Section 32- Nail Apparatus Flashcards
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
Treatment for chronic paronychia
Protection
Glucocorticoids
Treat secondary infection
Secondary infection in chronic paronychia may be due to
Candida spp
Pseudomonas aeruginosa
S.aureus
Detachment of the nail from its bed at distal and/or lateral attachments
Onycholysis
Secondary causes of onycholysis
Vesicobullous disorders
-contact derm, dyshidrotic eczema, herpes simplex
Nail bed hyperkeratosis
- onychomycosis, psoriasis, chronic contact derm
Nail bed tumors
Drugs
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
Management of onycholysis
Debride all nails separated from nail bed
Treat underlying disorder
P.aeruginosa produces this green pigment that is seen in onycholysis (green nail syndrome)
Pyocyanin
Thickening of entire nail plate
Seen in elderly
Onychauxis
Thickening of nail plate with ram’s hornlike deformity
Most common in great toe
Onychogryphosis
Most common dermatosis affecting the nail apparatus
Psoriasis
This finding on the nails is pathognomonic for psoriasis and may be seen in only one finger
Punctate leukonychia
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
Treatment for psoriasis in nails
Matrix involvement: intralesional triamcinolone 3-5mg/ml
Nail bed: topical steroid(occluded)
Longitudinal ridging and fissuring of the nail plate with brittleness and breakage
Onychorrhexis
“Twenty nail syndrome”
-loss of all 20 nails without any other evidence of this disease elsewhere in the body
Lichen planus
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
What disease? Geometric pitting Hammered brass appearance Mottled erythema of lunulae Trachonychia
Alopecia areata
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
