Section 3 -- Nail Pathologies Flashcards
Onychocryptosis
Definition Site Presentation Etiology Complications
Corner of the nail pierces the skin of the nail fold, or the nail curves towards the nail bed in either the lateral or medial edges. Once a spicule punctures/penetrates the sulcus, the area is vulnerable to bacterial growth.
Frequently appears in the hallux, (unilateral or bilateral)
Swollen/shiny/tight skin, Piercing of skin, Erythema, Throbbing, Tender, Infx
Often r/t improperly cut nails, Congenital or acquired deformity, Trauma, Impaired circulatory, Pressure from hose or shoes, Subungual bone spur, Softening of surrounding tissue, molding action of pressure causes the nail plate to turn downwards and “dig-in”, Thickening and abnormal growth of toenails due to existing foot problems like arthritis or nail-fungus
Limited movement, Infection, Increased pain associated with footwear
Spicula
Singular
Definition
Spicule
Small spike at outer margin of the nail plate. In onychocryptosis = digging in to the surrounding soft tissue.
Involuted nails
Unilateral or bilateral?
In severe cases?
Nails that have an increase in the transverse curvature, may be unilateral or bilateral; and may be mild or severe.
In severe cases, the nail edges come together (pincer or “C” shaped nails), entrapping or strangling the nail bed, ulceration may occur.
Onychogryphosis
Definition Site Presentation Etiology Complications
Ram’s horn nails. An abnormality characterized by thickening and overgrowing of the nail.
All nails vulnerable, commonly affects hallux
Nail grows upward and sideways, curving in the process. Yellowish-brownish discolouration with pronounced ridges.
Increase in the subungual hyperkeratotic tissue forms an obstruction to the forward growth of the nail. The nail becomes thickened; one side usually grows quicker than the other side causing it to spiral as it grows. As the nail spirals it may embed itself in the soft tissue surrounding the nail. Frequently, the hyponycium* hypertrophies***. In most cases this condition is not painful, but it is disfiguring.
Acute or chronic trauma, Shoes, Ischemia, Unable to self-care
Pressure in toe box of shoe, Risk of cutting the hyponycium with nail nippers, Ulceration r/t nail pressure on surrounding skin, adjacent toes or distal surface where nail has curved over, If unTx’d pain/infx/other complications
Subungual bone spur
What is it?
What is it usually caused by?
What does it lead to?
A small bone spur that grows on the top of the bone lying just under the toenail
usually the result of trauma
With the bone pushing upward on the center of the nail, the nail becomes deformed (it peaks in the middle and the two edges are pushed downward into the skin).
(Onychocryptosis)
Subungual hyperkeratosis
Buildup of soft yellow keratin under the nail
Onycholysis
Definition
Appearance
Most common site and sex
Separation of the nail plate from the nail bed at the distal end and/or the lateral margins.
Air entering from the distal free edge gives a greyish-white appearance to the nail plate.
More common in fingernails than toenails
Affects women more frequently than men.
Separation of the nail plate from the nail bed at the distal end and/or the lateral margins.
Onycholysis
Ram’s horn nails. An abnormality characterized by thickening and overgrowing of the nail.
Onychogryphosis
Corner of the nail pierces the skin of the nail fold, or the nail curves towards the nail bed in either the lateral or medial edges. Once a spicule punctures/penetrates the sulcus, the area is vulnerable to bacterial growth.
Onychocryptosis
Onychomycosis
Definition Site Presentation Etiology Complications
A fungal infection of the nail bed and/or nail plate. Often seen on clients who have suffered with athlete’s foot for years.
All nails vulnerable, hallux is most often affected.
Thick, often yellow or light brown nails. Nails are brittle, easily crumble. Pitting/longitudinal ridging.
Trichophyton rubrum
Pressure if nail becomes thickened, Possible ulceration and exudate under the nail, Disturbed body image, Further spread of infx (tinea pedis, tinea corporis)
A fungal infection of the nail bed and/or nail plate. Often seen on clients who have suffered with athlete’s foot for years.
Onychomycosis
What type of Dx is onychomycosis and how is it made
Onychomycosis is a medical diagnosis that can only be made by microscopic examination and culture of a nail clipping.
What is another name for fungi?
Dermatophytes
What dermatophyte causes onychomycosis and in approximately how many cases?
Trichophyton rubrum
Responsible for 70% of fungal nail infx
How does Trichophyton rubrum flourish on your toes?
Fungi (dermatophytes) possess the ability to metabolize keratin and thereby grow and proliferate in the presence of protein. The human nail and nail bed provide and exceedingly suitable environment in which the dermatophytes flourish.
Subungual Malignant Melanoma
Common or rare? Dangerous?
Appearance
Nails or skin?
Rare, potentially life-threatening.
May appear as a brown or black spot or streak in the nail bed or within the nail plate.
Can also be present in the skin of the toes without nail involvement.
Rare, potentially life-threatening. May appear as a brown or black spot or streak in the nail bed or within the nail plate. Can also be present in the skin of the toes without nail involvement.
Subungual Malignant Melanoma
Paronychia
An infection involving the medial or lateral nail folds
