Nail Disorders

Question 1

What is the causative agent in Tinea Unguium/Onychomycosis?

Answer 1

Agent: T rubrum or mentagrophytes

Question 1

Fungal infection of the nail - 80% on feet (great toes)

Associated with tinea pedia

Most common in immunocompromised patients and diabetics

Patient presents with:
Onycholysis
Debris under the nail
Yellowed, thickening and crumbling (Look for separation of the nailbed)
Chalky white patches on nail

Requires systemic treatment

Answer 1

Tinea Unguium/Onychomycosis

Question 2

What are some treatment options for Tinea Unguium/Onychomycosis?

Answer 2

Topical: Sporanox, Lamisil, ciclopirox

Oral: Terbinafine, Itraconazole

Other: debridement and/or removal of the nail

Question 3

Acute infection of lateral or proximal nail folds

Usually associated with break in integrity of the epidermis - i.e. hangnail, nailbiting, trauma, manicure, dish-washing, chemicals

Answer 3

Paronychia

Question 4

What is the most common organism with paronychia?

Answer 4

Typically S. aureus

Question 5

What are some clinical manifestations of a paronychia?

Answer 5

Erythema
Swelling
Throbbing pain
+/- abscess formation
Infection may extend deeper, forming a felon

Question 6

What is the treatment for a paronychia?

Answer 6

Can resolve spontaneously
Warm soaks
I&D if abscess present
PO antibiotics controversial

Question 7

Infection of the pulp of the finger

Answer 7

Felon

Question 8

the absence of nails

Answer 8

Anonychia

Question 9

When the absence is congenital, it usually involves all of the nails, and the condition is permanent

This condition may also occur temporarily following trauma or as a result of systemic/local disease

It is also seen in nail-patella syndrome

Answer 9

Anonychia

Question 10

Transverse lines or ridges that mark repeated disturbances of nail growth

May be associated with trauma or a systemic disease process

Answer 10

Beau’s Lines

Question 11

This disorder of the nail is associated with chronic pulmonary disease as well as cardiac disease

Answer 11

Clubbing

Question 12

Refers to extremely soft nails that may be prone to splitting

This is associated with endocrine disturbances and malnutrition,
as well as contact with strong alkali solutions

Answer 12

Hapalonychia

Question 13

Hemorrhage beneath the toenail may be associated with what conditions?

Answer 13

Vitamin C deficiency
subacute bacterial endocarditis
dermatologic disorders

Question 14

Hypertrophy of the nail bed that may be associated with onychomycosis, psoriasis, and other dermatologic disorders

Answer 14

Hyperkeratosis Subungualis

Question 15

Concavity of the nail plate in both the longitudinal and transverse axes that is associated with nutritional disorders, iron deficiency anemia, and endocrine disorders

Answer 15

Koilonyhia

Question 16

White spots or striations in the nail resulting from trauma or systemic diseases such as nutritional and endocrine deficiencies

Answer 16

Leukonychia

Question 17

A greatly thickened nail plate caused by persistent mild trauma and/or onychomycosis

Answer 17

Onychauxis

Question 18

Inflammation of the nail matrix causing deformity of the nail plate

Trauma, infection, and systemic diseases such as exanthemas are causes

Answer 18

Onychia

Question 19

Inflammation of the nail

Answer 19

Onychitis

Question 20

Breakage or fracture of the nail plate

Answer 20

Onychoclasis

Question 21

Ingrowing of the nails or more specifically hypertrophy of the nail lip

Also referred to as hypertrophied ungualabia

It is one of the most frequent pathologic conditions of the toenail

Answer 21

Onychocryptosis

Question 22

Claw nail or ram’s horn nail

Extreme hypertrophy of the nail gives the appearance of a claw or horn

The condition may be congenital or a symptom of many chronic systemic diseases such as tinea infections

See onychauxis (synonym)

Answer 22

Onychogryphosis

Question 23

Loosening of the nail plate beginning along the distal or free edge when trauma, injury by chemical agents, or diseases loosen the nail plate

This condition is associated with psoriasis, onychomycosis, acute fevers, and syphilis

Answer 23

Onycholysis

Question 24

A tumor of the nail unit

Answer 24

Onychoma

Question 25

Complete loss of the nail plate

Answer 25

Onychomadesis

Question 26

Softening of the nail

Answer 26

Onychomalacia

Question 27

Fungal infection of the nail associated with fungal disease of the foot

Answer 27

Onychomycosis

Question 28

Longitudinal ridging and splitting of the nails caused by dermatoses, nail infections, systemic diseases, senility, or injury by chemical agents

Answer 28

Onychorrhexis

Question 29

Lamination and scaling away of the nails in thin layers caused by dermatoses, syphilis, or injury by chemical agents

Answer 29

Onychoschizia

Question 30

Disease or deformity of the nail plate

Answer 30

Onychosis

Question 31

Atrophy or failure of development of a nail caused by trauma, infection, endocrine dysfunction, or systemic disease

Answer 31

Onychotrophia

Question 32

Extreme thickening of all the nails

In this condition, the nails are more solid and more regular than in onychogryphosis

Usually this is a congenital condition associated with hyperkeratosis of the palms and soles

Answer 32

Pachyonychia

Question 33

Inflammation in the soft tissues around the nail margin

It may occur following infection or trauma

The infectious agent may be either bacterial or fungal

Answer 33

Paronychia

Question 34

The cuticle appears to grow distal to the nail plate and splits the nail into two or more portions that gradually reduce in size and the pterygium widens

This may result from trauma or poor circulation in the toes

Answer 34

Pterygium