Nail Changes in Commonskin diseases Psoriasis Lichen planus Fungal infections Bacterial infections Ingrown nails (trauma-induced)

2. Common skin conditions with nail changes
• Psoriasis
• Lichen planus
• Fungal infections
• Bacterial infections
• Ingrown nails (trauma induced)

3. Nail psoriasis
• Seen in upto 50% of patients with psoriasis
• May be the first manifestation of psoriasis
• Seen in several nails; both finger and toe nails may
be affected
• Diagnostic signs include extensive irregular pitting,
oil drop sign and onycholysis with erythematous
borders.
• Other abnormalities often seen are nail thickening,
subungual hyperkeratosis, nail crumbling etc.

7. Nail Lichen planus
• Nail abnormalities evident in 10% cases with skin /
mucosal lichen planus
• Commonly occurs in absence of skin / mucosal
involvement
• Thinning and longitudinal ridging [onychorrhexis] /
fisssuring of nail plate, pterygium unguis formation,
subungual hyperkeratosis
• Permanent destruction may occur
• Twenty nail dystrophy

10. Onychomycosis
Infection of nail by dermatophytes, yeasts and moulds.
Over 90 % of fungal infections of nail are caused by
dermatophytes , mainly T.rubrum.
• Examination of skin may give a clue
• Types-
• Distal subungual –end of nail lifts up and free edge
crumbles
• Proximal-yellow spots on halmoon area
• White superficial-white flaky patches and pits on nail
plate

11. • Total dystrophic- complete destruction of nail plate
• Lateral- whitish or yellowish discolouration only on one side
of nail
• T.unguim distal or lateral onychomycosis and progess to nail
dystrophy
• Candidial onychomycosis starts as paronychia mostly.
• Systemic antifungals are the treatment of choice.

13. Distal subungual onychomycosis

14. Proximal subungual onychomycosis

15. Candida onychomycosis

16. Ingrown nail or onychocryptosis
• Common condition due to piercing of nail plate into
lateral nail fold
• Most common causes are improper trimming of
nails and tight, ill-fitting footwear
• Great toe nail most commonly involved
• Causes inflammation, pain ,infection and sometimes
formation of extra granulation tissue
• Treatment: avulsion of nail plate and destruction of
lateral horns of nail plate by phenolisation

18. paronychia
Paronychia means inflammation of nail folds.
ACUTE – staphylococcal ,streptococcal or pseudomonas.
The nail fold is separated from the nail plate and becomes
erythematous painful and tender with purulent discharge.
Requires systemic and local antibiotics.
CHRONIC- mainly fungal in origin due to candida.
Predisposing factors include chronic immersion in water or
irritant contact dermatitis.
Treatment is systemic antibiotics or topical antifungal losions.

20. Thank you