DOCSLIB.ORG

Congenital Malalignment of the Great Toenail (CMGT) Is Based on a Lateral Deviation of the Nail Plate

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Congenital Malalignment of the Great Toenail (CMGT) Is Based on a Lateral Deviation of the Nail Plate Review of Common Toenail Conditions and Current Treatment Options Dock Dockery, DPM [email protected] Review of Common Toenail Conditions and Current Treatment Options Dock Dockery, DPM [email protected] DOCK DOCKERY, DPM [email protected] • These appear as indentations or grooves that run across the nails transversely. • In infants, these lines are commonly seen soon after birth. • In older children, they can be seen after a high fever, HFM Disease, trauma, or uncommonly, can be a sign of zinc deficiency or hypocalcemia. • Gerard E et al. Risk factors, clinical variants and therapeutic outcome of retronychia: a retrospective study of 18 patients. Eur J Dermatol. 2016 Aug 1;26(4):377-381, 2016. • Akpolat ND and Karaca N. Nail changes secondary to hand-foot-mouth disease. Turk J Pediatr. 58(3):287-290, 2016. PROXIMAL NAIL SHEDDING: ONYCHOMADESIS & BEAU’S LINES A. Damage occurs to the nail matrix: trauma, fever, illness, malnutrition, etc. B. Arrest in nail growth follows and then normal growth resumes. R L R L (B, D) Great toenail dystrophy of left great toenail presenting growth retardation compared to (A, C) normal right great toenail during 4 months. Arrow head is a CO2 laser marking. Onychomadesis is a periodic idiopathic shedding of the nails beginning at the proximal end, caused by the temporary arrest of the function of the nail matrix. Onychomadesis with proximal nail fold paronychia Onychomadesis with proximal nail fold paronychia de Berker, D, et al. Retronychia: Proximal ingrowing of the nail plate. J Am Acad Daermatol, 58:978-983, 2008. 16-year-old male with left partial hallux nail 14-year-old male with right hallux nail involvement 18-year-old male with left Great toenail dystrophy presenting with shrimp Total hallux nail nail or multiple onychomadesis events 11-years old 4-weeks old 6-years old Congenital Malalignment of Great Toenail (CMGT) • Congenital malalignment of the great toenail (CMGT) is based on a lateral deviation of the nail plate. This longitudinal axis shift is due to a deviation of the nail matrix, possibly caused by increased traction of the hypertrophic extensor tendon of the hallux. • Congenital malalignment of the big toe nail is typically present at birth. Ingrown toenails, paronychia and onchogryphosis are among the most common complications. • Depending on the degree of deviation, conservative or surgical treatment may be recommended. • Dockery G. Nail and periungual reconstruction, In, Lower Extremity Soft Tissue & Cutaneous Plastic Surgery, 2nd Edition, Ch 24, 2012. • Lipner SR and Scher RK. Congenital Malalignment of the Great Toenails With Acute Paronychia. Pediatr Dermatol.33(5):e288-289, 2016. • Richert B, et al. Cosmetic surgery for congenital nail deformities. J Cosmet Dermatol. 7(4):304-308, 2008. 12-month old male 6-month old male His brother and sister had also experienced ingrown toenails since childhood. Conservative care: with daily foot bath of diluted povidone-iodine, gentle massage of nail folds and topical mupirocin. Cayirh M, et al. Congential malalignment of the great toenail, J Turk Acad Dermatol. 10:(1):161011, 2016. SURGICAL TREATMENT From: Dockery G. Nail and periungual reconstruction, In, Dockery G and Crawford M: Lower Extremity Soft Tissue & Cutaneous Plastic Surgery, 2nd Edition, Ch 24, pp 289-305, 2012. 