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| Line 50: |
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| ===[[Subungual hyperkeratosis]]=== | | ===[[Subungual hyperkeratosis]]=== |
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Fingernail label.jpg|A normal nail
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| Image:Fingernails1.JPG|Normal fingernails
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| </gallery>
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| </div>
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|
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|
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Toes.jpg|Normal toenails
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| Image:HEMORRHAGESUBUNG1.JPG|Subungual hematoma (mild)
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| </gallery>
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| </div>
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|
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| ==Diseases==
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| *''Onychia'' is an inflammation of the matrix (surrounding tissue) of the nail with formation of [[pus]] and shedding of the nail. Onychia results from the introduction of microscopic [[pathogen]]s through small wounds.
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|
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| *''[[Ingrown nail|Onychocryptosis]]'', commonly known as "ingrown nails" (''unguis incarnatus''), can affect either the fingers or the toes. In this condition, the nail cuts into one or both sides of the nail bed, resulting in inflammation and possibly infection. The relative rarity of this condition in the fingers suggests that pressure from the ground or shoe against the toe is a prime factor. The movements involved in [[walking]] or other physical disturbances can contribute to the problem. Mild onychocryptosis, particularly in the absence of infection, can be treated by trimming and rounding the nail. More advanced cases, which usually include infection, are treated by surgically excising the ingrowing portion of the nail down to its bony origin and thermally or chemically [[cauterizing]] the matrix, or 'root', to prevent recurrence. This surgery is called matrixectomy. The best results are achieved by cauterizing the matrix with [[phenol]]. Another, much less effective, treatment is [[excision]] of the matrix, sometimes called a 'cold steel procedure'.
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|
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| *''Onychodystrophy'' is a deformation of the nails that can result from cancer chemotherapy which includes bleomycin, hydroxyurea, or 5-fluorouracil. It can include discoloration of the nail, or dyschromia.
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|
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| *''[[Onychogryposis]]'', also called "ram's-horn nail", is a thickening and increase in curvature of the nail. It is usually the result of injury to the matrix. It may be partially [[hereditary]] and can also occur as a result of long-term neglect. It is most commonly seen in the great toe but may be seen in other toes as well as the fingernails. An affected nail has many grooves and ridges, is brownish in color, and grows more quickly on one side than on the other. The thick curved nail is difficult to cut, and often remains untrimmed, exacerbating the problem.
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|
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| *''Onycholysis'' is a loosening of the exposed portion of the nail from the nail bed, usually beginning at the free edge and continuing to the [[lunula (anatomy)|lunula]]. It is frequently associated with an internal disorder, trauma, infection, nail fungi, allergy to nail enhancement products, or side effects of drugs.
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| *''Onychomadesis'' is the separation and falling off of a nail from the nail bed. Common causes include localized infection, minor injury to the matrix bed, or severe systemic illness. It is sometimes a side effect of [[chemotherapy]] or [[x-ray]] treatments for [[cancer]]. A new nail plate will form once the cause of the disease is removed.
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| *''[[Onychomycosis]]'', also known as [[tinea|''tinea unguium'']], is a contagious infection of the nail caused by the same fungal organisms which cause [[ringworm]] of the skin (''Trichophyton rubrum'' or ''T. mentagrophytes'', rarely other trichophyton species or ''Epidermophyton floccosum'' <ref name="mycology">{{cite book |last= Hall |first= John C. |editor= John C. Hall |title= Sauer's Manual of Skin Diseases |edition= 9th edition |year= 2006 |publisher= Lippincott Williams & Wilkins |location= Philadelphia |isbn= 0-7817-2947-5|pages= 244=266 |chapter= 25. Dermatologic mycology.}}</ref>). It can result in discoloration, thickening, chalkiness, or crumbling of the nails and is often treated by powerful oral medications which, rarely, can cause severe side effects including liver failure. Mild onychomycosis sometimes responds to a combination of topical antifungal medication, sometimes applied as special medicinal nail lacquer, and periodic filing of the nail surface. For advanced onychomycosis, especially if more than one nail is infected, systemic medication (pills) is preferred. Home remedies are often used, although their effectiveness is disputed. In a study at the University of Rochester [[tea tree oil]] applied twice daily in conjunction with [[debridement]] was found to be an appropriate initial treatment strategy, equally effective to topical use of [[clotrimazole]]<ref name="scratch">[http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=8195735&dopt=AbstractPlus].</ref>. Another procedure is to apply two drops of distilled white vinegar to the nail base, or, additionally, nail plate and under the nail, two or three times daily for approximately six months or until the fungus is gone. This treatment is very effective, due to the vinegar's acidity, if followed consistently.
