Dermatology lecture

1. Nail abnormalities
Dr. Bashir nur

2. Nail Abnormalities

3. • Healthy nails appear smooth and have
consistent coloring. As you age, you may
develop vertical ridges, or your nails may be a
bit more brittle. This is harmless. Spots due to
injury should grow out with the nail.

4. The nail unit is composed
• The nail plate,
• the nailbed,
• the hyponychium,
• the nail matrix,
• the nail folds,
• the cuticle,
• the anchoring portion of the nailbed,
• and the distal phalangeal bones.
The nail plate is the largest component of the nail
unit. The nail matrix gives rise to the nail plate.

6. Abnormalities of the fingernail
• discoloration (dark streaks, white streaks, or
changes in nail color)
• changes in nail shape (curling or clubbing)
• changes in nail thickness (thickening or thinning)
• nails that become brittle
• nails that are pitted
• bleeding around nails
• swelling or redness around nails
• pain around nails
• a nail separating from the skin

7. These nail changes can be caused by a
variety of different conditions:
• Beau’s lines
• Clubbing
• Spooning
• Leukonychia
• Mees’ lines
• Onycholysis
• Pitting
• Terry’s nails
• Yellow nail syndrome

8. Beau’s lines

9. • Beau’s lines
• Depressions that run across your fingernail are called
Beau’s lines. These can be a sign of malnourishment.
Other conditions that cause Beau’s lines are:
• diseases that cause a high fever such as measles,
mumps, and scarlet fever
• peripheral vascular disease
• pneumonia
• uncontrolled diabetes
• zinc deficiency

10. Clubbing

11. • Clubbing is when your nails thicken and curve
around your fingertips, a process that generally
takes years. This can be the result of low oxygen
in the blood and is associated with:
• cardiovascular diseases
• inflammatory bowel disease
• liver diseases
• pulmonary diseases
• AIDS

12. Koilonychia (spooning)

13. • Koilonychia is when your fingernails have raised ridges and
scoop outward, like spoons. It’s also called “spooning.”
Sometimes the nail is curved enough to hold a drop of
liquid. Spooning can be a sign that you have:
• iron deficiency anemia
• heart disease
• hemochromatosis, a liver disorder that causes too much
iron to be absorbed from food
• lupus erythematosus, an autoimmune disorder that causes
inflammation
• hypothyroidism
• Raynaud’s disease, a condition that limits your blood
circulation

14. Leukonychia (white spots)

15. • Nonuniform white spots or lines on the nail
are called leukonychia. They’re usually the
result of a minor trauma and are harmless in
healthy individuals. Sometimes leukonychia is
associated with poor health or nutritional
deficiencies. Factors can include infectious,
metabolic, or systemic diseases as well as
certain drugs.

16. Mees’ lines

17. • Mees’ lines are transverse white lines. This can
be a sign of arsenic poisoning. If you have this
symptom, your doctor will take hair or tissue
samples to check for arsenic in your body.

18. Onycholysis

19. • When the nail plate separates from the nail
bed, it causes a white discoloration. This is
called onycholysis. This can be due to
infection, trauma, or products used on the
nails.
• Other causes for onycholysis include:
• psoriasis
• thyroid disease

20. Pitting

21. • Pitting refers to small depressions, or little
pits, in the nail. It’s common in people who
have psoriasis, a skin condition that causes the
skin to be dry, red, and irritated. Some
systemic diseases can also cause pitting.

22. Terry’s nails

23. • When the tip of each nail has a dark band, it’s
called Terry’s nails. This is often due to aging,
but it can also be caused by:
• congestive heart failure
• diabetes
• liver disease

24. Yellow nail syndrome

25. • Yellow nail syndrome is when the nails get thicker and
don’t grow as fast as normal. Sometimes the nail lacks
a cuticle and may even pull away from the nail bed.
This can be the result of:
• internal malignancies
• lymphedema, swelling of the hands
• pleural effusions, fluid buildup between the lungs and
chest cavity
• respiratory illnesses such as chronic bronchitis or
sinusitis
• rheumatoid arthritis