6-year-old 4-year-old 13-year-old 23-year-old • Koilonychia, a concave nail dystrophy, has multiple etiologies and may be hereditary, acquired or idiopathic. • These nails have a soft texture and appear scooped out, due to the thin, soft nature of a young child’s nails. They often occur on thumbs and hallux. • In infants, koilonychia of the toenails is commonly transient and idiopathic, although familial and syndromic cases are reported. • Koilonychias has been linked to iron deficiency, but mostly in adults. • Walker J, et al. Koilonychia: an update on pathophysiology, differential diagnosis and clinical relevance. J Eur Acad Dermatol Venereol. 30(11):1985-1991, 2016. • Chinazzo M, et al. Nail features in healthy term newborns: a single-centre observational study of 52 cases. J Eur Acad Dermatol Venereol. 31(2):371-375, 2017. KOILONYCHIA (Spoon Nails) TREATMENT: Childhood koilonychia is typical of the toenails, whereas iron deficiency koilonychia is seen in both fingernails and toenails. It is not necessary to assess iron in a child with koilonychias of the toenails. Tests for iron deficiency should be pursued only if koilonychias is widespread and when it is seen in both fingernails and toenails. Leukonychia Inherited leukonychia occurs at birth and leukonychia totalis occurs in early childhood days. CLASSIFICATION of LEUKONYCHIA: • True Leukonychia • Apparent Leukonychia • Pseudo Leukonychia 1. True Leukonychia: the white coloration is the result of pathology in the nail matrix. A. Hereditary: Autosomal dominant disorder with or without other medical conditions, B. Acquired: the result of nail matrix disturbances due to systemic disease, injury or poisoning. 2. Apparent Leukonychia: the pathology is within the subungual soft tissue. 3. Pseudo leukonychia: comes from an outside origin for example fungal infection (SWO) and excessive nail dehydration from nail polish. Inherited leukonychia occurs at birth and Leukonychia totalis occurs in early childhood days. LEUKONYCHIA: MUST rule-out Superficial White Onychomycosis (SWO) when dealing with Leukonychia. SWO scraps off easily with a fine curette, whereas leukonychia does not scrap off. Superficial White Onychomycosis Superficial White Onychomycosis Leukonychia (puncta) Also known as "true" leukonychia, this is the most common form of leukonychia. Picking and biting of the nails and micro-trauma to the base (matrix) of the toenail are a prominent causes in young children and nail biters. Besides parakeratosis, air trapped between the cells cause this appearance. When trauma is the case the white spots disappear after around eight months. • Onycholysis is the separation of a toenail from its nail bed. The separation occurs gradually and is usually painless. • The most common cause of onycholysis in children is trauma. Even slight trauma can cause onycholysis when it happens repetitively — for example, daily wear of tight socks or shoes, toe walking and activities like kicking. • Onycholysis is also commonly seen in toenail infections, especially onychomycosis, drugs and skin conditions. The ends of the nails become frayed and split. Commonly seen in the first few years of life, onychoschizia is usually present on the thumbs and big toes and thought to be due to repeated trauma. Must rule out anemia and malnutrition when many nails are involved. Koilonychia, onychoschizia of toenails or absence of lunula are physiological features of nails in newborns. Sarifakioglu E, et al. Nail alterations in 250 infant patients: a clinical study. J Eur Acad Dermatol Venereol. 22(6):741-744, 2008. Hochman LG, et al. Brittle Nails: Response to Daily Biotin Supplementation. Cutis. 51(4):303-305, 1993. Iorizzo M, et al. Brittle Nails. J Cosmet Dermatol. 3(3):138-144, 2004. Scheinfeld N, et al. Vitamins and minerals: their role in nail health and disease. J Drugs Dermatol. 