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