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|
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| *''Onychophosis'' is a growth of horny [[epithelium]] in the nail.
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| *''Onychoptosis'' is the periodic shedding of one or more nails, in whole or part. This condition may follow certain diseases such as [[syphilis]], or can result from [[fever]], [[Physical trauma|trauma]], systemic upsets or adverse reaction to drugs.
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| *''[[Paronychia]]'' is a bacterial or fungal infection where the nail and skin meet. {{main|Paronychia}}
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| *''[[Koilonychia]]'' is when the nail curves upwards (becomes spoon-shaped) due to an [[iron deficiency]]. The normal process of change is: brittle nails, straight nails, spoon-shaped nails.
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|
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| *''[[Subungual hematoma]]'' occurs when trauma to the nail results in a collection of blood, or [[hematoma]], under the nail. It may result from an acute injury or from repeated minor trauma such as running in undersized shoes. Acute subungual hematomas are quite painful, and are usually treated by releasing the blood by creating a small hole in the nail. Drilling and thermal cautery (melting) are common methods for creating the hole. Thermal cautery is not used on acrylic nails because they are flammable.
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|
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| ==Associated Conditions with Nail Changes==
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|
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| Nail inspection can give a great deal of information about the internal working of the body as well, and like tongue or [[Iris (anatomy)|iris]] inspection, has a long history of diagnostic use in traditional medical practices such as [[Chinese medicine]].
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|
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| ===Pliability:===
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| *Brittleness is associated with iron deficiency, thyroid problems,<ref>http://www.bhcs.com/healthinformation/baylorhealthmagazine/2005/nov/AS_thyroid.htm</ref> impaired kidney function, circulation problems, and biotin deficiency<ref name="scratch" />
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| *Splitting and fraying are associated with psoriasis and deficiencies of folic acid, protein and Vitamin C.
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| *Unusual thickness is associated with circulation problems.
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| *Thinning nails and itchy skin are associated with [[lichen planus]]<ref name="jewel">Judith Cobb, [http://www.nspforum.com/faq/index.cgi?read=929 Fingernails, Jewels or Tools]? ''Nature's Field'' - Nail diagnosis]</ref>.
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|
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| ===Shape and texture:===
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| *Clubbing, or nails that curve down around the fingertips with nailbeds that bulge is associated with oxygen deprivation and lung, heart, or liver disease.
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| *Spooning, or nails that grow upwards is associated with iron or B12 deficiency.
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| *Flatness can indicate a B12 vitamin deficiency<ref name="jewel" /> or [[Raynaud's disease]]<ref name="tool">Mariann Cade, [http://www.nspforum.com/faq/bbs.cgi?read=1191 Fingernails - Diagnostic Tool]</ref>
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| *Pitting of the nails is associated with [[Psoriasis]].
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| *Ridges across the nail indicate stress.
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| *[[Beau's lines]] across the nail are associated with many serious conditions.
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| *Ridges along the nail are associated with arthritis<ref name="scratch" />.
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| *Grooves along the nail are associated with kidney disorders, aging, and iron deficiency<ref name="scratch" />.
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| *Beading is associated with [[rheumatoid arthritis]]<ref name="scratch" />.
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| *Nails that resemble hammered brass are associated with (or portend) [[hair loss]]<ref name="jewel" />.
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| *Short small beds are associated with heart disease.
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|
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| ===Coloration of the nail bed:===
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| *[[Mee's lines]] are associated with [[arsenic]] or [[thallium]] [[poison]]ing, and renal failure.
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| *White lines across the nail are associated with heart disease, liver disease, or a history of a recent high fever<ref name="jewel" />.
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| *[[Terry's nails|Opaque white nails with a dark band at the fingertip]] are associated with cancer, cirrhosis, congestive heart failure, diabetes and aging<ref name="jewel" />.
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| *Paleness or whitening is associated with liver or kidney disease and anemia<ref name="jewel" />.
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| *Yellowing of the nail bed is associated with chronic bronchitis, lymphatic problems, diabetes, and liver disorders.
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| *Brown or copper nail beds are associated with arsenic or copper poisoning, and [[Onychomycosis|local fungal infection]].
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| *Grey nail beds are associated with [[arthritis]], [[edema]], [[malnutrition]], post-[[Surgery|operative]] effects, [[glaucoma]] and [[cardio]]-[[pulmonary]] disease.