6(8):782-787, 2007. CANDIDAL NAIL INFECTION 8-year-old boy Candidiasis Onychomycosis Difficult to Treat Unless Proper Diagnosis is Made. ATOPIC DERMATOSIS Chronic Atopy w/ Xerosis & Nail Dystrophy in 12-YO Boy with Asthma and Upper Respiratory Bronchitis Frequently misdiagnosed as tinea pedis and onychomycosis 6-Year-Old 13-Year-Old Generalized: Accentuated skin Chronic Focal: Frequently lines & creases –xerosis misdiagnosed as tinea infection Intermediate Stage of Atopy: 7-Year-old boy Hyperlinear palmar Lichenification, dystrophic and finger creases nails, xerosis, accentuated lines ATOPIC DERMATITIS •MAJOR Features (Must Have 3 or More): •MINOR Features (Must Have 3 or More): • Cheilitis (dry cracked corners of the mouth) • Conjunctivitis (recurrent) • Eczema • Keratosis Pilaris • Facial Pallor/Facial Erythema • Orbital Darkening • • Food Allergies or Intolerances Palmar Hyperlinearity • Pityriasis Alba • Hand Dermatitis • Wool Intolerance • Ichthyosis • Xerosis • Itching when Sweating Candida Paronychia Relhan V, et al. Management of chronic paronychia Indian J Dermatol. 59(1):15-20,2014. En Bloc Resection of Proximal Nail Fold Chronic Candida Paronychia Rigopoulos D, et al. Acute and chronic paronychia. Am Fam Physician. 1;77(3):339-346,2008. Grover C, et al. En bloc excision of proximal nail fold for chronic paronychia. Dermatol Surg. 32(3);393-399, 2006. Subungual exostoses and osteochondromas more common on hallux than other toes. • Tuzuner T, et al. Subungual Osteochondroma. J Am Podiatr Med Assoc, 96(2):154-157, 2006. • Lee SK, et al. Two distinctive subungual pathologies: subungual exostosis and subungual osteochondroma. Foot Ankle Int. 28(5):595-601, 2007. Vazquez-Flores H, et al. Subungual osteochondroma: clinical and radiologic features and treatment. Derm Surg. 30:1031-1034, 2004 Tuzuner T, et al.: Subungual osteochondroma. JAPMA 96 (2): 154 – 157, 2006. Mavrogenis A, et al. Skeletal osteochondromas revisited. Orthopedics;31:1018–1028, 2008. Vazquez-Flores H, et al. Subungual osteochondroma: clinical and radiologic features and treatment. Derm Surg. 30:1031-1034, 2004 Tuzuner T, et al.: Subungual osteochondroma. JAPMA 96 (2): 154 – 157, 2006. Mavrogenis A, et al. Skeletal osteochondromas revisited. Orthopedics;31:1018–1028, 2008. Lee SK, et al. Two distinctive subungual pathologies: subungual exostosis and subungual osteochondroma.
Load more

Recommended publications
  • Pediatrics-EOR-Outline.Pdf
    DERMATOLOGY – 15% Acne Vulgaris Inflammatory skin condition assoc. with papules & pustules involving pilosebaceous units Pathophysiology: • 4 main factors – follicular hyperkeratinization with plugging of sebaceous ducts, increased sebum production, Propionibacterium acnes overgrowth within follicles, & inflammatory response • Hormonal activation of pilosebaceous glands which may cause cyclic flares that coincide with menstruation Clinical Manifestations: • In areas with increased sebaceous glands (face, back, chest, upper arms) • Stage I: Comedones: small, inflammatory bumps from clogged pores - Open comedones (blackheads): incomplete blockage - Closed comedones (whiteheads): complete blockage • Stage II: Inflammatory: papules or pustules surrounded by inflammation • Stage III: Nodular or cystic acne: heals with scarring Differential Diagnosis: • Differentiate from rosacea which has no comedones** • Perioral dermatitis based on perioral and periorbital location • CS-induced acne lacks comedones and pustules are in same stage of development Diagnosis: • Mild: comedones, small amounts of papules &/or pustules • Moderate: comedones, larger amounts of papules &/or pustules • Severe: nodular (>5mm) or cystic Management: • Mild: topical – azelaic acid, salicylic acid, benzoyl peroxide, retinoids, Tretinoin topical (Retin A) or topical antibiotics [Clindamycin or Erythromycin with Benzoyl peroxide] • Moderate: above + oral antibiotics [Minocycline 50mg PO qd or Doxycycline 100 mg PO qd], spironolactone • Severe (refractory nodular acne): oral
    [Show full text]
  • Isotretinoin Induced Periungal Pyogenic Granuloma Resolution with Combination Therapy Jonathan G
