Nail, Hair And Scalp Disorders Flashcards
Pigmentation of the nail plate is where?
Suprabasalar layers of the distal matrix
- high levels of melanocytes
Beaus lines
Transverse furrows that progress dismally
- due to temporary arrest of the nail matrix
- depth = extent of damage, width = duration for systemic insult
Usually bilateral but can be single nails
Causes = mechanical trauma is most common but can also be eczema or paronychia issues
- also systemic illness or major illness that are febrile and last decently long
Onychomadesis
Essentially more severe beaus lines. Shows proximal detachment of nails and a sulcus forms (looks kind of like a new nail is growing underneath the actual nail
- complete arrest of nail matrix activity
Most common cause = trauma to the nail
less common Causes:
- very common in infants with hand/foot/mouth disease that isnt treated well
- the fever associated causes onychomadesis
- neurological damage or marathon runners are also common
**takes 6-8 months to look normal again though since that’s how long it takes for a brand new nail to grow
Pitting
Abnormal keratinization of proximal nail matrix
- clusters of parakeratotic cells in the dorsal nail plate
common in psoriasis, eczema and alopecia areata
Onychorrhexis
Longitudinal ridging of the nail plate
- diffuse damage to the nail matrix and thinning of the nail
Casues = aging, reptitive trauma and vascular diseases
Trachyonychia
Proximal nail matrix damage
- looks like worse onychorrhexis
Causes = alopecia areata is #1 but also psoriasis, eczema and autoimmune disorders
Treatment = treat underlying cause and it resolves spontaneously
Leukonychia
Opaque discoloration of the distal nail matrix
- signifies nail matrix damage
- **looks white and does not disappear with pressure to the nail
usually caused by trauma but can also be due to onychomycosis
mee’s lines
True type of Leukonychia
- single broad transverse white band
- always should signify possible arsenic poisoning**
- can also be sepsis, thallium poisoning, AAA/TAA, parasitic infections, chemotherapy
Koilonychia
Thinning and “spooned-shaped” (concave) nails
Is normal in children!!
- however in adults means pathology = ****chronic iron deficiency!!
- can also be hemochromatosis and hyperthyroidism
Onycholysis
Seperation of the nail plate form the nail beds
- shows nail discoloration of the nails (looks more white and yellow (like nail is being peeled off kinda))
causes
- bacterial/fungal infections (especially candida/pseudomonoas)
- however #1 = trauma and psoriasis**
- **thyroid dysfunctions
- malignancy
Apparent Leukonychia
Leukonychia that is false
- goes away with pressure and DOES NOT grow with the nail or move distally
Half and half (Lindsay nails)
Apparent Leukonychia
Very heavily tied to renal dysfunctions and hemodialysis patients
Muehrckes lines
Apparent Leukonychia with narrow multiple white transverse bands
- must grow in pairs
Chronic hypoalbuminemia (nephrotic syndromes) and combo chemotherapy are the msot common causes
Terry nails
Apparent Leukonychia where almost the whole nail is taken up by white nail
Due to telangiecasias in the nail beds
Casues = metabolic issues with CHF/diabetes/liver cirrhosis
Splinter hemorrhages
Dark-red thin longitudinal lines on the distal or proximal nails
Proximal causes:
- **endocarditis!!
- also vasculitis and trichinosis or mountain sickness
Distal causes:
- trauma and psoriasis are most common
Hutchinson sign
Hyperpigmentation along the entire nail that also includes the proximal and lateral nail fold
highly suspect of malignant melanoma
Green nail syndrome
Green-blue/black nail discoloration
- caused by pyocyanin pigments due to pseudomonas aeruginosa infections
Treatment = topical quinolone and acetic acid for 1-4 months
Pyogenic granuloma
Red growths under nails that can be cancerous
- common in pregnancy, trauma and drugs
must rule out amelanotic melanoma with biopsy