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....

Psoriasis

Nail psoriasis is most commonly characterized by pits, 'salmon' or oil patches, onycholysis and nail dystrophy. Pits develop from tiny psoriatic lesions located in the most proximal matrix region. These produce parakeratotic mounds which remain on the nail plate surface as long as the growing nail is covered by the proximal nail fold they then break off and leave a small depression in the nail surface. The depth of the pits reflects the severity of the lesion, their longitudinal diameter their...

Warts

Verrucous epidermal naevus Subungual papilloma Subungual onychopapilloma Verrucous lesions in incontinentia pigmenti Subungual corn Epidermoid cyst Onychomatricoma Fibromatous lesions Keloids Acquired periungual fibrokeratoma Subungual filamentous tumour Benign juvenile digital fibromatosis Leiomyoma Giant cell tumour Xanthoma Lipoma Neurogenic tumours Multicentric reticulohistocytosis Actinic keratosis Arsenical keratosis Naevus flammeus and angioma Angiokeratoma circumscriptum Aneurysmal bone...

Lichen Planus

Specific nail involvement occurs in about 10 of patients with lichen planus and permanent damage of at least one nail occurs in approximately 4 of patients. However, if lichen planus is correctly diagnosed and treated, permanent damage to the nail unit is rare, even where there is diffuse involvement of the nail matrix. Systemic steroids are effective in treating nail lichen planus intramuscular triamcinolone acetonide 0.5 mg kg every month for 2-3 months usually produces recovery of the nail...

Figure 540

Chronic paronychia and thumb sucking Candidal paronychia, usually in association with oral candidiasis, may arise as a result of chronic maceration due to thumb sucking Figure 5.41 . Chronic paronychia is not uncommon in children. It differs from the condition seen in adults in the source of the maceration, associated diseases, the clinical appearances of the lesion, and the patient's responses to the symptoms. In children the lesions are generally prominent, with total involvement of the...

Myxoid pseudocysts rarely occur without wear and tear osteoarthritis

A multitude of treatments have been recommended, including repeated incision and drainage, simple excision, multiple needlings and expression of contents, X-irradiation 5 Gy, 50 kV, Al 1mm, three times at weekly intervals , electrocautery, chemical cautery with nitric acid, trichloroacetic acid or phenol, massages or injection of proteolytic substances, hyaluronidase, steroids fluoran-drenolone tape, or injections and sclerosing solutions, cryosurgery, radical excision and even amputation. The...

Epithelial tumours

Onychomatricoma Mri

Epidermoid cysts of the distal phalanx are rare, usually secondary to trauma with implantation of epidermis into subcutaneous tissue or even into bone. An old trauma often goes unnoticed. The cyst may develop on a scar after surgery. The phalanx progressively expands and clubbing becomes obvious. The pain is of late onset, sometimes on the occasion of a pathological fracture. Histological investigation shows an epidermoid cyst filled with orthokeratin and lined with a thin layer of epidermis....

Nail melanoma

Melanoma of the nail apparatus most commonly derives from the matrix, much less frequently from the nail bed or hyponychium. Matrix melanoma usually causes longitudinal melanonychia see Chapter 5 . Whether atypical melanocytic hyperplasia is already subungual in situ melanoma is not entirely clear. Large, atypical melanocytes in all layers of the matrix and nail bed epithelium, pycnotic melanocytes in the nail plate mirroring the pagetoid spread in the epithelium, and mitoses, are seen as proof...

Melanocytic naevus of the nail organ

Naevi may be located at any site in or around the nail organ, and may pose considerable differential diagnostic problems when they cause longitudinal melanonychia. This sign may be due to a focus of functionally active melanocytes as in ethnic pigmentation , to an accumulation of active melanocytes as in the Laugier-Hunziker-Baran syndrome , or to a common lentigo, junctional melanocytic naevus, compound naevus or malignant melanoma. Most naevi are of the junctional type. A few barely visible...