    Isotretinoin Induced Periungal Pyogenic Granuloma Resolution with Combination Therapy Jonathan G. Bellew, DO, PGY3; Chad Taylor, DO; Jaldeep Daulat, DO; Vernon T. Mackey, DO Advanced Desert Dermatology & Mohave Centers for Dermatology and Plastic Surgery, Peoria, AZ & Las Vegas, NV Abstract Management & Clinical Course Discussion Conclusion Pyogenic granulomas are vascular hyperplasias presenting At the time of the periungal eruption on the distal fingernails, Excess granulation tissue and pyogenic granulomas have It has been reported that the resolution of excess as red papules, polyps, or nodules on the gingiva, fingers, the patient was undergoing isotretinoin therapy for severe been described in both previous acne scars and periungal granulation tissue secondary to systemic retinoid therapy lips, face and tongue of children and young adults. Most nodulocystic acne with significant scarring. He was in his locations.4 Literature review illustrates rare reports of this occurs on withdrawal of isotretinoin.7 Unfortunately for our commonly they are associated with trauma, but systemic fifth month of isotretinoin therapy with a cumulative dose of adverse event. In addition, the mechanism by which patient, discontinuation of isotretinoin and prevention of retinoids have rarely been implicated as a causative factor 140 mg/kg. He began isotretinoin therapy at a dose of 40 retinoids cause excess granulation tissue of the skin is not secondary infection in areas of excess granulation tissue in their appearance. mg daily (0.52 mg/kg/day) for the first month and his dose well known. According to the available literature, a course was insufficient in resolving these lesions. To date, there is We present a case of eruptive pyogenic granulomas of the later increased to 80 mg daily (1.04 mg/kg/day).
    [Show full text]
  • Ingrown Nail/Paronychia Referral Guide: Podiatry Referral Page 1 of 1 Diagnosis/Definition
    Ingrown Nail/Paronychia Referral Guide: Podiatry Referral Page 1 of 1 Diagnosis/Definition: Redness, warmth, tenderness and exudate coming from the areas adjacent to the nail plate. Initial Diagnosis and Management: History and physical examination. In chronic infection appropriate radiographic (foot or toe series to rule out distal phalanx osteomyelitis) and laboratory evaluation (CBC and ESR). Ongoing Management and Objectives: Primary care should consist of Epsom salt soaks, or soapy water, and antibiotics for ten days. If Epsom salt soaks and antibiotics are ineffective, the primary care provider has the following options: Reevaluate and refer to podiatry. Perform temporary avulsion/I&D. Perform permanent avulsion followed by chemical cautery (89% Phenol or 10% NaOH application – 3 applications maintained for 30 second intervals, alcohol dilution between each application). Aftercare for all of the above is continued soaks, daily tip cleaning and bandage application. Indications for Specialty Care Referral: After the reevaluation at the end of the antibiotic period the primary care provider can refer the patient to Podiatry for avulsion/ surgical care if they do not feel comfortable performing the procedure themselves. The patient should be given a prescription for antibiotics renewal and orders to continue soaks until avulsion can be performed. Test(s) to Prepare for Consult: Test(s) Consultant May Need To Do: Criteria for Return to Primary Care: After completion of the surgical procedure, patients will be returned to the primary care provider for follow-up. Revision History: Created Revised Disclaimer: Adherence to these guidelines will not ensure successful treatment in every situation. Further, these guidelines should not be considered inclusive of all accepted methods of care or exclusive of other methods of care reasonably directed to obtaining the same results.
