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Pod practice > Nail Deformities > Flashcards

Nail Deformities Flashcards

1
Q

What is Onychauxis?

A
  • Pronounced ‘ony-coxicks’
  • Clinical Abbreviation = OX
  • hypertrophied nail
  • uniform thickening (all across the nail plate)
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2
Q

What are clinical features of OX?

A
  • Uniform thickening across the nail
  • Can be discoloured - yellow/brownish
  • Because of thickness, may not be abel to see vascularised nail bed underneath the plate
  • sulci often enlarged as a result of OX
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3
Q

What is the Aetiology of OX?

A
  • Damage to the nail matrix
  • Trauma
  • Shallow toe box
  • Fungal infection
  • Poor peripheral circulation
  • Age related
  • Psoriasis
  • Digital deformity
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4
Q

What is the pathology of OX?

A
  • Changes to the nail matrix is the main cause of the hypertrophy
  • Keratinocytes/Onychocytes grow upwards rather than forwards
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5
Q

What is the treatment of OX?

A
  • Cut + file nails
  • reduce thickness using nail burr/drill
  • remove debris (OP) with blacks file
  • Footwear appraisal - stitching in footwear is normally double the thickness of the material and is not flexible, meaning the foot has to conform to its shape.
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6
Q

What is Onychogryphosis?

A
  • Clinical abbreviation = OG
  • Classed as hypertrophy of the nail with deformity
  • Also known as ‘Rams Horn’ deformity
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7
Q

What are clinical features of OG?

A
  • Transversal ridged surface of nail plate
  • Enlarged/inflamed sulci
  • Nail grey/yellow/brownish
  • Hypertrophy of nail plate
  • Curvature of nail plate to the side
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8
Q

What is the aetiology of OG?

A
  • Major trauma - often single heavy blow
  • Repeated minor trauma - e.g ill fitting shoes
  • Secondary to an infection
  • Impaired blood supply
  • Epidermal dyplasias
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9
Q

What is the pathology of OG?

A
  • Neglect of the free edge of the nail can result in increased intermittent compression to the nail and therefore can damage part of the nail matrix
  • Proximal nail fold can retract meaning there is no uniform shape to the nail plate and it does not extend straight across the nail bed
  • The part of the nail matrix which has been damaged grows slower and produces less onychocytes than the undamaged part of the matrix, resulting in the curvature
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10
Q

What is the treatment of OG?

A
  • Reduce the thickness with a nail drill
  • Clear OP from sulci with blacks file
  • Cut and file nail
  • Patient advice
  • Nail Avulsion
    • Surgical option - total nail avulsion with chemical destruction of the nail matrix, if the patient is suitable
    • Conservative option - 40% urea cream, applied biweekly.
      • Urea is a keratolytic, allows hydration of the nail plate and maceration of the nail plate, enabling it to be debrided
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11
Q

What is Onychophosis?

A
  • Clinical Abbreviation = OP
  • Debris in the sulci, lateral nail folds
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12
Q

What are clinical features of OP

A
  • Debris to sulci - Dry + Hard / Soft + Moist
  • Subungal corn / callus
  • Can result in localised inflammation and pain
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13
Q

What is the aetiology of OP?

A
  • Poor nail cutting technique
  • Pressure from footwear
  • Excessive pronation - rubbing and shearing of hallux both medially and laterally
  • Pressure from adjacent toes
  • Atrophic skin
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14
Q

What is the pathology of OP?

A
  • Lateral pressure to the toe nail
  • Inflammation of the nail sulci
  • Inflammation of the epithelium
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15
Q

What is the treatment of OP?

A
  • Removal of soft debris with blacks file
  • Callus debridement, corn enucleation
  • Nail may need to be cut to expose OP
  • File with blacks file to limit trauma
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16
Q

What is Onychomychosis?

A
  • Clinical Abbreviation = OM
  • Fungal nail infection of the toes, can also affect fingernails
  • Can involve any component of the nail (Matrix, Plate, Bed)
  • Generally not painful, however thickened nails can sometimes press into sulci
  • About 3% of UK population may have OM, thought to be increasing due to aging population
  • Diabetes patients more susceptible to getting it
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17
Q

What are the four different clinical presentations of OM?

A
  • Distal Subungal (DSO)
  • White Superficial (WSO)
  • Proximal Subungal (PSO)
  • Candida Onychomychosis
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18
Q

What is Distal Subungal Onychomychosis?