Sculptured artificial nails

Some natural nail keratin must be present for sculptured artificial nails to be used. The natural nail is first roughened with a burr, then painted with the acrylic resins which harden at room temperature and become moulded on to the nail. The prosthesis can be filed and manicured to shape. As the nail grows out, further applications of the self-curing acrylic resins can be made to maintain a regular contour. Allergic contact dermatitis may appear, generally after 2-4 months of application, as...

Veillonella infection in the newborn

Many epidemics of subungual infection have been described among infants in postnatal wards and special care baby units. The number of fingers affected per patient ranged from one to ten the thumbs are less frequently involved than other fingers toe nails are not affected. Three stages occur first, a small amount of clear fluid appears under the centre of the nail, along with mild inflammation at the distal end of the finger. This initial vesicle lasts approximately 24 hours it sometimes...

Local causes

The nail may be damaged by repeated trauma or by chemical agents such as detergents, alkalis, various solvents, sugar solutions and especially by hot water. The nail plate takes a minimum of 5-6 months to regenerate and therefore it is vulnerable to daily insults. Housework is commonly the cause particularly at risk are the first three fingers of the dominant hand. Anything that slows the rate of nail growth will increase the risk. Cosmetic causes are rare. Some varnishes will damage the...

Onychomycosis

Fungal infections of the nail organ are the most common nail disorders. Even though they are usually easily diagnosable they may be indistinguishable from nail psoriasis and the conditions may in fact occur together. Superficial white onychomycosis is easy to diagnose a tangential biopsy of the nail plate is taken with a no. 15 scalpel and sent to the laboratory. Formalin fixation is not necessary. The thin nail slice is processed and cut as usual and stained with periodic acid-Schiff reagent...

Onycholysis

Onycholysis detachment of the nail plate from the nail bed starts in the central or lateral portion of the nail plate free margin, progresses proximally and can even involve the whole nail. The onycholytic area looks whitish because of the presence of air under the detached nail plate. It may occasionally show a greenish or brown discoloration due to colonization of the onycholytic space by chromogenic bacteria Pseudomonas aeruginosa , moulds or yeasts. Onycholysis may be idiopathic or...

Ungual fibrokeratoma

Ungual fibrokeratomas may arise from the most proximal part of the matrix and remain in a supraungual position arise from the medial portion of the matrix and remain intraungual dissecting fibrokeratoma or arise from the distal matrix or nail bed growing entirely under the nail. The lesion is histologically characterized by a dense core of longitudinally arranged collagen, almost complete lack of elastic fibres, oedema in its acral part, and hyperkeratosis of the tip which usually includes...

Acrokeratosis paraneoplastica of Bazex and Dupre

Paraneoplasia Bazex

Acrokeratosis paraneoplastica occurs in association with malignant epithelial tumours of the upper respiratory or digestive tracts, in particular the pharyngolaryngeal area piriform fossa, tonsillar area, epiglottis, hard and soft palate, vocal cords, tongue, lower lip, oesophagus and the upper third of the lungs. It also occurs with metastases to the cervical and upper mediastinal lymph nodes. This 'paraneoplasia' may precede the signs of the associated malignancy, disappear when the tumour is...

Acquired longitudinal melanonychia after puberty in a whiteskinned individual requires urgent biopsy

Approximately 2-3 of melanomas in whites, and 15-20 in blacks are located in the nail unit. However, malignant melanoma is rare in black people thus the number of nail melanomas does not significantly differ between these population groups. Most white patients have a fair complexion, light hair, and blue or hazel eyes. There is no sex predominance, although some reports show variable female or male predominance. The mean age at onset is 55-60 years. Most tumours are found in the thumbs or great...

Digital Herpes Simplex

Recurrent herpes simplex despite being rarely diagnosed is not infrequent. Any recurrent blistering process around a finger nail, particularly when accompanied by early lymphangitis and radiating pain, should prompt a cytological examination. The blister roof is opened and a Tzanck smear taken for microscopic investigation as well as for virus culture or molecular biological tests. Early blisters with clear watery contents exhibit mainly keratinocytes, some of which are giant and...

