Onychomycosis and its treatment

Tinea Cruris Foto

Antonella Tosti, Robert Baran, Rodney PR Dawber, Eckart Haneke Candida onychomycosis Further reading Fungi may invade the nails in four different ways, leading to four separate types of onychomycosis with specific clinical features, prognosis and response to treatment. The type of nail invasion depends on the fungus responsible and the host susceptibility. Invasion occurs 1 Via the distal subungual area and the lateral nail groove, leading to distal lateral subungual onychomycosis Figure 8.1 ....

Table 43 Causes and associations of onychogryphosis Dermatological

Pityriasis Rubra Pilaris Nails

Ichthyosis Psoriasis Onychomycosis Syphilis, pemphigus, variola Local causes Isolated injury to the nail apparatus Repeated minor trauma caused by footwear Foot faults such as hallux valgus Regional causes Associated varicose veins Thrombophlebitis even in the upper limb Aneurysms Elephantiasis Disease involving the peripheral nervous system General causes Old age Vagrancy and senile dementia Disease involving the central nervous system Hyperuricaemia Idiopathic forms Subungual hyperkeratosis...

Table 45 Causes of thick nails andor subungual hyperkeratosis Frequent

Black Splinter Line Fingernails Picture

Onychomycosis Figure 4.19 Psoriasis Figures 4.14-4.15 Contact eczema Mineral oils Cement Hair styling products Repeated microtrauma Single major trauma Subungual clavus Less frequent Bowen's disease Lichen planus Figure 4.24 Norwegian scabies Pachyonychia congenita Figures 4.21-4.23 Pityriasis rubra pilaris Figure 4.20 Acrokeratosis paraneoplastica Bazex's syndrome Onychopapilloma of the nail bed Rare Alopecia areata Radiodermatitis Arsenic keratosis SPLINTER HAEMORRHAGES AND HAEMATOMAS The...

Table 42 Causes and associations of nail shedding

Subungual Hyperkeratosis

Local inflammation, e.g. acute paronychia Figures 4.7-4.12 Kawasaki's syndrome Fever or systemic upsets Syphilis Bullous dermatoses, e.g. pemphigus Stevens-Johnson syndrome Toxic epidermal necrolysis Lyell's syndrome Figures 4.7-4.9 Drugs Cytotoxics Antibiotics Retinoids Keratosis punctata Local trauma X-irradiation Hypoparathyroidism with amelogenesis imperfecta HYPERTROPHIC NAIL AND SUBUNGUAL HYPERKERATOSIS Ideally, the term 'hypertrophy of the nail plate' should be restricted to conditions...

Ragged Cuticles And Hangnail

Dermatomyositis Ragged Cuticle

Thickened, hyperkeratotic, irregular ragged cuticles Figure 5.12 are most commonly seen in dermatomyositis Figure 5.13 . Perionychial tissues are constantly subjected to trauma. In nail biters and 'pickers' the cuticles and nail folds may show considerable damage, erosions, haemorrhage and crusting. The ulnar side of the nail fold and cuticle is most vulnerable and there may be small trian-gular tags of skin hangnail, Figure 5.14 and separated spicules of nail, still attached proxi-mally....

Congenital andor hereditary Isolated

Hailey Hailey Disease Pictures

Acrokeratosis verruciformis Hopf Associated with koilonychia Figure 7.8 LEOPARD syndrome lentigines, electrocardiographic changes, ocular hypertelorism, pulmonary stenosis, abnormalities of genitalia, retarded growth, deafness Leukonychia totalis, multiple sebaceous cysts, renal calculi Darier's disease usually linear and longitudinal Acquired Pseudoleukonychia Diffuse form of distal and lateral subungual onychomycosis Proximal white subungual onychomycosis, especially in AIDS patients...

Alteration to surrounding tissue

Subungual Heloma

Tennis or sportman's toe is a brown-black discoloration due to subungual haemorrhage caused by special stresses on the longest toe great toe and or the second toe . Pain is associated with the appearance of the damage. In tennis, this occurs because the player frequently stops abruptly the forward motion of the body propels the toes into the toe box and tip of the footwear. Hard playing surfaces contribute to the injury. In distinction to tennis toe, jogger's toe tends to involve the third,...

Nail plate and soft tissue abnormalities

Lunula Dyschromias

Robert Baran, Rodney PR Dawber, Eckart Haneke, Antonella Tosti Onycholysis Onychomadesis and shedding Hypertrophic nail and subungual hyperkeratosis Splinter haemorrhages and haematomas Dorsal and ventral pterygium Further reading Onycholysis refers to the detachment of the nail from its bed at its distal and or lateral attachments Figure 4.1 . The pattern of separation of the plate from the nail bed takes many forms. Sometimes it resembles closely the damage from a splinter under the nail, the...

Traumatic disorders of the nail

Pyogenic Granuloma Under Nail

Repeated microtrauma of the nail apparatus The painful nail Further reading This chapter looks at three distinct aspects of trauma, under the headings 1 Major trauma involving any digit . This section considers major trauma, single overwhelming injury, necessitating only minor 'office' surgery. Complex laceration and most of the traumatic abnormalities are beyond the intended scope of this book. Damage from acute trauma may have immediate and or delayed effects. Acute subungual haematoma is...

Blistering distal dactylitis

Herpetic Whitlow

Blistering distal dactylitis is a variant of streptococcal skin infection. It presents as a superficial, tender, blistering beta-haemolytic streptococcal infection over the anterior fat pad of the distal phalanx of the finger Figure 5.40 . The lesion may or may not have a paronychial extension. This blister, containing thin, white pus, has a predilection for the tip of the digit and extends to the subungual area of the free edge of the nail plate. The area may provide a nidus for the...

Distorted nail shape may be due to a bone tumor

Trauma appears to be a major causative factor, although some authors claim that a history of trauma only occurs in a minority. The triad of pain (the leading symptom), nail deformation and radiographic features is usually diagnostic. The exostosis is a trabeculated osseous growth with an expanded distal portion covered with radiolucent fibrocartilage. Osteochondroma, commonly presenting with the same symptoms, has a male predominance. There is often a history of trauma. Its growth rate is slow....