A
  • Clinical Abbreviation = DSO (or DLSO if lateral as well)
  • Most common form of OM
  • Initially affect the hyponychium and lateral edges of nail, then spreads across the nail bed
  • Associated with Onychauxis, Onychophosis, Onycholysis
  • Typically caused by T.rubrum, but could also be T.mentagrophytes, T.tonsurans and E.floccosum
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19
Q

What are Dermatophytes?

A
  • Fungi that require keratin for growth
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20
Q

What is Proximal Subungal Onychomychosis?

A
  • Clinical Abbreviation = PSO
  • Relatively uncommon
  • Organisms invade the nail plate via the proximal nail fold
  • Can look similar to Leukonychia
  • Caused by T.rubrum, T.megninii, and E.floccosum
  • Considered an early clinical marker of HIV
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21
Q

What is White Superficial Onychomychosis?

A
  • Clinical Abbreviation = WSO
  • Occurs when there is bacterial invasion of the superficial layers of the nail plate directly
  • Presence of opaque ‘white islands’
  • Nail can become soft, rough and crumbly
  • Caused by T.mentagrophytyes
    *
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22
Q

What is the aetiology of OM?

A
  • Occurs more frequently in hallux nail plate
  • occurs usually distally to nail matrix
  • Micro trauma - break in the nail surface
  • Poor foot hygiene
  • Immunosuppression is a factor
  • Occlusive footwear - moisture not wicked away from the skin
  • Moist warm environment for fungal growth
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23
Q

What is the pathology of OM?

A
  • Crack in the nail
  • Dermatophytes replicate in this area
  • Dermatophytes can metabolise keratin
  • Nail plate is colonized, feed on keratin, dissolved with enzyme meaning nail is destroyed
  • Common dermatophytes:
    • Tricophytum rubrum
    • Tricophytum interdigitale
    • Tricophyton mentagrophytes
    • Epidermphyton flocossum
    • Candida Albicans
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24
Q

How can you diagose OM?

A
  • Nail sample can be taken off to confirm presence of Fungal elements
  • need to utilise clinical knowledge before this step is taken
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25
Q

How do you treat OM?

A
  • Reduction of thickness with drill
  • Remove any OP
  • Oral and topical treatments are availbale
  • In extreme cases, where oral treatments not avialable - nail surgery
  • Laser
  • Phototherapy
  • Nail avulsion
26
Q

What is Paronychia?

A
  • Inflammation of the tissue surrounding the nail plate
  • Frequently occurs alongside Onychia
27
Q

What are clinical features of Paronychia?

A
  • Inflammatory signs
  • Localised erythema
  • Paim
  • Warm
  • Acute or Chronic
28
Q

What is the aetiology of Paronychia?

A
  • Foreign body
  • Bacteria
  • Manifestation of systemic disease
  • Local trauma
29
Q

What is the pathology of Paronychia?

A
  • Localised inflammatory response
  • Acute - appears suddenly after trauma
  • Chronic - develops slowly, usually caused by fungal infections
30
Q

How should you assess Paronychia?

A
  • Should be regarded as potentially serious
  • Assess level of infection:
    • How far away do signs of infection spread from area?
    • Does patient present with any systemic signs?
  • Promote draining of purulent exudate (pus)
  • Swap, if clinically indicated to:
    • Identify infecting organism to…
    • Identify effective antibiotics
31
Q

What is the treatment of Paronychia?

A
  • Use a dressing pack
  • Sterile dressing & aseptic technique
  • Educate patient on:
    • Signs of clinical infection and indicators of worsening
    • dressing regime
    • return period
  • Referral if high risk patient
32
Q

What is Onychia?

A
  • Inflammation of nail bed and nail matrix
  • Same as Paronychia, except area of inflammation
33
Q

What is Subungal Haematoma?

A
  • Collection of blood underneath the nail plate
34
Q

What are the clinical characteristics of Subungal Haematoma?

A
  • Initially red underneath the nail plate - turns black once the blood is coagulated
  • Patient will usually report incident of trauma
  • Can be very painful for patient
  • Possible localised inflammation around the area of trauma
35
Q

What is the pathology of Subungal Haematoma?

A
  • Trauma results in rupturing of nail vessels, resulting in bleeding into the nail plate
  • Due to trauma Proximal Nail Fold (PNF) may also rupture, causing entry to bacteria
36
Q

What is the treatment of Subungal Haematoma? (acute)

A
  • Drill the distal edge of the haematoma using a fine burr attachment
  • this releases extruded blood an pressure, relieving pain
  • Irrigate and dress the area
37
Q

What is the treatment of Subungal Haematoma? (chronic)

A
  • If blood has coagulated / painful:
    • Use anti inflammatory device
    • Padding/dressing to offload pressure
  • If not painful - monitor
  • Check for Onycholysis / OX
  • Patient advice
38
Q

What are Single Longitudinal Ridges / Myxoid Cyst?