Melanoticmelanocytic lesions

Benign melanocytic hyperplasia Lentigo simplex and naevocytic naevus Atypical melanocytic hyperplasia Peutz-Jeghers-Touraine syndrome Malignant melanoma Subungual warts are painful and may mimic glomus tumour. The nail plate is not often affected, but surface ridging may occur and, more rarely, dislocation of the nail. Biting, picking and tearing of the nail and nail walls are common habits in people with periungual warts. This type of trauma is responsible for the spread of warts and their...

Further reading

Nail disorders are rarely subjected to thorough histopathological investigation. In contrast to skin, the nail is not easy to biopsy and many physicians as well as patients are therefore reluctant to undertake this procedure. To obtain relevant results it is necessary to consider the following 1 Nail changes usually reflect a pathological process of the matrix or much less frequenly of the nail bed. The biopsy must contain a relevant piece of matrix. 2 Some changes that are obvious to the naked...

Squamous cell carcinoma of the nail apparatus has a good prognosis compared with other sites

Trauma, chronic infection and chronic radiation exposure are possible aetiological factors human papillomavirus HPV has been incriminated in some cases. Two reported cases had associated congenital ectodermal dysplasia. Most lesions occur on the fingers, particularly the thumbs and index fingers Figure 5.31 . The presenting symptoms include pain, swelling, inflammation, elevation of the nail, ulceration, a tumour 'mass', ingrowing of the nail, 'pyogenic granuloma' and bleeding. Bone involvement...

Hard Nails

Hard nails are not uncommon on the toes, where they may present as onychogryphosis. In contrast, hard finger nails are unusual and are principally observed in an ectodermal dysplasia, pachyonychia congenita. The nails become yellowish-brown usually within months after birth and show subungual hyperkeratosis with elevation of the nail plate. The nails become progressively thicker and wedge-shaped. Jadassohn had to use a hammer and chisel on the hardened nails of his patient. Nail hardness is one...

Periungual Warts

Periungual and subungual warts are usually difficult to treat and frequently recur. The life span of periungual warts may be such that they and the various treatments may exceed the patience of both patient and physician Under such circumstances intelligent placebo therapy may well be appropriate. A great variety of treatments are listed in all pharmacopoeias, reflecting their individually limited success rates. The choice of treatment depends on location periungual and subungual

Epoxy resin dermatitis Occupational Figure 53 Dermatoses

Acrodermatitis enteropathica Figure 5.6 Hallopeau's acrodermatitis Ingrowing toe nail Lichen planus Pachyonychia congenita Parakeratosis pustulosa Pemphigus Psoriasis-Reiter's syndrome Figure 5.7, 5.8 Radiodermatitis Yellow nail syndrome Systemic disease Antiretroviral drugs Cytotoxic drugs Collagen vascular diseases Figure 5.9 Paraneoplastic acrokeratosis Sarcoidosis Figure 5.10 Stevens-Johnson syndrome Toxic epidermal necrolysis Vasculitis Zinc deficiency Figure 5.11 Miscellaneous...

Trauma

Subungual Warts Pictures

Childhood malalignment Cold injury Common type Crush and squeeze injuries Ingrowing toe nail Splinters, foreign bodies Sports and sport shoe injuries Inflammation Acro-osteolysis Herpes simplex Implantation epidermoid cyst Osteomyelitis Pincer nail severe form enclosing bone Post-cryosurgery may be prolonged bone pain Prosector's wart tuberculosis Sarcoid dactylitis Subcutaneous abscess Subungual foreign body Ventral pterygium Tumours soft tissue and bone Aneurysmal bone cyst Bowen's disease...

