nails pathophys Flashcards
what is show in image?
what are they?
how do they occur?
how do they often arise
what does this pathology present at the same level in all nails indicate?
Beau’s lines
defined as transverse depression of nail plate
secondary to discruption of nail plate formation by the nail matrix
traumatic
presence at same level = systemic cause
what is the function of the proximal nail fold
what is the function of the nail matrix?
know: proximal nail matrix –> dorsal nail plate
know: distal matrix(lunula) –> ventral nail plate
what is the function of nail bed?
proximal nail fold = protects nail
nail matrix - germinative cells that produce the nail plate
nail plate adhesion
what is the nail growth rate of finger nails, toe nails?
finger - 3mm/month
toe - 1 mm/month
unguis =
nail
ungual =
relating to the nail
onyx =
denoting a fingernail or toe nail
nail signs can be characterized into which three major categories:
nail signs due to abnormal matrix function
nail signs due to nail bed disorders
nail signs due to deposition of pigment within the nail plate
nail sign due to abnormal matrix function: this is a punctate depression of the nail plate surface
it migrates distally with nail growth
what is it due to?
in which pathologies(3) is it seen?
pitting
due to: foci of abnormal keratinization in the promixmal nail matrix
seen in: psoriasis, alopecia areata, eczema
nail signs due to abnormal nail matrix function: defined as nails with rough, ridged surface
- what is condition?
test question: 2. what is it associated with?(3)
trachyonychia
associated with: alopecia areata, LICHEN PLANUS, psoriaris , eczema
nail signs due to abnormal matrix functions
what is a white opaque discoloration (punctaate, striate or diffuse) due to damage of the distal matrix that is most often traumatic?
Test question: _____are true leukonychia with transverse white bands that have been associated with _______ and _____ toxicity
how do you differentiate true from apparent leukonychia?
true luekonychia
Mees’ lines are a true leukonychia with transverse white bands that have been traditionally associated with arsenic and thallium toxicity
Differentiate from “apparent leukonychia” by pressing on nail:
True: unchanged with pressure (nail plate is opaque)
Apparent: disappears with pressure (nail plate normal; abnormal nail bed)
what is shown in image?
TEST question: what is it associated with?
koilonychia (spoon nails)
associated with iron deficiency anemia
this is a distal nail plate detachment from the nail bed and the detachmed nail looks yellow white.
TEST question: what is it commonly due to?
onycholysis
psoriasis or onychomycosis
what is a white disocoloration that fades with pressure in which the nail plate transparency is maintained?
what is apparent leukonychia most commonly due to?
apparent leukoncychia
drugs (chemo agents), systemic diseases like hypoalbunemia
a condition due to damage to longitundianlly oriented nail bed capillaries that is most commonly associated with trauma
what is the most common systemic cause?
splinter hemorrhage
bacterial endocarditis
what is shown in the image below?
clues:
- single or multiple ongitudinal brown-black bands
- causes inlcude melanocyte activation, non-melanocytic tumors, melanocyte hyperplasia, nevi, and melanoma
- single band may be a sing of __________
- mulitple bands often due to _________or _________
- seen in ______ of AA
- Hutchinson’s sign. What is it? what does its presence raise concer for?
longitudinal melanonychia
single band = sign of nail melanoma
multiple bands = drugs or systemici disease
seen in 90% of AA
Hutchinson’s sign is the extension of pigment on to the nail folds, and it’s presence raises the concern for melanoma
what is the condition?
Greenish-black or greenish-blue nail plate discoloration
Nail is discolored because of __________a blue–green pigment produced by____________
Predisposing factors include exposure to water, detergents, and soaps
green nail syndrome
Greenish-black or greenish-blue nail plate discoloration
Nail is discolored because of pyocyanin, a blue–green pigment produced by Pseudomonas aeruginosa.
Predisposing factors include exposure to water, detergents, and soaps
which condition?
Multiple nails affected
Diagnostic signs :
Irregular pitting
Salmon patches (‘oil drop’ changes)
Onycholysis with erythematous border
Psoriatic arthropathy is often associated
Koebner phenomenon worsens nail symptoms
psoriasis
which condition?
Several nails usually affected
Nail thinning and fissuring
Dorsal pterygium: scarring of the proximal nail fold over the nail plate
lichen planus
which condition?
Geometric pitting
Children are most commonly affected
Trachyonychia(nails w/rough, ridged surface)
alopecia areata
which condition?
Irregular pitting and Beau’s lines
Subungual hyperkeratosis
Chronic paronychia(skin infection around the nails)
eczema(dermatitis)
which condition?
Lovibond’s angle: angle between the proximal nail fold and the nail plate
Normal: ~160°
__________: >180°
Associated with cardiopulmonary disease, sarcoidosis, cirrhosis, gastrointestinal disease, toxin exposures, trauma
clubbing
what is clubbing usually associated with?
cardiopulmonary disease
what are muehrcke’s lines? which condition are they associated with?
Apparent leukonychia with transverse white bands
“Apparent” because they disappear with pressure
Associated with hypoalbuminism
what are three examples of apparent leukonychia in systemic disease?
muehrcke’s lines, lindsday’s nails(half and half nails), terry’s nails
which condition? which disease is associated?
Lindsay’s nails (half-and-half nails)
White proximally and brown-red distally
Associated with chronic renal disease
which apparent leukonychia? associated with which condtion?
