Nail disorders Flashcards
The difference in pitting between alopecia areata and psoriasis?
Irregular spaced in psoriasis and in alopecia areata, it is rather organized and symmetric.
What are Beau’s lines?
Transverse depressions of nail plate.
What causes Beau’s lines?
A temporary disruption in mitotic activity in proximal nail matrix
What is the most common cause of Beau’s lines?
Mechanical trauma or dermatologic dz of proximal nail fold (eczema, psoriasis, paronychia)
What is the cause of Beau’s lines if all the nails are involved?
Systemic cause (febrile illness, drugs)
What is onychomadesis?
Nail shedding
What is the pathophysiology of onychomadesis?
A proximal detachment of nail plate, due to complete arrest of nail matrix activity (causes are the same as beau’s lines)
Pathophysiology of nail pitting?
Parakeratosis on the proximal nail matrix
Causes of pitting?
Psoriasis, alopecia areata, lichen planus, and eczema
What disease is pitting most specific for?
Alopecia areata
What is the difference between the nail pitting in psoriasis vs alopecia areata?
In psoriasis, it is more haphazard and centrally oriented. In alopecia areata, it is more evenly spaced and involves the lateral nail.
What is onychorrhexis?
Longitudinal ridges and fissures with thinned nail plate
What causes onychorrhexis?
Due to diffuse nail matrix dz, trauma, tumors compressing nail matrix, others
Mild longitudinal ridges are common features of aging
What is trachyonychia?
Twenty nail dystrophy/sandpaper nails, opaque, lusterless and rough nails
Most common things associated with trachyonychia?
Alopecia areata (most common), LP, psoriasis, and eczema
What is true leukonychia?
White, opaque discoloration due to parakeratotic cells on ventral plate (most common cause trauma)
Types of true leukonychia?
Punctate, striate, or diffuse
What is pseudoleukonychia?
Friable, fungi in nail plate with superficial white onchyo
What is apparent leukonychia?
Discoloration, nail bed edema, due to hypoalbuminemia or chemotherapy drugs
What is koilonychia?
spoon nails, thinned concave nails.
Causes of koilonychia?
Physiologic in toenails of kids, occupational or severe iron deficiency in adults
What is onycholysis?
Distal nail plate detachment
What causes onycholysis?
Trauma, psoriasis, or onychomycosis
Pigmentation in onycholysis is due to?
microbial colonization or blood
What is photo-onycholysis?
UV light alone or in combo with (tetracycline)
What are the 6 main things associated with onycholysis?
enviromental, primary skin diosrders, infections, drugs, metabolic/systemic disorders, tumors
What metabolic conditions can lead to onycholysis?
hyperthyroidism
What is onychauxis?
Thickened nail ue to subungual hyperkeratosis?
Causes of onychauxis?
Psoriasis, onychomycosis and eczema
Causes of splinter hemorrhages?
Psoriasis, endocarditis, vasculitis
What are some causes of external pigment nail changes?
Tobacco smokers, hair dye
What are some examples of pigment changes from under the nail plate?
Pseudomonas (green), dermatophytes (yellow-white)
What can cause pigment within the plate?
Melanin, iron, or gold
Two causes for the melanin within the nail plate for longitudinal melanonychia?
Activation of melanocytes in the nail matrix or melanocyte hyperlasia 2/2 lentigo, nevus, melanoma
What is hutchinson sign on the nail?
The pigment of proximal nail fold or hyponychium associated with longitudinal melanonychia.
What causes the green color seen in green nail syndrome?
Pseudomonas produces pyocyanin
Risk factor for green nail syndrome?
Prolonged water exposure, nail truama, use of detergents/soaps
Tx for green nail syndrome?
2% sodium hypochlorite or acetic acid for 2-4 months
What is congenital malalignment of great toenails and why is it important?
It is b/l lateral deviation of the big toenails and it predisposes to ingrown toenails
What are the genetics of racque thumbs?
AD
What is racquet thumbs?
Short distal phalanx, broad and short nails, can also be an isolated finding
What is nail-patella syndrome?
AD, LMX1B gene, hypoplasia of radial thumbnails, triangular lunulae, absent/hypoplastic patellae, iliac crest horns, nephropathy in 40%
What is congenital hypertrophy of the lateral fold?