Figure

Sarcoidosis Pancreatica

Squeezing the nail fold produces a cheesy material Sabouraud's medium negative . Chronic paronychia in psoriasis. Squeezing the nail fold produces a cheesy material Sabouraud's medium negative . Chronic granulomatous paronychia due to sarcoidosis. Courtesy of J. Hewitt. Chronic granulomatous paronychia due to sarcoidosis. Courtesy of J. Hewitt.

Bowens disease epidermoid carcinoma

Bowen Disease The Nail Bed

Bowen's disease is a term for intra-epithelial squamous carcinoma Figures 5.30-5.32 . It is not as rare as might be inferred from the medical literature. Epidermoid carcinoma subungual involvement. Epidermoid carcinoma subungual involvement. a Epidermal carcinoma b epidermal carcinoma, with nail plate trimmed back to show extension of invasion. Courtesy of G. Cannata, Italy. a Epidermal carcinoma b epidermal carcinoma, with nail plate trimmed back to show extension of invasion. Courtesy of G....

Nail apparatus melanoma has a poorprognosis with up to 50 of patients dying within 5 years of the diagnosis

Subungual melanoma has a poor prognosis. The reported 5-year survival rates range from 35 to 50 . Most patients present with advanced subungual melanoma however, even early diagnosis is not a guarantee of a good prognosis. Women have a better prognosis than men. Factors contributing to a poor prognosis are delay in diagnosis and, as a result of this, inadequate treatment. The tumour may be mistaken for a traumatic dystrophy, and valuable time may be lost before the diagnosis is made. Treatment...

Nail abrasion

Thick nails caused by diseases such as psoriasis, pityriasis rubra pilaris and pachyonychia congenita can be abraded. Hyperkeratosis is prone to be associated with onychomycosis of the toes. Nail abrasion helps to expose the nail bed to antifungal chemicals, especially in elderly people in whom systemic treatment is not advisable. Abrasion is a good way to improve the contour of an abnormal nail, for example in onychogryphosis. In selected cases of ingrowing toe nail, repeated thinning of the...

Malignant

Subungual Melanoma Surgery

Bowen's disease_Features clinically typical of subungual melanoma After Baran and Kichijian 1996 . LM, longitudinal melanonychia. a, b Malignant melanoma amelanotic. a, b Malignant melanoma amelanotic. without a history of severe trauma. It may follow repeated minor trauma which escapes the patient's attention, such as in 'tennis toe', or follow trauma from wearing hard ski boots. Although haematoma following a single traumatic event usually grows out in one piece, rather than as a longitudinal...

Tumours of the perionychium

In the authors' institution the main indications for MRI are vascular tumours and mucoid cysts. Numerous other lesions are explored, such as epithelial tumours warts, epidermoid cysts, onychomatricomas, keratoacanthomas , soft-tissue tumours fibrokeratomas, fibromas, tenosynovial giant cell tumours , and osteochondral lesions exostoses, chondromas, osteoid osteomas, chondrosarcomas . The accurate location of the tumour with MRI associated with its signal patterns is important for diagnosis....

Periungual and subungual warts

Foreign Body Granuloma

Common warts are caused by human papillo-maviruses of different biological types Figures 5.16-5.18 . They are benign, weakly infective, fibre-epithelial tumours with a rough keratotic surface. Usually periungual warts are asymptomatic, although fissuring may cause pain. Subungual warts initially affect the hyponychium, growing slowly toward the nail bed and finally elevating the nail plate. Bone erosion from verruca vulgaris occasionally occurs although some of these cases may have been...

Chronic paronychia is not a primary infection Chronic paronychia of the hands is typically intiated by frequent

Clinically, the proximal and lateral nail folds show erythema and swelling. The cuticle is lost and the ventral portion of the proximal nail fold becomes separated from the nail plate. This newly formed space has an important additional role in maintaining and aggravating chronic paronychia it becomes a receptacle for microorganisms and environmental particles that potentiate the chronic inflammation. With time the nail fold retracts and becomes thickened and rounded. The course of...