Terry’s nails
White proximally with 1-few mm of brown-red distally
Associated with cirrhosis
autoimmune connective tissue disorders: common nail abnormalities in which two condition?
Nail fold capillary abnormalities
Cuticular hemorrhages
Common in dermatomyositis and scleroderma
what are three common nail infections?
acute paronychia
warts
onychomycosis
what is the condition below?
the affected digit is usually _______and ______
compression of the nail fold may produce __________
condition is most commonly due to which two bacteria?
chronic _________ is most commonly due to __________infection
******recurrent episodes of actue paronychia should raise the suspicion of an ________infection
acute paronychia
The affected digit
Swollen, red and painful.
Compression of the nail fold may produce purulent drainage.
Acute paronychia is most commonly due to bacteria, especially Staphylococcus aureus or Streptococcus pyogenes
Chronic paronychia is most commonly due to Candida infection
Recurrent episodes of acute paronychia should raise the suspicion of an HSV infection
- what is the condition below?
- what causes this conditon?
- what does it look like?
- in recalcitrant lesions of this conditions, what should you consider?
WARTS
2.Caused by Human papillomavirus (HPV)
2. Periungual keratotic papules
3. Hyperkeratosis of the cuticle
Onycholysis
4. In recalcitrant lesions, consider the possibility of squamous cell carcinoma
what is the condtion below?
****what is the term used when it is secondary to a dermatophyte infection?
what are the four basic patterns of this condition?
KNOW:PSO is associated with _______ and ______
onychomycosis
Defined as fungal infection of the nail
Tinea unguium is the term used when it’s secondary to dermatophyte infection
Most commonly caused by Trichophyton rubrum
- *Four basic patterns:**
- *Distal subungual**
- *White superficial**
- *Proximal subungual (PSO)**
- *Candidal onychomycosis**
- *PSO** is associated with immunosuppression/HIV infection
defined as distal superficial splitting (horizontally) of the nail plate
onychoschizia
Nail brittleness results from __________ of the nail plate as a result of environmental factors such as ________
Nail brittleness results from dehydration of the nail plate as a result of environmental factors such as frequent handwashing.
what is the condition in picture?
what is absent?
what is condition usually secondary to?
Proximal nail fold inflammation
Absence of the cuticle
Fingernails affected
Chronic paronychia is usually secondary to chronic irritation or Candida infection
what is a median nail dystrophy due to habitual tic?
what is absent in this condition?
what does it look like?
Onychotillomania
Cuticle absent and proximal nail fold inflamed
Nail plate surface abnormalities, e.g. longitudinal central depression
Melanonychia
Hemorrhage and crust
what is the condition?
what causes the condition and what does it lead to?
how does the pigmentation move in this condition?
subungal hematoma
History of acute trauma
Leads to accumulation of blood under the nail plate
Purple–red to black in color
Pigmentation moves distally with nail growth
which condition?
what causes this condition?
which toe is most frequently affected?
KNOW: who does this condition most commonly present in?
ONYCHOGRYPHOSIS
Ram’s horn nails
Due to asymmetric growth
Thick, hard, yellow–brown nail plate
Hallux most frequently affected
Favored by chronic trauma
know: Elderly patients
Over-curvature of the distal nail plate
Can be hereditary or acquired
Acquired is most commonly due to ill-fitting shoes
Pincer Nails (Trumpet Nails)
Defined as ingrown nails
Congenital malalignment often present
Precipitated by improper nail cutting and hyperhidrosis(excessive sweating)
Painful inflammation of the lateral fold
Growth of granulation tissue
Onychocryptosis
Bleeding angiomatous nodule
Periungual or subungual
Often traumatic
which condition? benign or malignant?
Bleeding angiomatous nodule
Periungual or subungual
Often traumatic
Pink or skin-colored papules originating from the proximal nail fold
The fibroma may compress the nail matrix, which produces a longitudinal groove in the nail plate
Possible sign of tuberous sclerosis
which condition? benign or malignant?
in the setting of ______, this condition is known as ______
periungual fibroma
Possible sign of tuberous sclerosis
Koenen’s tumors - in the setting of tuberous sclerosis
Proximal nail fold swelling
Nail plate depression and grooves
Cysts are often connected to DIP joint and may drain joint fluid
Myxoid cysts (Digital Mucous Cyst)
Benign bony proliferation causes subungual, hard nodule
Commonly precipitated by trauma
Seen mainly on toenails
Confirm with X-ray
which condition?
subungual exostosis
condition?
what is the most frequent maligant tumor of nail appartus?
which virus may play a role in this tumor?
what is the clinical presentation of this tumor?
Squamous cell carcinoma
Most frequent malignant tumor of the nail apparatus
Causative role of HPV, (mostly HPV16) suggested in the development of this tumor
Clinical presentation:
Verrucous lesion
Ulcerated nodule
Onycholysis
Nail plate destruction
which condition?
melanoma
nail apparatus melanoma accounts for Accounts for ____________of all melanomas but 5 year survival rate is _______
Accounts for _________ of all melanomas but 5 year survival rate is _______
what is the most frequent site of nail melanoma? what does it look like?
Longitudinal melanonychia
Thumb is most frequent site
Nail plate destruction
KNOW: which sign is associated with nail melanoma?
Hutchinson’s sign
how often is nail melanoma amelanotic?
Amelanotic (non-pigmented) in 25% of cases
