Table 43 Causes and associations of onychogryphosis Dermatological

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

Acquired or hereditary_

Empty Nail Bed

Figure 4.19

Subungual hyperkeratosis due to Trichophyton rubrum infection.

Figure 4.19

Subungual hyperkeratosis due to Trichophyton rubrum infection.

positive, homogeneous, rounded or oval, amorphous masses surrounded by normal squamous cells which are usually separated from each other by empty spaces caused by the fixation process. These clumps, which coalesce and enlarge, have been described in psoriasis of the nail, onychomycosis, eczema and alopecia areata, and also in some hyperkeratotic processes such as subungual warts and pincer nails. The horny excrescences of the nail bed are not very obvious, but the ridged structure may become apparent if the nail plate is cut and shortened.

Pityriasis Rubra Pilaris Nails

Figure 4.20

Subungual hyperkeratosis due to pityriasis rubra pilaris. (Courtesy of

Figure 4.20

Subungual hyperkeratosis due to pityriasis rubra pilaris. (Courtesy of

A text atlas of nail disorders 102 R. Caputo, Milan.)

A text atlas of nail disorders 102 R. Caputo, Milan.)

Figure 4.21

Hypertrophic, hard nail in pachyonychia congenita.

Figure 4.21

Hypertrophic, hard nail in pachyonychia congenita.

Figure 4.22

Pachyonychia congenita.

Figure 4.23

Pachyonychia congenita—marked distal subungual thickening. (Courtesy of C.Beylot, Bordeaux.)

In keratosis cristarum the keratinizing process is limited to the peripheral area of the nail bed. It starts at the distal portion but may progress somewhat proximally. Scopulariopsis brevicaulis onychomycosis may present with similar changes.

Table 4.4 lists the causes of thick nails often associated with onycholysis; Table 4.5 lists the causes of thick nails and/or subungual hyperkeratosis.

Figure 4.24

Subungual hyperkeratosis due to lichen planus.

Table 4.4 Causes of thick nails (often associated with onycholysis)

Psoriasis/Reiter's syndrome (Figures 4.14, 4.15) Onychomycosis (Figure 4.19) Pityriasis rubra pilaris (Figure 4.20) Pachyonychia congenita (Figures 4.21-4.23) Contact eczema Mineral oils Cement

Hair styling products Acrokeratosis paraneoplastica (Bazex's syndrome) Lichen planus

Yellow nail syndrome

Bazex Syndrome

Figure 4.25

Darier's disease—distal, irregular, subungual thickening.

Figure 4.25

Darier's disease—distal, irregular, subungual thickening.

Curing Eczema Naturally

Curing Eczema Naturally

Do You Suffer From the Itching, Redness and Scaling of Chronic Eczema? If so you are not ALONE! It strikes men and women young and old! It is not just

Get My Free Ebook


Post a comment