Dermatological

Silver Nitrate Stain Skin

Amyloid primary Basal cell carcinoma Bacterial infection Bowen's disease Fungal infection Laugier-Hunziker-Baran syndrome Lichen planus Malignant melanoma Peutz-Jeghers-Touraine syndrome Porphyria cutanea tarda Radiotherapy and radiodermatitis Regional and local Carpal tunnel syndrome Repeated minor injuries Friction significant abnormalities can produce brown or black discoloration Table 7.2 . Most of the causes will be self-evident at the time of presentation, either from the history or on An...

Myxoid pseudocysts of the digits

Nail Bed Cyst

The many synonyms for mixed pseudocyst of the digits reflect the controversial nature of this lesion dorsal distal interphalangeal joint ganglion digital mucinous pseudocyst focal myxomatous degeneration Whereas some authors regard it as a synovial cyst, most now believe it to be a periarticular degenerative lesion. Myxoid cysts occur more often in women. They are typically found in the proximal nail fold of the fingers and rarely on toes Figures 5.27-5.29 . Usually asymptomatic, these lesions...

Figure 948

Nail shedding in a long-distance runner. self-inflicted anonychia of the toe nails is associated with small or absent nails and crushing due to traumatic bleeding periodic shedding of the nails can result from biomechanical causes and is frequently seen in runners. Worn-down nail Figures 9.49, 9.50 see Chapter 2 koilonychia toes of rickshaw pullers 4 Brittle nails see Chapter 6 . 5 Onychogryphosis and hypertrophic nail see Chapter 4 . 6 Frictional melanonychia Figure 9.51 frictional...

Ethnic nail pigmentation

Ungual Melanoma

Ethnic nail pigmentation is usually easy to recognize by its familial inheritance and the polydactylic distribution of the bands. When observed with epiluminescence microscopy the bands have a fairly homogeneous grey background and thin grey lines comparable with those observed in lentigo Figure 12.10 . Ungual lentigo in an adult's finger nail. Dermoscopy reveals a Ungual lentigo in an adult's finger nail. Dermoscopy reveals a relatively homogeneous greyish background between the two short...

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....

Alteration of the nail itself

Furrows Nail Disease

This category includes 1 Self-inflicted injury Figures 9.45-9.47 the habit of pushing back the cuticle see Chapter 2 Heller's median nail dystrophy see Chapter 2 self-inflicted nail damage may cause longitudinal melanonychia LM nail artefacts, caused by deliberate acts of injury to the nail apparatus with the intention of creating a 'diversion for personal gain' they may also be caused 'subconsciously'. Nail artefacts take various forms. Such patients usually have psychological problems....

Fragile Brittle And Soft Nails

Hapalonychia

Many of the nail diseases that disrupt nail formation and structure cause secondary brittleness and fragility. In this chapter only those conditions leading to nail fragility or brittleness as a major sign are considered in any detail Figures 6.1-6.7 . 'Hapalonychia' is the term used for cryptogenic soft nail cases for which there is no primary specific local nail disease to explain the change. Diseases and conditions associated with this include

Magnetic Resonance Imaging

Mri Phase Array Coil

There have been a few reports of MRI investigations of subungual tumours, particularly glomus tumours. In practice the perionychium may be routinely imaged by MRI with the ability to obtain high spatial resolution images with small surface coils dedicated to wrist or finger Figure 11.3 . A voxel height close to 100 m, about the thickness of the epithelial layer of the nail bed, is necessary. Nevertheless, unlike the skin, which is a superficial structure, the nail unit may require evaluation of...

Fibromas

Acquired Digital Fibrokeratoma

Many different types of fibroma may occur in and around the nail Figure 5.19 . They may be true entities or merely variants of one process. Hypertrophic scars and keloids result from injuries to the nail fold or nail bed and may significantly distort the nail apparatus. Nail apparatus dermatofibromas are rare and may resemble cutaneous horns, fibrokeratomas or supernumerary digits the latter, however, usually arise on the ulnar aspect of the fifth metacarpophalangeal joint. The histological...