A
  • Benign tumours / Myxoid cysts / warts in the proximal nail fold may exert pressure of the nail fold causing longitudinal groove
39
Q

What is Onycholysis?

A
  • Progressive seperation of the nail plate from the nail bed - distal to proximal
40
Q

What is the aetiology of Onycholysis?

A
  • Systemic - poor peripheral circulation, iron deficiency anaemia, thyrotoxicotis
  • Psoriasis, Eczema
  • Hyperhidrosis
  • Trauma - repetitive minor injury, toe deformity, long nails, shallow/short footwear
41
Q

What is the treatment of Onycholysis?

A
  • Seperation from nail bed is uaually asymptomatic as free end quickly becomes filled with keratinous material and debris
  • Due to location, rarely becomes infected
  • Keep nail short - to prevent recurrence of trauma elevating incident
42
Q

What is Subungal Exostosis?

A
  • Small outgrowth of bone under nail plate, near to the free edge
43
Q

What are clinical characteristics of Subungal Exostosis?

A
  • Cherry red area underneath nail plate
  • Depending on the location of the exostosis, the nail plate may lift from the bed
  • Extreme pain when pressure applied to area
  • Generally speaking occur on the Hallux
44
Q

What is the aetiology of Subungal Exostosis?

A
  • Currently unknown
  • possibly due to trauma, especially extended hallux taking excessive pressure from footwear
45
Q

What is the pathology of Subungal Exostosis?

A
  • Irritation and elevation of the periosteum from the surface of the bone
  • Outgrowth of bone ossifies (bone creation)
  • Appears as a ‘mushroom like’ formation consisting of bone cells
46
Q

What is the treatment of Subungal Exostosis?

A
  • Conservative padding
  • Footwear appraisal
  • Referral for podiatric surgery - surgical procedure is called Exostectomy
47
Q

What is Onychomadesis?

A
  • Seperation of the nail plate from the nail matrix from the proximal end to the distal
48
Q

What is the aetiology of Onychomadesis?

A
  • Temporary cessation of nail growth
  • Nail matrix inflammation
  • If single digit - common causes are trauma, infection, subungal blistering
  • If multiple digits - systemic illness, use of drugs
49
Q

What are Beaus Lines?

A
  • Transverse ridges or grooves
  • Caused by temporary cessation of nail growth
50
Q

What is Pterigium?

A
  • Adhesion of Eponychium to nail bed following the destruction of the matrix
  • Entire nail plate is eventually shed
  • Associated with diminished peripheral circulation
51
Q

What is Pterigium Inversum?

A
  • Attachment of the hyponychium to the distal end of the nail plate
52
Q

What is the aetiology of Pterigium Inversum?

A
  • Systemic:
    • Sclerosis
    • SLE
    • Raynauds
    • poor peripheral circulation
  • Local
    • Lichen planus
    • Trauma
53
Q

What is the treatment of Pterigium Inversum?

A
  • Caution when cutting nails, as tissue could easily be cut when cutting nails
54
Q

What is Onychoschizia?

A
  • Split in the nail plate
55
Q

What is Onychorrhexis?

A
  • Also known as ‘reed nail’
  • Brittle nails, longitudinal ridging
  • May result in Onychoschizia
56
Q

What is Koilonychia?

A
  • Spoon shaped nail
  • Generally a result of deficieny anaemia such as iron
57
Q

What is Onychocryptosis?

A

Ingrown toe nail

58
Q

What are the clinical characteristics of OC?

A
  • Nail spike in sulci, pus my exudate from the point of penetration in the sulcus
  • Usually occurs in hallux
  • Painful, acute tenderness
  • Paronychia / presence of infection
  • Swollen nail folds overlap nail plate
  • Hypergranulation of tissue in chronic cases
59
Q

What is the aetiology of OC?

A
  • Narrow tight-fitting footwear/hosiery
  • Onychomycosis
  • Involuted nails
  • Hyperhidrosis
  • Trauma
  • Family history of OC
60
Q

what is the pathology of OC?

A
  • Nail cut too short / injury occurs
  • Protection is removed
  • Nail grows forward, along the sulci, and spike presses into skin

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