    [Show full text]
  • Onychomycosis/ (Suspected) Fungal Nail and Skin Protocol
    Onychomycosis/ (suspected) Fungal Nail and Skin Protocol Please check the boxes of the evaluation questions, actions and dispensing items you wish to include in your customized protocol. If additional or alternative products or services are provided, please include when making your selections. If you wish to include the condition description please also check the box. Description of Condition: Onychomycosis is a common nail condition. It is a fungal infection of the nail that differs from bacterial infections (often referred to as paronychia infections). It is very common for a patient to present with onychomycosis without a true paronychia infection. It is also very common for a patient with a paronychia infection to have secondary onychomycosis. Factors that can cause onychomycosis include: (1) environment: dark, closed, and damp like the conventional shoe, (2) trauma: blunt or repetitive, (3) heredity, (4) compromised immune system, (5) carbohydrate-rich diet, (6) vitamin deficiency or thyroid issues, (7) poor circulation or PVD, (8) poor-fitting shoe gear, (9) pedicures received in places with unsanitary conditions. Nails that are acute or in the early stages of infection may simply have some white spots or a white linear line. Chronic nail conditions may appear thickened, discolored, brittle or hardened (to the point that the patient is unable to trim the nails on their own). The nails may be painful to touch or with closed shoe gear or the nail condition may be purely cosmetic and not painful at all. *Ask patient to remove nail
    [Show full text]
  • Skin Disease and Disorders
    Sports Dermatology Robert Kiningham, MD, FACSM Department of Family Medicine University of Michigan Health System Disclosures/Conflicts of Interest ◼ None Goals and Objectives ◼ Review skin infections common in athletes ◼ Establish a logical treatment approach to skin infections ◼ Discuss ways to decrease the risk of athlete’s acquiring and spreading skin infections ◼ Discuss disqualification and return-to-play criteria for athletes with skin infections ◼ Recognize and treat non-infectious skin conditions in athletes Skin Infections in Athletes ◼ Bacterial ◼ Herpetic ◼ Fungal Skin Infections in Athletes ◼ Very common – most common cause of practice-loss time in wrestlers ◼ Athletes are susceptible because: – Prone to skin breakdown (abrasions, cuts) – Warm, moist environment – Close contacts Cases 1 -3 ◼ 21 year old male football player with 4 day h/o left axillary pain and tenderness. Two days ago he noticed a tender “bump” that is getting bigger and more tender. ◼ 16 year old football player with 3 day h/o mildly tender lesions on chin. Started as a single lesion, but now has “spread”. Over the past day the lesions have developed a dark yellowish crust. ◼ 19 year old wrestler with a 3 day h/o lesions on right side of face. Noticed “tingling” 4 days ago, small fluid filled lesions then appeared that have now started to crust over. Skin Infections Bacterial Skin Infections ◼ Cellulitis ◼ Erysipelas ◼ Impetigo ◼ Furunculosis ◼ Folliculitis ◼ Paronychea Cellulitis Cellulitis ◼ Diffuse infection of connective tissue with severe inflammation of dermal and subcutaneous layers of the skin – Triad of erythema, edema, and warmth in the absence of underlying foci ◼ S. aureus or S. pyogenes Erysipelas Erysipelas ◼ Superficial infection of the dermis ◼ Distinguished from cellulitis by the intracutaneous edema that produces palpable margins of the skin.
    [Show full text]
  • Nutritional Dermatoses in the Hospitalized Patient
    HOSPITAL CONSULT IN PARTNERSHIP WITH THE SOCIETY FOR DERMATOLOGY HOSPITALISTS Nutritional Dermatoses in the Hospitalized Patient Melissa Hoffman, MS; Robert G. Micheletti, MD; Bridget E. Shields, MD Nutritional deficiencies may arise from inadequate nutrient intake, abnormal nutrient absorption, or improper nutrient PRACTICE POINTS utilization.4 Unfortunately, no standardized algorithm for • Nutritional deficiencies are common in hospitalized screening and diagnosing patients with malnutrition exists, patients and often go unrecognized. making early physical examination findings of utmost • Awareness of the risk factors predisposing patients importance. Herein, we present a review of acquired nutri- to nutritional deficiencies and the cutaneous manifes- tional deficiency dermatoses in the inpatient setting. tations associated with undernutrition can promote copy early diagnosis. Protein-Energy Malnutrition • When investigating cutaneous findings, undernutri- tion should be considered in patients with chronic Protein-energy malnutrition (PEM) refers to a set of infections, malabsorptive states, psychiatric illness, related disorders that include marasmus, kwashiorkor and strict dietary practices, as well as in those using (KW), and marasmic KW. These conditions frequently are certain medications. seen in developing countries but also have been reported 5 • Prompt nutritional supplementation can prevent patient in developed nations. Marasmus occurs from a chronic morbidity and mortality and reverse skin disease. deficiencynot of protein and calories. Decreased insulin pro- duction and unopposed catabolism result in sarcopenia and loss of bone and subcutaneous fat.6 Affected patients include children who are less than 60% ideal body weight Cutaneous disease may be the first manifestation of an underlying nutri- 7 tional deficiency, highlighting the importance of early recognition by der- (IBW) without edema or hypoproteinemia.
