Nails Flashcards
What are Beau’s Lines?
Transverse depressions of the nail plate.

What are Beau’s Lines caused by?
Secondary to disruption of nail plate formation by the nail matrix. Usually trauma.
If Beau’s Lines are present at the same level in all nails, what is this indicative of?
Systemic dz
What are punctate depressions of the nail plate surface?
Pitting.

Pitting is due to what?
Foci of abnormal keratinization in the proximal nail matrix.
What diseases is pitting seen in?
Psoriasis, alopecia areata, and eczema.
What is trachyonychia?
Nails with a rough, ridged surface. Caused by proximal nail matrix damage.

What diseases is trachyonychia seen in?
Alopecia areata, lichen planus, psoriasis, eczema
What is True Leukonychia?
White opaque discoloration in punctate, striate, or diffuse patterns. Due to damage of the distal matrix. Most often caused by trauma.

How do you distinguish true leukonychia from apparent leukonychia?
True will be unchanged with pressure aka nail plate is opaque. Apparent will disappear with pressure aka nail plate is normal but nail bed is abnormal.
What are Mees’ Lines?
A true leukonychia with transverse white bands associated with arsenic and thallium toxicity.

What is koilonychia?
Spoon nails. Thin, flat, spoon-shaped nails.

An iron deficient anemic pt would have what type of nails?
Spoon nails (kioilonychia)
What is onycholysis?
Distal nail plate detachment from the nail bed. Detached nail looks yellow-white.

What is onycholysis commonly due to?
Psoriasis or onychomycosis
What is apparent leukonychia commonly due to?
Chemotherapy drugs or systemic dz (e.g. hypoalbuminemia)

What would you call a sliver of extravasated blood visible beneath the nail plate?
Splinter hemorrhage…from damage to longitudinally oriented nail bed capillaries.

What is a splinter hemorrhage most commonly associated with? What is the most common systemic association?
- Trauma 2. Bacterial Endocarditis
What is longitudinal melanonychia?
Single or multiple longitudinal brown-black bands due to deposition of pigment. Single: may be a sign of nail melanoma. Multiple: often due to drugs or systemic dz.

What is Hutchinson’s Sign?
Longitudinal melanonychia but with extension of pigment on to the nail folds. Raises concern for melanoma.
What is Green Nail Syndrome? What is it caused by?
Greenish-black or greenish-blue nail plate discoloration. Due to P. aeruginosa: produces pyocyanin which is a blue-green pigment. Predisoposing factors=exposure to water, detergents, and soaps.

How does psoriasis affect nails?
Diagnostic signs of psoriasis with regards to nails=irregular pitting, Salmon patches, or onycholysis with erythematous border. Also, multiple nails will be affected. Psoriatic arthropathy is often associated and Koebner phenomenon worsens nail symptoms.

Lichen planus and nails?
Several nails usually affected. Nail thinning and fissuring present.

What is Dorsal Pterygium and what dz is it associated with?
Scarring of the proximal nail fold over the nail plate. It is associated with lichen planus.
What nail changes are seen with alopecia areata? What patient population is most commonly affected?
Geometric pitting and trachyonychia. Children.

Eczema and nails?
Irregular pitting and Beau’s Lines. Subungal hyperkeratosis. Chronic paronychia.

How is clubbing defined?
Angle between the proximal nail fold and the nail plate > 180 degrees.

What nail abnormality will be seen in cardiopulmonary dz, sarcoidosis, cirrhosis, GI dz, toxin exposures, and trauma?
Clubbing
What are Muehrcke’s Lines and what dz are they associated with?
Apparent leukonychia with transverse white bands. Hypoalbuminism.

What are Lindsay’s nails? Terry’s nails? What dz is each associated with?
Lindsay’s: white proximally and brown-red distally (half and half). Chronic renal dz. Terry’s: white proximally with bit of brown-red distally. Cirrhosis. Remember: Lindsay (top) is only a half bitch, Terry’s (bottom) a whole bitch who doesn’t deserve a liver.

What are common nail changes seen in dermatomyositis and scleroderma?
Nail fold capillary abnormalities and cuticular hemorrhages.

What is acute paronychia most commonly due to?
Staph aureus or Strep pyogenes infection

What is chronic paronychia most commonly due to?
Candida infection
Reccurent episodes of acute paronychia should raise the suspicion of what type of infection?
HSV
What are warts caused by?
HPV. Present on the nail with warts=periungal keratotic papules, hyperkeratosis of the cuticle, onycholysis.

What should you suspect if you have really stubborn warts that won’t go away on a patient’s nail?
Squamous cell carcinoma
What is a fungal infection of the nail called?
Onychomycosis
An onychomycosis secondary to dermatophyte infection is called what? What organism is most commonly responsible?
Tinea unguium. Trichophyton rubrum.
What are the 4 basic patterns of onychomycosis?
- Distal subungal 2. White superficial 3. Proximal subungal (PSO) 4. Candidal onychomycosis

***PAY ATTENTION*** PSO type onychomycosis is associated with what?
Immunosuppression/HIV infection

What is onychoschizia?
Distal superficial horizontal splitting of the nail plate aka brittle nails.

Nail brittleness results from what?
Dehydration of the nail plate from environmental factors such as frequent handwashing.
What is chronic paronychia?
Proximal nail fold inflammation with absence of the cuticle. Fingernails are affected.

What is chronic paronychia usually secondary to?
Chronic irritation or Candida infection
Onychotillomania
Bat shit crazy patients eff with their nails. Cuticle absent and proximal nail fold inflamed with nail plate surface abnormalities. Melanonychia. Hemorrhage and crust. At this point I hate this lecture.

Subungal hematoma
Self explanatory

What is onychogryphosis?
Ram’s horn nails due to assymetric growth. Nail plate is thick, hard, yellow-brown. Hallux most frequently affected. Elderly patients.

What is an over-curvature of the distal nail plate that is most often due to ill-fitting shoes?
Pincer Nails

What is onychocryptosis?
Ingrown nails

What are the 4 benign nail tumors?
- Pyogenic Granuloma 2. Periungal Fibromas 3. Myxoid Cysts 4. Subungal Exostosis
Bleeding angiomatous nodule
pyogenic granuloma

Pink or skin-colored papules originating from the proximal nail fold
periungal fibroma (possible sign of tuberous sclerosis)

Proximal nail fold swelling often connected to DIP joint
myxoid cyst

Benign bony proliferation caused by a hard subungal nodule
subungal exostosis

***PAY ATTENTION*** What is the most frequent malignant tumor of the nail apparatus?
Squamous cell carcinoma

What is the clinical presentation of SCC in the nail?
Verrucous lesion, ulcerated nodule, onycholysis, nail plate destruction

What virus is involved in the development of SCC in the nail?
HPV (particularly HPV16)
Melanoma is most frequently seen in which digit?
Thumb
What is seen with melanoma in the nail?
Longitudinal melanonychia, nail plate destruction, Hutchinson’s sign