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| *Redness is associated with heart conditions.
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| *Dark nails are associated with B12 deficiency.
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| *Stains of the nail plate (not the nail bed) are associated with nail polish<ref name="scratch" />, smoking, and henna use.
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|
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| ===Markings:===
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| *Pink and white nails are associated with kidney disease<ref name="jewel" />.
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| *[[Muehrcke's lines]] are white lines across the nail associated with [[hypoalbuminemia]].
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| *Red skin at the base of the nail is associated with connective tissue disorders<ref name="jewel" />.
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| *Blue lunulae are associated with silver poisoning or lung disorder<ref name="jewel" />.
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| *Blue nail beds are (much like blue skin) associated with poor oxygenation of the blood ([[asthma]], [[emphysema]], etc)<ref name="jewel" />.
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| *[[Leukonychia|Small white patches]] are associated with zinc or calcium deficiency or malabsorption, parasites, or local injury<ref name="tool" />.
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| *Receded lunulae (fewer than 8) are associated with poor circulation<ref name="tool" />, shallow breathing habits or thyroid mysfunction<ref name="jewel" />.
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| *Large lunulae (more than 25% of the thumb nail) are associated with high blood pressure.
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|
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| == Diagnosis ==
| |
|
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| === History and Symptoms ===
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| * History of [[psoriasis]]
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| * Family history
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| * Occupational history
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| * Hobbies
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|
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| === Physical Examination ===
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| * Complete skin exam
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|
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| === Laboratory Studies ===
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| * Periodic Acid-Schiff (PAS)
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| * Fungal cultures
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| * Bacterial cultures
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|
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| === Other Diagnostic Studies ===
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| * [[Nail matrix]] [[biopsy]]
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| * Possible dermatology referral
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|
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| == Differential Diagnosis of Causes of Nail changes==
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|
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| === Beau's Lines ===
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| ''Transverse furrows, sign of a previous arrest in the growth process''
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| *[[Coronary occlusion]]
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| *[[Delirium]]
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| *[[Depression]]
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| *[[Gout]]
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| *[[Malnutrition]]
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| *[[Reiter's Disease]]
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| *[[infectious disease|Severe infectious disease]]
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| *[[Shock]]
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| *[[Surgery]]
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| *[[Toxin]]s
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| *[[Trauma]]
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| *[[nail matrix|Traumatic damage to nail matrix]]
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|
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| === Blue discoloration ===
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| *[[Argyria]]
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| *[[Dapsone|DADPS]]
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|
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| === Brown-black discoloration ===
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| *[[Acral lentiginous melanoma]]
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| *[[Alcaptonuria]]
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| *[[Hematoma]]
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| *[[Mole]]s
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| *[[Ochronosis]]
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|
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| == Green-black discoloration ==
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| *[[infection]] with [[pseudomonas aeruginosa]]
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|
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| === Half and Half Nails ===
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| ''White (proximal) and brown (distal) reversible coloration of the nail''
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| *[[Uremia]]
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|
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| === Hippocratic Nails ===
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| ''Large, curved nails that usually occur in conjunction with clubbing''
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| *[[Arteriovenous fistula|Arteriovenous shunts]]
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| *[[Biliary Cirrhosis]]
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| *[[Bronchiectasis]]
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| *[[Bronchial carcinoma]]
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| *[[Cerebral contusion|Cerebrovascular trauma]]
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| *[[Congenital heart disease|Cyanotic congenital heart disease]]
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| *[[Crohn's Disease]]
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| *[[Emphysema]]
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| *[[Heart Failure]]
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| *[[Infectious Endocarditis]]
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| *[[Hepatocellular carcinoma|Liver Tumors]]
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| *[[Lung Abscess]]
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| *[[Mesothelioma]]
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| *[[Pachydermoperiostosis]]
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| *[[Pulmonary artery]] [[sclerosis]]
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| *[[Pulmonary fibrosis]]
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| *[[metastase|Pulmonary metastases]]
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| *[[Silicosis]]
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| *[[Sprue]]
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| *[[Tuberculosis]]
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| *[[Ulcerative Colitis]]
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|
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| === [[Koilonychia]] ===
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| ''A malformation of the nails which the outer surface is concave''
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| *[[Addison's Disease]]
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| *[[Cushing's Disease]]
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| *[[Diabetes Mellitus]]
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| *[[Grave's Disease]]
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| *[[Hereditary]]
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| *[[Hypochromic anemia]]