    [Show full text]
  • Hair Loss in Infancy
    SCIENCE CITATIONINDEXINDEXED MEDICUS INDEX BY (MEDLINE) EXPANDED (ISI) OFFICIAL JOURNAL OF THE SOCIETÀ ITALIANA DI DERMATOLOGIA MEDICA, CHIRURGICA, ESTETICA E DELLE MALATTIE SESSUALMENTE TRASMESSE (SIDeMaST) VOLUME 149 - No. 1 - FEBRUARY 2014 Anno: 2014 Lavoro: 4731-MD Mese: Febraury titolo breve: Hair loss in infancy Volume: 149 primo autore: MORENO-ROMERO No: 1 pagine: 55-78 Rivista: GIORNALE ITALIANO DI DERMATOLOGIA E VENEREOLOGIA Cod Rivista: G ITAL DERMATOL VENEREOL G ITAL DERMATOL VENEREOL 2014;149:55-78 Hair loss in infancy J. A. MORENO-ROMERO 1, R. GRIMALT 2 Hair diseases represent a signifcant portion of cases seen 1Department of Dermatology by pediatric dermatologists although hair has always been Hospital General de Catalunya, Barcelona, Spain a secondary aspect in pediatricians and dermatologists 2Universitat de Barcelona training, on the erroneous basis that there is not much in- Universitat Internacional de Catalunya, Barcelona, Spain formation extractable from it. Dermatologists are in the enviable situation of being able to study many disorders with simple diagnostic techniques. The hair is easily ac- cessible to examination but, paradoxically, this approach is often disregarded by non-dermatologist. This paper has Embryology and normal hair development been written on the purpose of trying to serve in the diag- nostic process of daily practice, and trying to help, for ex- ample, to distinguish between certain acquired and some The full complement of hair follicles is present genetically determined hair diseases. We will focus on all at birth and no new hair follicles develop thereafter. the data that can be obtained from our patients’ hair and Each follicle is capable of producing three different try to help on using the messages given by hair for each types of hair: lanugo, vellus and terminal.
