Pathophys-Day 3 Nails Flashcards
Beau’s lines what?
Transverse depressions of nail plate
Secondary to disrupted nail plate formation by matrix
If present in all fingers, indicates systemic dz
Nail pitting is why?
Foci of abnormal keratinization in prox nail matrix
Seen in psoriasis, alopecia areata, eczema
Nail pitting is a sign of what?
psoriasis, alopecia areata, eczema
Trachyonychia is most commonly associated with:
Lichen planus, also alopecia areata and psoriasis, eczema
True leukonychia is commonly associated with?
Arsenic poisoning, also thalium poisoning
True leukonychia cause
Damage of distal matrix, usually due to trauma
Koilonychia is a sign of
iron deficiency anemia
Onycholysis
Distal nail plate detachment from nail bed; most commonly due to psoriasis or fungal nail infections
What are some causes of apparent leukonychia?
Chemo or systemic diseases such as hypoalbuminemia
What is splinter hemorrhage associated with?
Trauma and bacterial endocarditis
Longitudinal melanychia causes
melanocyte activation, non-melanoma tumors, melanoma, melanoma hyperplasia, moles
Longitudinal melanychia single vs multiple?
Single more suggestive of melanoma; multiple suggests systemic disease
What is Hutchinson’s sign?
extension of pigment on to the nail folds, and it’s presence raises the concern for melanoma
What causes a green nail and how do you get it?
Pseudomonas aeruginosa
Water, detergent, etc
What is the Koebner phenomenon?
Skin disease occurring at sites of previous skin trauma or injury
Psoriasis nail findings
Irregular pitting
Salmon patches / oil drop
Onycholysis with red border
What causes lichen planus?
scarring of the proximal nail fold over the nail plate
Alopecia areata nail findings
Geometric pitting
Eczema nail findings
Beau’s lines
Subungual hyperkeratosis
Chronic paronychia (redness)
Digital clubbing associated with
Pulmonary esp TB
What are Muehrcke’s lines?
Apparent leukonychia with 2 transverse bands - assoc with hypoalbuminism
Terry’s nails
White proximally with brown distal band - cirrhosis
Autoimmune CT disorders cause these nail findings
Nail fold capillary issues
Cuticular hemorrhage
Dermatomyosis, scleroderma common to see
Acute paronychia causes
S aureus or Strep pyogenes most common
Chronic paronychia causes
Candida
Recurrent episodes of acute paronychia should prompt -
HSV
Warts
HPV Periungual keratotic papules Cuticular hyperkeratosis Onycholysis If won't go away, consider SCC
HIV infection causes what nail finding?
proximal subungual onychomycosis (fungal infection)
What is tinea unguium?
Fungal nail infection secondary to dermatophyte infxn, most commonly trichophyton rubrum
Four basic patterns of onychomycosis?
Distal subungual
White superficial
PSO
Candidal onychomycosis
Onychoschizia causes
(Brittle nails)
Frequent handwashing
Chronic paronychia is usually caused by -
Candida
Onychotillomania
Trauma-induced absence of cubicle and inflammation of proximal nail fold with abnormal surface abnormalities and maybe hemorrhage
Subungual hematoma vs melanoma?
Hematoma moves with plate growth
**Onychogryphosis is often seen in __
OLD PEOPLE
Onychoryptosis AKA and causes
ingrown toenail
Congenital malalignment
etc
Pyogenic granuloma
bleeding nodule, traumatic often cause
Periungual fibroma is a sign of _
tuberous sclerosis (Koenen’s tumors)
Myxoid cysts be careful because -
May be part of joint bursa so don’t want to pop and introduce infection
Subungual exostosis is?
benign bony proliferation causing hard nodule, commonly from trauma, usually on toenails
**What is the most frequent tumor of the nail apparatus and a common cause?
SCC, HPV 16
Ungual SCC presentation
Verrucuous lesion, ulcerated nodules, onycholysis, nail plate destruction
Ungual melanoma facts
Thumb usually
Hutchinson’s sign
Sometimes non-pigmented
Longitudinal melanonchyia
5 year survival just 15%
