Nail Disorder Flashcards
What are the nail disorders?
Psoriasis Onycomycosis Onycholysis Paronychia Subungual Hematoma Ingrown Toenail (unguis incarnatus)
How do onychomycosis appear?
complaints about the appearance of the nail, with no physical symptoms
As the disease progresses, interference with standing, walking, and exercising
Paresthesia, pain, discomfort, and loss of dexterity
Loss of self-esteem and inhibited social interaction
How do you dx onycomycosis?
KOH in DMSO
What are the topical treatment for onycomycosis?
Ciclopirox olamine 8% nail lacquer solution
Efinaconazole 10% topical solution (the first FDA-approved topical triazole for toenail onychomycosis)
Topical treatments may be useful to prevent recurrence in patients cured with systemic agents
What is the systemic treatment for onychomycosis?
Terbinafine
Itraconazole
What co infection is suspected with onycholysis?
yeast infection is suggested- Perform mycologic studies to exclude onychomycosis, including potassium hydroxide wet mount and fungal cultures
How do you treat onycholysis?
tx underlying cause,topical antifungal imidazole or allylamine twice daily to avoid superinfection of the nail.
What is the tx for onycholysis due to psoriasis or eczema?
midstrength topical corticosteroid
How do you tx onycholysis with onychomycosis?
oral broad-spectrum antifungal agent (ie, fluconazole, itraconazole, terbinafine)
What do you see in nails with psoriasis?
oil stain or nail pitting
What are nail disorders associated with systemic disease?
Muehrckes Nails Half and Half Nail Fold Telangiectasia Onycholysis Periungual Fibroma Yellow Nail Syndrome Blue Nails Splinter Hemorrhage Beau’s Lines Koilonychia Clubbed Fingers Terry’s Nails
What are paired horizontal white bands that are immobile and what causes this?
muehrckes nails due to nephrotic syndrome or low serum albumin
What are Proximal 2/3 white Distal 1/3 red nails and what causes it?
terry’s nail, CHF and hepatic cirrhosis
What is Dilation of terminal small blood vessels?
telangiectasia
What causes nail fold telangiectasia?
Dermatomyositis
SLE
Scleroderma
RA
What causes blue nails?
wilson’s disease - accumulation of copper
What medication do you give for blue nails?
minocycline, quinacrine
What is clubbed nails?
acquired via cardiopulm disease
What causes koilonychia?
spoon nail due to iron def anemia
What is Temporary growth arrest, due to any stress?
beau’s lines
What causes splinter hemorrhages?
bacterial endocarditis
What causes unguis incarnatus?
Wearing shoes that are so tight they compress the ridges of the cuticles against the relatively stiff nail material, turning the nail into a cutting surface
cutting nails too short
What toe is most involved in ingrown toenail?
big toe, lateral side more than medial
What is Soft tissue infection around a fingernail that begins as cellulitis but that may progress to a definite abscess?
paronychia
How does acute paronychia present?
painful, purulent condition
How can you remove nail?
life nail out, entire lateral side of nail and cauterize so it doesnt grow back
What is the most common cause of paronychia?
staphylococci
What test do you get if herpetic whitlow is suspected in paronychia?
tzanck smear
How do you treat early paronychia?
warm soaks 3-4 times daily[1
How do you tx pt with cellulitis with paronychia?
clindamycin, Augmentin, or Keflex
What do you have to do for paronychia abcess?
incision and drainage
What causes subungual hematoma?
blunt or sharp trauma
What happens in subungual hematoma?
blood builds up and can cause nail bed to fall off and never come back
How do you treat subungual hematoma?
nddle 18 guage - within first few days, get x ray to check for fracture
Does drainage of subungual hematoma accelerate healing?
no
Is subungual hematoma painful?
no