Figure 433

Scleroderma associated with Raynaud's phenomenon, disseminated lupus erythematosus, and causalgia of the median nerve. The condition may be idiopathic, congenital, and familial or acquired. A congenital, aberrant, painful hyponychium has been described associated with oblique, deep fractures of the nails. In one case an unusual acquired association of pterygium inversum unguis and lenticular atrophy of the palmar creases was recorded. Pain in the finger tip from minor trauma and haemorrhages...

Figure 121

Toe Nail Single Longitudinal Line

Nail apparatus melanoma ALM-type, Clark's level II, 0.2 mm thickness in a finger nail. Dermoscopy shows a brown background with irregularly pigmented lines long arrow . A faint pigmentation of the cuticle is only visible on epiluminescence microscopy micro-Hutchinson's sign short arrow . Figures 12.1-12.12 are reproduced with kind permission of Josep Malvehy, editor of the Atlas of Dermoscopy. Nail apparatus melanoma, ALM-type, Clark's level III, 0.6 mm thickness in a thumb nail. Dermoscopy...

Dermoscopy of nail pigmentation

Dermoscopy equipment Semiological patterns Diagnosis Further reading Diagnosis of melanonychia striata is one of the most difficult aspects of clinical dermatology. Melanoma is feared in most situations however, melanoma of the nail apparatus is rare about 1 of all cutaneous melanomas . The clinical presentation of early nail apparatus melanoma longitudinal pigmentation is shared by many other clinical processes with much more favourable outcomes, such as nail apparatus naevus or lentigo,...

Traumatic disorders of the nail

Onychomadesis

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...

Herpes simplex

Herpes Finger

Distal digital herpes simplex infection may affect the terminal phalanx as a primary herpetic 'whitlow' or start as an acute, intensely painful paronychia Figures 5.37, 5.38 . It is relatively common in dental staff, anaesthetists and those involved with the care of the mouth and upper respiratory tract in unconscious patients. Recurrent forms are generally less severe and have a milder clinical course than the initial infection. After an incubation period of 3-7 days, during which local...

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...

Impetigo

Impetigo The Nail

The dorsal aspect of the distal phalanx may be involved by impetigo Figure 5.39 . It presents in two forms 1 Vesiculopustular, with its familiar honey-crusted lesions, usually due to beta-haemolytic streptococci. 2 Bullous, usually due to phage type 71 staphylococci. The latter is characterized by the appearance of large, localized, intra-epidermal bullae that persist for longer periods than the transient vesicles of streptococcal impetigo which subsequently rupture spontaneously to form very...

Acute paronychia needs urgent systemicantibiotic treatment to prevent permanent nail dystrophy

The distal edge of the nail, a prick from a thorn in a lateral groove, or sometimes from subungual infection secondary to haematoma Figures 5.1, 5.2 . The infection begins in the lateral paronychial areas with local redness, swelling and pain. At this stage medical treatment is indicated wet compresses for example with Burrow's aluminium acetate solution and appropriate systemic antibiotic therapy are given. Because the continuation of antibiotics may mask a developing pathological process that...

Nail Biting And Onychotillomania

Frequent application of distasteful topical preparations on the nail and periungual skin can discourage patients from biting and chewing their finger nails. Possible alternatives include quaternary ammonium derivatives 4 quinine sulphate in petrolatum. Patients with severe onychophagia or median nail dystrophy can be helped by daily bandaging the injured fingers with permeable adhesive tape. Fluoxetine at high dosages 60 mg day can be helpful in interrupting this compulsive disorder in adults.

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...

Onychomycosis and its treatment

Dermatophytoma

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 55 Causes of longitudinal melanonychia Racial variation

Laugier Hunziker Syndrome

Laugier-Hunziker-Baran syndrome Figure 5.34 Lateral band of longitudinal melanonychia. Lateral band of longitudinal melanonychia. Focal activation of the nail matrix melanocytes This is the most common cause of LM, and is typified by the presence of melanocytes with long dendrites located among nail matrix basal layers. There is no atypia or theque formation. Melanocyte activation occurs in 77 of African-Americans over 20 years of age and in almost 100 of those over 50 years old. It is observed...

