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Nail Diseases 03-2009Nail Diseases 03-2009
Tom Paige MDTom Paige MD
Department of DermatologyDepartment of Dermatology
CCRMCCCRMC
How To Approach Nail DiseasesHow To Approach Nail Diseases
Abnormalities of the nail plate surface
Nail discoloration
Abnormalities of the cuticle and nail fold
Abnormalities of nail shape
Loss of nails
Lesions around nails
Nail ApparatusNail Apparatus
Abnormalities of the nail plate surface
Pitting seen in– *Psoriasis– Eczema– Alopecia areata
Beau’s lines– *Trauma– Dermatologic diseases– Systemic conditions
Median nail dystrophy– *Trauma– Familial– Drugs
Onychogryphosis– *Elderly neglect– *Trauma– Peripheral vascular
disease
Nail discoloration
Darier’s disease– Hereditary disease
Yellow nails– Y N Syndrome
associated w/ lymphedema and respiratory tract disease
Green nails– Infection w/
Pseudomonas aeruginosa
Salmon patches or “oil drop sign”– Psoriasis
Abnormalities of the cuticle and nail fold
Paronychia– Acute
BacterialViral
– ChronicExposure to irritants and/or allergens
Nailfold telangiectasias– Dermatomyositis
Ragged cuticleEnlarged capillaries
– SclerodermaCapillary changes like DM
– SLESee wandering glomeruloid loopsNo skip areas
Abnormalities of nail shape
Enlarged nail– Osteoid osteoma
(bone tumor)
Clubbing of nails– Hereditary– Acquired
Koilonychia– Physiologic in children– Iron deficiency in
adults
Pachyonychia congenita– Hereditary– Autosomal dominant
Loss of nails
Onychophagia – Compulsive habit– Up to 30% of kids bite
their nails by some studies
Lichen planus– 10% of patients w/ LP
have nail changesNail thinning and fissuring most commonly seen
Possible cicatricial outcome (dorsal pterygium formation and/or anonychia)
Lesions around nails
Paronychial warts– HPV types 1, 2 ,and 4
Squamous cell carcinoma in situ– Verrucous lesion– Onycholysis– Melanonychia– Inflammation and
crusting
Purple toe syndrome– Many causes
Subungal tumor– Osteoma
Assosciated Assosciated conditionsconditions– Diabetes mellitusDiabetes mellitus– Iron deficiency anemiaIron deficiency anemia– TraumaTrauma– End stage renal End stage renal
diseasedisease– None of the above None of the above
This entity is seen inThis entity is seen in– Warfarin intakeWarfarin intake– Cholesterol emboliCholesterol emboli– SmokingSmoking– Mercury poisoningMercury poisoning– None of the aboveNone of the above
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