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| *[[Iron deficiency]]
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| *[[Malnutrition]]
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| *[[Multiple Myeloma]]
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| *[[Pellagra]]
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| *[[Raynaud's disease]]
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| *[[Vitamin B12 Deficiency]]
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|
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| === [[Leukonychia]] ===
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| ''White coloration of nails''
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| *[[Anemia]]
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| *[[Heart disease|Cardiac Diseases]]
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| *[[Cirrhosis]]
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| *[[Darier's disease]]
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| *[[Fever]]
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| *[[Hypoalbuminemia]]
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| *[[Mycosis]]
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| *[[Nitrate]] [[solution]]
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| *[[Silver]] [[solution]]
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| *[[Noxa]]
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| *[[Trauma]]
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|
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| === Mee's Lines ===
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| ''Horizontal white bands of the nails''
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| *[[Drug]]s/[[Toxin]]s
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| *[[Fluorosis]]
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| *Occasionally occurs in [[leprosy]]
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|
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| ===Onychogryphosis ===
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| ''Brittle, Split nails''
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| *[[Anemia]]
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| *Chronic [[chemical]] damage
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| *[[Lichen|Lichen ruber]]
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| *[[Thyroid Disease]]
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|
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| === Onchodystrophy ===
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| ''Deformed, brittle, rough, discolored nails''
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| *[[Eczema]]
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| *[[Fungal infection]]
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| *[[Psoriasis]]
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|
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| === Onycholysis ===
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| ''Painless loss of the nail''
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| *[[ICD-10 Chapter IX: Diseases of the circulatory system|Circulatory system diseases]]
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| *[[Diabetes Insipidus]]
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| *[[Diabetes Mellitus]]
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| *[[Drug]]s
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| *[[Eczema]]
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| *[[Hemangioma]] under the nail
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| *[[Onychomycosis]]
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| *[[Psoriasis]]
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| *[[Reiter's Disease]]
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| *[[Thyroid Disease]]
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| *[[Tumor]]
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|
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| === Paronychia ===
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| ''Inflammation of the nail bed''
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| *[[Bacteria]]l
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| *[[Candida]]
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| *[[Syphillis]]
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|
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| === Pitted Nails ===
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| ''Pinpoint depressions in the nails''
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| *[[Alopecia areata]]
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| *[[Lichen|Lichen ruber]]
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| *[[Lupus erythematosus]]
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| *[[Neurodermatitis]]
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| *[[Psoriasis]]
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| *[[Rheumatic Fever]]
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|
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| === Yellow nails ===
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| ''Yellow-greenish discoloration of the nails (some or all) with subsequent [[onycholysis]]''
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| *[[Congenital]] [[hypoplasia]] / [[dysplasia]] of peripheral [[lymph vessel]]s
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| *Diseases of the [[bronchial tube]]s
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| *Diseases of the [[paranasal sinus]]es
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| *Smoker's fingers
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|
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| ==Pathological Findings==
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|
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| == Treatment ==
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|
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| === Acute Pharmacotherapies ===
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| * Systemic antifungals
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| * Intralesional steroids
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| * Topical paint-on ciclopirox
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| * Systemic antipsoriatic therapies
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|
| |
| == References ==
| |
| {{Reflist|2}}
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|
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| ==See also==
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|
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| * [[Leukonychia]]
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| * [[Mee's lines]]
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| * [[Beau's lines]]
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| * [[Occupational hazards associated with exposure to human nail dust]]
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|
| |
| == External links ==
| |
| * [http://www.mckinley.uiuc.edu/handouts/ingrown%5Ftoenail/ingrown%5Ftoenail.html Ingrown Toenail] - explanation covering causes, treatment, and prevention (with diagram)
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| * [http://www.lib.uiowa.edu/hardin/md/nailspictures.html Links to pictures of Nail Diseases (Hardin MD/Univ of Iowa)]
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| *[http://www.associatedcontent.com/article/38824/how_fingernail_fungus_spreads_and_how.html How Fingernail Fungus Spreads, and How to Treat It] a practical guide for the layman.
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| *[http://www.aafp.org/afp/20040315/1417.html Nail Abnormalities: Clues to Systemic Disease]
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|
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| {{Diseases of the skin and subcutaneous tissue}}
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|
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| [[Category:Signs and symptoms]]
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| [[Category:Dermatology]]
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| [[Category:Primary care]]
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| [[Category:Physical examination]]
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|
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| {{WikiDoc Sources}}
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