Skin diseases affecting the nails

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Since the nail plate consists of specialised keratin produced by basal cells, it is not surprising that it is affected by skin diseases. Some conditions, such as psoriasis, may produce characteristic changes whereas in other conditions, such as eczema, the changes are much less specific.

Psoriasis causes an accumulation of keratin, as in lesions of the skin. This may result in the nail being both thickened and raised from the nail bed (onycholysis). There may be the changes of pustular psoriasis in the surrounding tissues, indistinguishable from acrodermatitis pustulosa. Loss of minute plugs of abnormal keratin results in "pitting".

Lichen planus produces atrophy of the nail plate which may completely disappear. The cuticle may be thickened and grow over the nail plate, known as pterygium formation.

Eczema may be associated with brittle nails that tend to split. Thickening and deformity of the nail occurs in eczema or contact dermatitis, sometimes with horizontal ridging.

Darier's disease results in dystrophy of the nail and longitudinal streaks which end in triangular-shaped nicks at the free edge. On the skin there may be the characteristic brownish scaling papules on the central part of the back, chest, and neck. These are made worse by sun exposure.

Alopecia areata is quite often associated with changes in the nails including ridges, leuconychia, and friable nails. It may be associated with "20 nail dystrophy".

Autoimmune conditions such as pemphigus and pemphigoid may be associated with a variety of changes including ridging, splitting of the nail plate, and atrophy in some or all of the nails.

Discoloration of the nail and friability are associated with lupus erythematosus.

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