Nail Disorders Flashcards
acute paronychia
- acute infection of proximal or lateral nail folds
- nail fold is swollen, erythematous and painful +/- abscess formation
- break in integrity of epidermis
MC infection in paronychia
staph aureas
tx of acute paronychia
- topical abx
- oral abs
- I&D if abscess present
felon
- abscess of the distal pad of the fingertip (MC w/ staph)
- may compromise blood flow and lead to necrosis of the skin, pad, or osteomyelitis
S/S of a felon
- intense throbbing pain
- erythema and swelling
- +/- abscess
tx of felon
- oral abx
- tetanus if indicated
- consider radiograph
- I&D w/ abscess
green nails are caused by infection w/ what?
pseudomonas aeruginosa
green nails
- green to green/black discoloration of the nail
- often associated w/ onycholysis
- likely to have hx of prolonged exposure to water or detergents, or an ungual trauma
tx of green nails
- trim nail and soak 2-3 X/day in dilute bleach or vinegar solution
- no systemic abx
onychomycosis / tinea unguium causative fungi
- dermatophyte fungi, mainly trichophyton rubrum is the major cause
- can be from many others
presentation of onychomycosis / tinea unguium
- white/yellow discoloration of nail w/ subungual hyperkeratosis, onycholysis and thickened nail plate
- +/- pain
- tinea pedis often present
- typically involves distal/lateral subungual portion
- white superficial pattern
- candida in the immune suppressed
dx of onychomycosis / tinea unguium
- most sensitive: nail clipping in formalin - fungus stains + w/ PAS
- fungal culture
- KOH false negatives common
tx of onychomycosis / tinea unguium
- fluconazole
- antifungal creams or powders after tx
nail psoriasis
- nail pitting, onycholysis w/ erythematous border, subungual debris and salmon patches (oil drop sign)
- appear as yellow - red areas of discoloration in the center of nail or border
- can be isolated but is in 50% of those w/ cutaneous psoriasis
tx of nail psoriasis
- hard to tx
- topical high potency steroids
- calcipotriol
- tazarotene
- IL Kenalog
- acetretin
lichen planus of the nail
- abrupt onset w/ longitudinal riging, thinning, fissuring and loss of nail palte
- onycholysis and/or subungual hyperkeratosis also possible
association of lichen planus of the nails and lichen planus
- about 10% of pts w/ mucosal membrane or skin LP also have nail involvement
- commonly occurs in isolation
progression of lichen planus of the nails can lead to what?
-pterygium formation: scarring to nail matrix; v-shaped extension of the skin of proximal nail fold that adheres to nail bed
tx of nail lichen planus
- 1st line: systemic or intralesional corticosteroids
- topical tacrolimus; combo tazarotene and clobetasol
- urea
- oral retinoids
alopecia areata of nails
- small, superficial nail pitting in a regularly distributed pattern
- possible punctate leukonychia, mottled lunulae, acute onycholysis, sandpaper-like nails
- nail changes can precede, occur w/, or after hair loss
tx of alopecia areata of nails
- oral or intralesional corticosteroids
- possible spontaneous resolution
- topical tazarotene
onycholysis
- detachement of nail plate from bed
- appears white d/t air b/w
- cause: traumatic, mechanical, or chemical damage
- bacteria can cause color change such as green, black, blue
tx of onycholysis
- clipping of affected nail
- keep dry
- rarely meds and light exposure
chronic paronychia MC affects which fingers?
first, second, and third fingers of the dominant hand
presentation of chronic paronychia
-inflammation of nail fold w/ mild redness, edema and tenderness
cuticle missing or separated from nail plate
-cuticle damage and secondary bacterial or candida
management of chronic paronychia
- hand protection from environmental hazards is mandatory for remission
- tx w/ topical steroids
habit tic deformity
-thumb nail shows a central longitudinal furrow w/ multiple transverse parallel lines
habit tic deformity is caused by?
nervous tic of pushing back the cuticle and the proximal nail fold of thumb w/ index finger
tx of habit tic deformity
- behavior modification is best
- SSRIs or other tx for OCD
- super glue to proximal nail fold 1-2 x/week as barrier
nail signs of systemic dz
- beau’s lines
- onychomadesis
- terry nails
- koilonychia
- clubbing
beau’s lines
- transverse furrows that begin in matrix and progress distally
- d/t temporary arrest of functional nail matrix
- usually b/l
possible causes of beau’s lines
- chemo
- high fever
- viral illness
- surgery
onychomadesis
- shedding of nail plate from the proximal end
- from temporary arrest of the nail matrix fxn
- causes are same as for beau’s lines but more severe
onychomadesis in children often relates to what?
-recent coxsackievirus infection (hand foot mouth)
terry nails
- distal 1-2 mm of nail shows nl pink and proximal nail has white appearance
- liver dz, chronic CHF, very elderly
koilonychia
- spoon nails
- thin and concave w/ edges everted
- familial forms can occur
- can be associated w/ faulty Fe metabolism, deficiency, and hypothyroid
nail clubbing
- overcurvature of nails
- they bulge and are curved in a convex arc. transverse and longitudinal
- soft tissues of terminal phalanx are bulbous
what is schamroth’s sign
- no diamond-shaped window when dorsal surfaces of corresponding finger of each hand are opposed
- seen in nail clubbing
causes of nail clubbing
- pulmonary, cardiac, thyroid, hepatic, or GI dz
- HIV
- can be hereditary