Alteration to surrounding tissue

Onychophosis

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,...

Table 42 Causes and associations of nail shedding

Onychogryphosis

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...

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...

Onychodermal Band

Muehrcke Lines

In subtotal leukonychia there is a pink arc of about 2-4 mm in width distal to the white area. Nucleated cells in the distal area were believed to mature, lose their keratohyalin granules and then produce normal nail keratin several months after their formation. It was also suggested that parakeratotic cells are present along the whole length of the nail these decrease in number as they approach the distal end, thus producing the normal pink colour up to the point of separation from the nail...

Nail plate and soft tissue abnormalities

Photoonycholysis

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...

Common

Parakeratosis Pustulosa

Psoriasis Figures 3.26, 3.27, 3.29, 3.30 Alopecia areata Figure 3.31 Eczema Occupational trauma Parakeratosis pustulosa Uncommon Normal Pityriasis rosea Secondary syphilis Sarcoidosis Reiter's syndrome Lichen planus Large, deep and irregular pits are common in psoriasis and eczema Small, superficial and regular pits are typical of alopecia areata An isolated pit is not diagnostic and may be dye to minor trauma

Figure 330

Selective Immunoglobulin Deficiency

Diffuse pitting of the whole nail in psoriasis. Multiple nail pits 'rippled' effect in alopecia areata. Table 3.3 lists the causes of nail pitting. Multiple nail pits 'rippled' effect in alopecia areata. Table 3.3 lists the causes of nail pitting. The term 'twenty-nail dystrophy' or trachyonychia describes a spectrum of nail plate surface abnormalities that result in nail roughness Figures 3.32-3.38 . Patients with trachyonychia can be divided into two main groups 1 Trachyonychia and a past...

Table 34 Causes and associations of trachyonychia

Idiopathic twenty-nail dystrophy Figure 3.34 Alopecia areata Figure 3.32 Lichen planus Figures 3.37, 3.38 Eczematous histology Chemicals and alopecia areata makes it common to observe trachyonychia in other conditions frequently associated with alopecia areata, such as atopic dermatitis, ichthyosis or Down's syndrome. Table 3.4 lists the known causes and associations of trachyonychia. In onychoschizis the distal portion of the nail splits horizontally. The nail is formed in layers somewhat...

Pitting And Rippling

Pitting and rippling are also known as pits, onychia punctata, erosions and Rosenau's depressions. Pits develop as a result of defective nail formation in punctate areas located in the proximal portion of the nail matrix. The surface of the nail plate is studded with small punctate depressions which vary in number, size, depth and shape. The depth and width of the pits relates to the extent of the matrix involved their length is determined by the duration of the matrix damage. Pits result from...

Transverse Lines

Chemotherapy Beau Lines

Transverse, band-like depressions extending from one lateral edge of the nail to the other, and affecting all nails at corresponding levels, are called Beau's lines Figures 3.183.22 . They may be noted after any severe, sudden particularly febrile illness. In milder cases the nails of the thumb and the great toe are the most reliable markers, as the former supplies information for the previous 6-9 months and the latter shows evidence of disease for up to 2 years relating to the different rates...

Jean Luc Drap MD PhD

Congenital Toe Abnormalities

Professor of Radiology, H pital Cochin, University of Paris Paris, France 1990, 1996, 2003, Martin Dunitz, a member of the Taylor amp Francis Group First published in the United Kingdom in 1990 by Martin Dunitz, Taylor amp Francis Group plc, 11 New Fetter Lane, London EC4P 4EE Tel 44 0 20 7583 9855 Fax 44 0 20 7842 2298 E-mail info dunitz.co.uk Website http www.dunitz.co.uk This edition published in the Taylor amp Francis e-Library, 2005. To purchase your own copy of this or any of Taylor amp...