At birth, there is an overgrowth of the lateral skin folds which can partially cover the anil plate and can be painful
What specific nail findings are seen in Darier dz?
Red and white longitudinal streaks, V shaped subungual hyperkeratosis and fissuring (nicking) distal edge, multinuc giant cells in nail bed
What specific nail findings can be seen in psoriasis?
Irregular pits oil spots, onycholysis
note that on the toenails this can look indistinguishabl e from onychomycosis
Nail findings in acrodermatitis continua of Hallopeau?
Usually on one digit with pustules of the nailbed and periungual areas. Can also occur in palmoplantar or generalize pustular psoriasis
Nail findings in parakeratosis pustulosa?
Exclusively in kids, usually on one digit with erythema and vesicles on the fingertip that progresses to onycholysis and subungual hyperkeratosis
Nail findings in lichen planus?
10% have findings. Onychorrhexis (long ridges), dorsal pterygium (if prox nail fold adhesion to nail bed)
Nail findings in alopecia areata?
20-50% of AA, grid-like pitting or trachyonychia in kids
Nail findings in eczema?
If rash involves the prox nail fold or matrix, irregular pitting, onycholysis, beau’s lines
What is the definition of clubbing?
>180* angle between proximal nail fold and the nail plate (lovibond’s angle), osteoarthritis, congenital heart defect, CF (anything that causes hypoxia)
Nail findings in yellow nail syndrome?
Nail growth reduced/arrested, associated with lymphedema or respiratory disease
What are Terry’s Nails?
Up to 80% of liver cirrhosis pts, leukonychia of the whole nail except the distal band
1/2 and 1/2 (Lindsey’s nails), what are they?
25% of chronic renal dysfunction patients, leukonychia of the proximal nail
What are Meuhrcke’s nails?
Nephrotic syndrome (hypoalbuminemia), multiple transverse white bands, go away with pressure on the plate
What are Mees lines?
Leukonychia striata, but a defect in the plate, don’t go away with pressure and can be from thallium/arsenic poisoning
What nail changes can chemotherapy agents cause?
Beau’s lines and onychomadesis, true leukonychia, nail thinning and brittleness, onycholysis/photo-onycholysis, apparent leukonychia (Muehrcke’s nails), melanonychia
What drugs can cause onycholysis?
Chemo, tetracyclines, psoralens, NSAIDS?
What medications can cause melanonychia?
chemo, psoralens, zidovudine
What drugs can cause nail discoloration (not melanin?)
Minocycline, antimalarias, gold, silver
What drugs can cause paronychia and periungual pyogenic granulomas?
Retinoids, antiretroviral drugs, EGFR inhibitors, Methtrexate, capecitabine, sirolimus
What drugs can cause splinter hemorrhages?
Tyrosine kinase inhibitors and VEGF inhibitors
What are some common causes of chronic paronychia and what is chronic paronychia?
Contact rxn to irritants or occupational (food handlers) characterized clinically by inflammation of the proximal nail fold with erythema, edema, and absence of the cuticle. One or several fingernails are affected, in particular the thumb, 2nd or 3rd fingers of the dominant hand.
What is onychotillomania?
basically 3 entities that are associated with nervous tics that affect the nails:
1. Nail biting
2. Habit-tic deformity
3. Median canaliform dystrophy of heller
What is median canalform dystrophy of Heller?
Like habit-tic but is considered a separate entity. There is a longitudinal split of the nail with an inverted fir tree-like pattern, also probably caused by trauma
What things can lead to periungual pyogenic granuloma?
Often from penetrating trauma, also: ingrown nails, systemic drugs, nerve damage, frictional onycholysis
What are pincer nails?
Usually seen on toes, may be hereditary or acquired; the latter is most commonly due to ill-fitting shoes, the nail plate displays excessive transverse over curvature especially distally and so it looks like it curls around
What group are most common for myxoid cysts?
Middle-aged women
Tx for mucous cyst?
sclerotherapy, ILK, cryo
What medications are associated with increased nail growth?
Itraconazole and fluconazole
Also increased in males, pts w/ psoriasis, and pregnancy
