Section 32- Nail Apparatus Flashcards by Jenica Dela Cruz

Associated with damage to the cuticle

Chronic dermatitis of proximal nail fold and matrix- loss of cuticle, separation of nail plate from proximal nail fold

Chronic paronychia

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Treatment for chronic paronychia

Protection
Glucocorticoids
Treat secondary infection

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Secondary infection in chronic paronychia may be due to

Candida spp
Pseudomonas aeruginosa
S.aureus

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Detachment of the nail from its bed at distal and/or lateral attachments

Onycholysis

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Secondary causes of onycholysis

Vesicobullous disorders
-contact derm, dyshidrotic eczema, herpes simplex

Nail bed hyperkeratosis
- onychomycosis, psoriasis, chronic contact derm

Nail bed tumors
Drugs

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Colonization of this bacteria in onycholysis results in a biofilm on the undersurface of the nail plate causing a brown or greenish discoloration

P. aeruginosa

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Management of onycholysis

Debride all nails separated from nail bed

Treat underlying disorder

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P.aeruginosa produces this green pigment that is seen in onycholysis (green nail syndrome)

Pyocyanin

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Thickening of entire nail plate

Seen in elderly

Onychauxis

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Thickening of nail plate with ram’s hornlike deformity

Most common in great toe

Onychogryphosis

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Most common dermatosis affecting the nail apparatus

Psoriasis

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This finding on the nails is pathognomonic for psoriasis and may be seen in only one finger

Punctate leukonychia

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Term for rough surface of nail

Nail dull, rough and fragile

Can be seen in alopecia areata, lichen planus and AD

May regress spontaneously

Trachonychia

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Treatment for psoriasis in nails

Matrix involvement: intralesional triamcinolone 3-5mg/ml

Nail bed: topical steroid(occluded)

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Longitudinal ridging and fissuring of the nail plate with brittleness and breakage

Onychorrhexis

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“Twenty nail syndrome”

-loss of all 20 nails without any other evidence of this disease elsewhere in the body

Lichen planus

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Partial loss of central nail plate presents as V-shaped extension of skin of proximal nail fold adherent to the nail bed

Pterygium formation

lichen planus

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What disease?
Geometric pitting
Hammered brass appearance
Mottled erythema of lunulae
Trachonychia

Alopecia areata

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This nail changes are pathognomonic of what disease?

Longitudinal streaks (red and white)
Distal subungual hyperkeratotic papules with distal V or wedge shaped fissuring of nail plate

Darier disease

Splitting or lamination if nail plate, usually in the horizontal plane at free edge

Onychoschizia

Pseudocyst or ganglion originates in distal interphalangeal joint- associated with osteoarthritis

Can present on proximal nail fold resulting in longitudinal depressed groove in nail plate

Digital myxoid cyst

Tan, brown or black longitudinal streak within the nail plate

Due to increased melanin synthesis, increase in total number of melanocytes or nevomelanocytic nevus

Most originate in distal matrix

Longitudinal melanonychia

What sign?

Periungual extension of brown black pigmentation onto proximal and lateral nail folds

Hutchinson sign

Differential diagnosis of acrolentiginous melanoma

Subungual hemorrhage

Dermoscopy helps distinguish

Management of SCC in the nail

Mohs surgery | Amputation of digit- lesions involving periosteum

Most common pathogens infecting the nail apparatus

Dermatophytes

Most common cause of acute paronychia

S.aureus

Acute infection of the lateral or proximal nail fold

Acute paronychia

Acute infection of the fingertip Soft tissue infection of the pulp space of the distal phalanx Closed spaced infection of multiple compartments created by fibrous septa between skin and periosteum

Felon

Commonly as secondary infection of chronic paronychia Invasion of nail plate usually occurs only in immunocompromised host

Candida onychia

Most reliable technique in diagnosing onychomycosis

Histology of nail clipping | PAS stain

Management of tinea unguium

Terbinafine 250mg/d x 6 weeks for fingernails and 12-16 weeks for toenails -most effective Itraconazole (approved in USA for onychomycosis) 200mg/d x 6 weeks; 12 weeks toenails

Dermatologic disease associated with transverse or Beau lines

Eczema Erythroderma Paronychia

Total division of nail plate that can happen when duration of disease completely inhibits matrix activity for 7-14 days

Onychomadesis

Leukonychia associated with hepatic disorders

Terry type leukonychia

Type of leukonychia: Opaque white plate obscuring lunula and extending to within 1-2mm from distal edge

Terry type

Type of leukonychia: Associated with renal disorders

Uremic half and half nail of Lindsay

Type of leukonychia: Proximal nail dull white obscuring lunula, distal nail pink

Half and half nail of Lindsay

Type of leukonychia: Paired, narrow and white transverse bands Associated with chemotherapy, hypoalbuminemia

Muehrcke lines | Banded nails

Associated with lymphedema, respi tract disease, rheumatoid arthritis and internal malignancies Nails stop growing, hard, excessively curved from side to side, cuticles absent Diffuse yellow discoloration

Yellow nail syndrome

Most common cause of splinter hemorrhages

Minor trauma

Skin colored tumor beneath the nail fold associated with a longitudinal groove in the nail plate caused by matrix compression

Periungual fibroma | Associated with tuberous sclerosis

Nail findings associated with connective tissue disease

Nail fold/ periungual erythema and telangiectasia

Nail plate adheres to fingertip skin in scleroderma

Pterygium inversum unguium

Spoon shaped nails Associated with Plummer-Vinson syndrome (IDA, dysphagia, glossitis)

Koilonychia

Nails are called clubbed if angle between proximal nail fold and nail plate is how many degrees?

>180 degrees