* Typically affects nose, cheeks and forehead
* Flushing is often first symptom
* Telangiectasia are common
* Later develops into persistent erythema with papules and pustules
* Rhinophyma
* Ocular involvement: blepharitis
Acne Rosacea Management
Management
* Topical metronidazole may be used for mild symptoms (i.e. Limited number of papules and pustules, no plaques)
* More severe disease is treated with systemic antibiotics e.g. Oxytetracycline
* Recommend daily application of a high-factor sunscreen
* Camouflage creams may help conceal redness
* Laser therapy may be appropriate for patients with prominent
telangiectasia
Acne vulgaris
Follicular epidermal hyperproliferation resulting in the formation of a keratin plug. This in turn
causes obstruction of the pilosebaceous follicle. Activity of sebaceous glands may be controlled
by androgen, although levels are often normal in patients with acne
* Colonisation by the anaerobic bacterium propionibacterium acnes
* Inflammation
Acne may be classified into mild, moderate or severe:
Mild: open and closed comedones with or without sparse inflammatory lesions.
* Moderate acne: widespread non-inflammatory lesions and numerous papules and pustules
* Severe acne: extensive inflammatory lesions, which may include nodules, pitting, and scarring
A simple step-up management scheme often used in the treatment of acne is as follows:
- Single topical therapy (topical retinoids, benzyl peroxide)
- Topical combination therapy (topical antibiotic, benzoyl peroxide, topical retinoid)
- Oral antibiotics: e.g. Oxytetracycline, doxycycline. Improvement may not be seen for 3-4
months. Minocycline is now considered second line treatment due to the possibility of irreversible pigmentation. Gram negative folliculitis may occur as a complication of long-term antibiotic use - high-dose oral trimethoprim is effective if this occurs - Oral isotretinoin: only under specialist supervision
Isotretinoin Adverse effects
Adverse effects
* Teratogenicity: ♀s MUST be using two forms of contraception (e.g. Combined oral
contraceptive pill and condoms)
* Dry skin, eyes and lips: the most common side-effect of isotretinoin
* Nose bleeds (caused by dryness of the nasal mucosa)
* Low mood
* Raised triglycerides
* Hair thinning
* Benign intracranial hypertension: isotretinoin treatment should not be combined with
tetracyclines for this reason
Zinc deficiency
Features
* Perioral dermatitis: red, crusted lesions
* Acrodermatitis
* Alopecia
* Short stature
* Hypogonadism
* Hepatosplenomegaly
* Geophagia (ingesting clay/soil)
* Cognitive impairment
Koebner phenomenon describes skin lesions which appear at the site of injury.
Psoriasis
* Vitiligo
* Warts
* Lichen planus
* Lichen sclerosus
* Molluscum contagiosum
Café-au-lait spots: Hyperpigmented lesions that vary in color from light brown to dark brown, with borders that may be smooth or irregular
Causes:
* Neurofibromatosis type I & II
* Tuberous sclerosis
* *
Fanconi anemia Mccune-Albright syndrome
Bullous pemphigoid cause
autoimmune condition causing sub-epidermal blistering of the skin. This is secondary to the development of antibodies against hemidesmosomal proteins BP180 and BP230
Bullous pemphigoid is more common in elderly patients. Features include
- Itchy, tense blisters typically around flexures
- Mouth is usually spared
Skin biopsy - Immunofluorescence shows IgG and C3 at the dermoepidermal junction
Bullous pemphigoid
Management
* Referral to dermatologist for biopsy and confirmation of diagnosis
* Oral corticosteroids are the mainstay of treatment
* Topical corticosteroids, immunosuppressants and antibiotics are also used
Pemphigus vulgaris
s an autoimmune disease caused by antibodies directed against desmoglein, a cadherin-type epithelial cell adhesion molecule. It is more common in the Ashkenazi Jewish population
bullous pemphigoid vs pemphigus vulgaris
- No mucosal involvement: bullous pemphigoid
- Mucosal involvement: pemphigus vulgaris
Molluscum contagiosum:
caused by poxvirus, common in immunocompermised patients, flesh-white or colored, dome-shaped, and pearly in appearance. They are often 1–5 millimeters in diameter, with a dimpled center. They are generally not painful, but they may itch or become irritated. Picking or scratching the bumps may lead to further infection or scarring.
Dermatitis herpetiformis
Dermatitis herpetiformis is an autoimmune blistering skin disorder associated with coeliac disease. It is caused by deposition of IgA in the dermis.
Irritant contact dermatitis:
common - non-allergic reaction due to weak acids or alkalis (e.g.
