NAIL PATHOLOGY AND SKIN DISEASES

Question 1

– 36% of psoriatics have positive family history

– 50% of psoriatics have nail disease

– Incidence climbs to 90% over
lifetime

– Pitting is most classic change
• Parakeratotic onychocyte clusters
• Fingernail pits
• Resemble ice pick dents

– Onycholysis and leukonychia

– Subungual thickening and
crumbling

Answer 1

Psoriasis

Question 2

– Persistent parakeratotic cells in ventral nail plate

– Opaque white patches or striae
    • Immature nucleated cells
appear white
    • Mature corneocytes are
transparent

– Often resolves before reaching the
distal edge

Answer 2

Defective keratinization of the

distal matrix

Question 3

– due to microtrauma

– Typically fingernails of children

Answer 3

Punctate leukonychia

Question 4

– Tan brown or black longitudinal streak of nails

Answer 4

Longitudinal melanonychia ‐ LM

Question 5

– in distal nail matrix are more plentiful

– Distal nail plate edge may identify origin

– Pigment localized in dorsal half of nail plate arises from proximal matrix

– Pigment localized in ventral nail plate originates from distal nail matrix

– Permanent nail plate deformity is less likely when biopsy is performed in distal
portion of nail matrix or lunula

Answer 5

Melanocytes

Question 6

– Increased melanic pigmentation of the nail matrix epithelium without a concurrent increase in the number of
melanocytes

Answer 6

Melanocytic Activation

Question 7

– Non‐neoplastic causes of single streak
• Trauma
• Carpal tunnel
• Splinter‐foreign body
• Longitudinal hematoma
• Post‐inflammatory
hyperpigmentation

– Neoplastic causes of single streak
• Melanocytic nevi or melanoma
• Basal cell
• Verrucae
• Histiocytoma

Answer 7

Single Band Melanonychia

Question 8

– Non‐neoplastic causes
• Normal racial pigmentation
• Systemic diseases‐hyperthyroidism, porphyria
• Chladosporum fungal, yeast or bacterial infection

– Neoplastic causes of multi‐band melanonychia

– Addisons disease

Answer 8

Multi‐band Melanonychia

Question 9

– Benign fibroepithelial growths with rough surface

– Most difficult verrucae to cure

Answer 9

Periungual and subungual

verrucae

Question 10

– proud flesh

Answer 10

Pyogenic granuloma

Question 11

– True fibromas‐rarest form

– Commonly acquired periungual fibrokeratomas

Answer 11

Periungual fibromas

Question 12

– Synonymous with synovial cysts
– Dermal tumors arising near fingers and toes
– Mucoid degeneration of collagen after trauma

Answer 12

Myxoid Cysts, benign

Question 13

– Not just more commonly seen reactive spurring

– Arises between 20 and 40 years of age

– Painful osseous growth which elevates nail plate

– Most frequently found in great toe

– Occasionally history of trauma can be elicited

– Radiographically ‐ trabeculated osseous
growth with expanded distal portion covered with a radiolucent fibrocartilage

Answer 13

Subungual Exostosis, benign

Question 14

– Painful subungual bone growth
with distortion of nail unit soft
tissue

Answer 14

Osteochondroma, benign

Question 15

– Painful benign overgrowth of
digital glomi

– Glomus normally regulates distal digital perfusion

Answer 15

Glomus Tumor

Question 16

– Systemic‐to‐pulmonary congenital cardiovascular communication

– Pulmonary hypertension

– Cyanosis

– The mean age at death of patients with Eisenmenger physiology has been reported to be 37 years or less

– Patients PDA develop deoxygenated lower extremities

– Clubbing of toes but not fingers

– ECG, Chest XR, Cardiology referral

Answer 16

Eisenmenger’s Syndrome

Question 17

– Enlarged finger tip soft tissue mass with preserved Lovibond’s angle

– Enlargement due to
hyperparathyroidism or sarcoidosis dactylitis induced soft tissue collapse and terminal phalangeal bony erosion

Answer 17

Pseudoclubbing

Question 18

– Benign fibroepithelial tumor of nail matrix

– Dermoscopy
• Surface splinter hemorrhage
• Characteristic multiple
honeycomb cavities

Answer 18

Onychomatricoma