26. Paronychia

27. • Paronychia is a soft-tissue infection of the crease between the nail
and the nail fold (shown). It is the most commonly encountered
hand infection, often seen in individuals whose occupation requires
frequent contact with water. Patients typically describe pain and
tenderness. Acute paronychia typically develops after minor trauma
and can lead to infection, with Staphylococcus aureus as the
organism most commonly implicated in infection. Chronic
paronychia develops after exposure to moist environments and
lasts 6 weeks or longer, with Candida albicans as the most common
etiologic agent. On examination, the affected area may appear
erythematous and swollen with pus in advanced cases and nail
changes in chronic ones. Acute paronychia is treated with warm
soaks and oral antibiotics. Chronic paronychia is treated by keeping
the lesion dry and by the application of topical antifungals. Surgical
intervention may be required in acute or chronic paronychia cases
that are refractory to therapy or in which an abscess develops.

28. Melanonychia

29. • Melanonychia is a brown or black
pigmentation of the nail plate. It most often
occurs because of increased production of
melanin by melanocytes in the nail matrix. It is
more common in darkly pigmented individuals
and may be found in almost 100% of African
Americans over the age of 50 years. There are
2 types of melanonychia: diffuse and
longitudinal. Distinction depends upon the
extent of discoloration

30. Distal onycholysis

31. Contd…
• Distal onycholysis refers to spontaneous separation of
the nail plate starting at the distal free margin and
progressing proximally. Local irritation is the most
common insult, such as excessive filing or chemical
overexposure in manicures. Onycholysis has also been
associated with a number of other systemic disorders,
specifically systemic lupus erythematosus,
hyperthyroidism, iron-deficiency anemia, primary
dermatologic diseases (such as atopic dermatitis and
psoriasis vulgaris), or neoplasms (including squamous
cell carcinoma and lung carcinoma), as well as
medications (especially fluoroquinolones and
doxycycline), infections, or congenital etiologies.

32. Contd…
• Patients do not typically report any pain or
discomfort unless there is a superimposed
infection. Treatment involves controlling or
eliminating any risk factors and clipping off
the unattached nail to prevent additional
prying off and to allow for normal
replacement of nail growth. Image courtesy of
the National Institutes of Health

33. Subungual hematoma

34. • Subungual hematomas are common nailbed
injuries caused by blunt or sharp trauma to the
nail. The rich vascular supply in the nailbed makes
it prone to bleeding. Patients with minor
hematomas are typically asymptomatic. Large
hematomas may produce enough throbbing pain
for patients to seek medical attention. Treatment
involves trephination, in which a hole is drilled or
burned through the nail body to release pressure,
or nail removal. Image courtesy of Wikimedia
Commons.

35. Onychocryptosis

36. • Onychocryptosis refers to an ingrown toenail, typically found in the
big toe. Extrinsic compression of a toenail, typically from tight
footwear, places constant pressure on the nail wall. If the nail is cut
inappropriately short and the nail fold is irritated or penetrated,
then colonization of bacteria or fungi may occur. Inflammation,
edema, erythema, and pain are common findings; an abscess or
cellulitis may develop. Treatment for early inflammation focuses on
avoiding compressive footwear, dislodging the embedded nail plate,
and education on proper nail care, including trimming the nail with
squared corners. Treatment for more advanced cases involves
partial or complete toenail removal. Antibiotic therapy is typically
not required except for those who are diabetic,
immunocompromised, or who show significant evidence of
cellulitis. Image courtesy of Wikimedia Commons

37. Psoriatic nail disease

38. • Psoriatic nail disease is deformation of the nail
unit of unclear etiology. It typically occurs in
patients with clinically evident psoriasis and
rarely is the only cutaneous finding. The clinical
manifestations are protean and depend upon the
portion of the nail unit affected. Findings may
include pitting, Beau's lines (transverse lines in
the nail caused by intermittent growth arrest),
salmon patches, subungual hyperkeratosis,
onycholysis, nail plate crumbling, splinter
hemorrhages, and a spotted lunula. Diagnosis is
made on clinical findings or by a nail biopsy.

39. • Treatment focuses on the functional and
psychosocial aspects of the disease, as no
curative treatment is available. Options
include corticosteroids, psoralen plus
ultraviolet light (PUVA), chemotherapeutic
agents, and avulsion therapy

40. onychomycosis

44. Thank you