Detergents). Often seen on the hands. Erythema is typical, crusting and vesicles are rare
- Allergic contact dermatitis
type IV hypersensitivity reaction. Uncommon - often seen on the head following hair dyes. Presents as an acute weeping eczema which predominately affects the margins of the hairline rather than the hairy scalp itself. Topical treatment with a potent steroid
Nickel Dermatitis:
is a common cause allergic contact dermatitis and is an example of a type IV
hypersensitivity reaction. It is often caused by jewellery such as watches. It is diagnosed by a skin
patch test
Porphyria Cutanea Tarda cause
most common hepatic porphyria. It is due to an inherited defect in uroporphyrinogen decarboxylase or caused by hepatocyte damage e.g. alcohol, estrogens
Porphyria Cutanea Tarda features
Features
* Classically presents with photosensitive rash with blistering and skin fragility on the face and dorsal aspect of hands (most common feature)
* Hypertrichosis
* Hyperpigmentation
Porphyria Cutanea Tarda investigations
Investigations:
* Urine: elevated uroporphyrinogen and pink fluorescence of urine under Wood’s lamp
Keratoacanthoma
benign epithelial tumour. They are more frequent in middle age and do not become more common in old age (unlike basal cell and squamous cell carcinoma)
Features - said to look like a volcano or crater
* Initially a smooth dome-shaped papule
* Rapidly grows to become a crater centrally-filled with keratin
Granuloma annulare
Papular lesions that are often slightly hyperpigmented and depressed centrally
* Typically occur on the dorsal surfaces of the hands and feet, and on the extensor aspects of the
arms and legs
Erythrasma
generally asymptomatic, flat, slightly scaly, pink or brown rash usually found in the groin or axillae.
overgrowth of the diphtheroid Corynebacterium minutissimum
Topical miconazole or antibacterial are usually effective
Photosensitive skin disorders diseases aggravated by exposure to sunlight:
- Systemic lupus erythematosus, discoid lupus * Porphyria (not acute intermittent)
- Herpes labialis (cold sores)
- Pellagra
- Xeroderma pigmentosum * Solar urticaria
- Polymorphic light eruption
Tinea capitis (scalp ringworm)
A cause of scarring alopecia mainly seen in children
* Most common cause is trichophyton tonsurans in the UK and the USA
* May also be caused by microsporum canis acquired from cats or dogs
* Diagnosis: lesions due to microsporum canis green fluorescence under wood’s *
Tinea corporis
Causes include Trichophyton rubrum (also causes fungal nail infection) and Trichophyton verrucosum (e.g. From contact with cattle)
* Well-defined annular, erythematous lesions with pustules and papules
* May be treated with oral fluconazole
Tinea pedis (athlete’s foot)
- Characterized by itchy, peeling skin between the toes
- Common in adolescence
Stevens-Johnson syndrome features
features
* Rash is typically maculopapular with target lesions being characteristic. May develop into vesicles or bullae
* Mucosal involvement
* Systemic symptoms: fever, arthralgia
Stevens-Johnson syndrome causes
Causes
* Idiopathic
* Bacteria: mycoplasma, streptococcus
* Viruses: herpes simplex virus, orf
* Drugs: penicillin, sulphonamides, carbamazepine, allopurinol, nsaids, oral contraceptive pill
* Connective tissue disease e.g. Sle
* Sarcoidosis
* Malignancy
pruritus: causes
Liver disease
Iron deficiency anemia
Polycythemia
CKD
Causes of hirsuitism
hirsuitism is often used to describe androgen-dependent hair
Polycystic ovarian syndrome
* Cushing’s syndrome
* Congenital adrenal hyperplasia
* Androgen therapy
* Adrenal tumour
* Androgen secreting ovarian tumour
* Drugs: phenytoin
causes of Hypertrichosis
Hypertrichosis being used for androgen-independent hair growth
Drugs: minoxidil, Cyclosporin, diazoxide
* Congenital hypertrichosis lanuginosa,
congenital hypertrichosis terminalis
* Porphyria cutanea tarda
* Anorexia nervosa
* GI and Lung malignancies.
Assessment of hirsuitism
- Ferriman-Gallwey scoring system: 9 body areas are assigned a score of 0 - 4, a score > 15 is considered to indicate moderate or severe hirsutism
Management of hirsuitism
Management of hirsuitism
* Advise weight loss if overweight
* Cosmetic techniques such as waxing/bleaching - not available on the NHS
- Consider using combined oral contraceptive pills such as co-cyprindiol (Dianette) or ethinylestradiol and drospirenone (Yasmin). Co-cyprindiol should not be used long-term due to the increased risk of venous thromboembolism
- Facial hirsuitism: topical eflornithine - contraindicated in pregnancy and breast-feeding
Yellow nail syndrome: associations
Bronchiectasis
* Chronic sinus infections
Congenital lymphedema
* Pleural effusions
Onychomycosis causes
Dermatophytes - mainly Trichophyton rubrum, 90% of cases
* Yeasts - such as Candida
* Non-dermatophyte moulds
Onychomycosis treatment t
- Treatment is successful in around 50% of people
- Diagnosis should be confirmed by microbiology before starting treatment
- Dermatophyte infection: oral terbinafine is currently recommended first-line with oral
itraconazole as an alternative. Six weeks therapy is needed for fingernail infections whilst
toenails should be treated for 12 weeks - Candida infection: mild disease should be treated with topical antifungals (e.g. Amorolfine)
whilst more severe infections should be treated with oral itraconazole for a period of 12 weeks
Onycholysis describes the separation of the nail plate from the nail bed
Causes
* Idiopathic
* Trauma e.g. Excessive manicuring
* Infection: especially fungal
* Skin disease: psoriasis, dermatitis
* Impaired peripheral circulation e.g. Raynaud’s
* Systemic disease: hyper- and hypothyroidism