    [Show full text]
  • Pediatric Cutaneous Bacterial Infections Dr
    PEDIATRIC CUTANEOUS BACTERIAL INFECTIONS DR. PEARL C. KWONG MD PHD BOARD CERTIFIED PEDIATRIC DERMATOLOGIST JACKSONVILLE, FLORIDA DISCLOSURE • No relevant relationships PRETEST QUESTIONS • In Staph scalded skin syndrome: • A. The staph bacteria can be isolated from the nares , conjunctiva or the perianal area • B. The patients always have associated multiple system involvement including GI hepatic MSK renal and CNS • C. common in adults and adolescents • D. can also be caused by Pseudomonas aeruginosa • E. None of the above PRETEST QUESTIONS • Scarlet fever • A. should be treated with penicillins • B. should be treated with sulfa drugs • C. can lead to toxic shock syndrome • D. can be associated with pharyngitis or circumoral pallor • E. Both A and D are correct PRETEST QUESTIONS • Strep can be treated with the following antibiotics • A. Penicillin • B. First generation cephalosporin • C. clindamycin • D. Septra • E. A B or C • F. A and D only PRETEST QUESTIONS • MRSA • A. is only acquired via hospital • B. can be acquired in the community • C. is more aggressive than OSSA • D. needs treatment with first generation cephalosporin • E. A and C • F. B and C CUTANEOUS BACTERIAL PATHOGENS • Staphylococcus aureus: OSSA and MRSA • Gp A Streptococcus GABHS • Pseudomonas aeruginosa CUTANEOUS BACTERIAL INFECTIONS • Folliculitis • Non bullous Impetigo/Bullous Impetigo • Furuncle/Carbuncle/Abscess • Cellulitis • Acute Paronychia • Dactylitis • Erysipelas • Impetiginization of dermatoses BACTERIAL INFECTION • Important to diagnose early • Almost always
    [Show full text]
  • Nails Develop from Thickened Areas of Epidermis at the Tips of Each Digit Called Nail Fields
    Nail Biology: The Nail Apparatus Nail plate Proximal nail fold Nail matrix Nail bed Hyponychium Nail Biology: The Nail Apparatus Lies immediately above the periosteum of the distal phalanx The shape of the distal phalanx determines the shape and transverse curvature of the nail The intimate anatomic relationship between nail and bone accounts for the bone alterations in nail disorders and vice versa Nail Apparatus: Embryology Nail field develops during week 9 from the epidermis of the dorsal tip of the digit Proximal border of the nail field extends downward and proximally into the dermis to create the nail matrix primordium By week 15, the nail matrix is fully developed and starts to produce the nail plate Nails develop from thickened areas of epidermis at the tips of each digit called nail fields. Later these nail fields migrate onto the dorsal surface surrounded laterally and proximally by folds of epidermis called nail folds. Nail Func7on Protect the distal phalanx Enhance tactile discrimination Enhance ability to grasp small objects Scratching and grooming Natural weapon Aesthetic enhancement Pedal biomechanics The Nail Plate Fully keratinized structure produced throughout life Results from maturation and keratinization of the nail matrix epithelium Attachments: Lateral: lateral nail folds Proximal: proximal nail fold (covers 1/3 of the plate) Inferior: nail bed Distal: separates from underlying tissue at the hyponychium The Nail Plate Rectangular and curved in 2 axes Transverse and horizontal Smooth, although
    [Show full text]
  • Nail Involvement in Alopecia Areata
    212 CLINICAL REPORT Nail Involvement in Alopecia Areata: A Questionnaire-based Survey on DV Clinical Signs, Impact on Quality of Life and Review of the Literature 1 2 2 1 cta Yvonne B. M. ROEST , Henriët VAN MIDDENDORP , Andrea W. M. EVERS , Peter C. M. VAN DE KERKHOF and Marcel C. PASCH1 1 2 A Department of Dermatology, Radboud University Nijmegen Medical Center, Nijmegen, and Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands Alopecia areata (AA) is an immune-mediated disease at any age, but as many as 60% of patients with AA will causing temporary or permanent hair loss. Up to 46% present with their first patch before 20 years of age (4), and of patients with AA also have nail involvement. The prevalence peaks between the 2nd and 4th decades of life (1). aim of this study was to determine the presence, ty- AA is a lymphocyte cell-mediated inflammatory form pes, and clinical implications of nail changes in pa- of hair loss in which a complex interplay between genetic enereologica tients with AA. This questionnaire-based survey eva- factors and underlying autoimmune aetiopathogenesis V luated 256 patients with AA. General demographic is suggested, although the exact aetiological pathway is variables, specific nail changes, nail-related quality of unknown (5). Some studies have shown association with life (QoL), and treatment history and need were evalu- other auto-immune diseases, including asthma, atopic ated. Prevalence of nail involvement in AA was 64.1%. dermatitis, and vitiligo (6). ermato- The specific nail signs reported most frequently were Many patients with AA also have nail involvement, D pitting (29.7%, p = 0.008) and trachyonychia (18.0%).
    [Show full text]
  • NAIL CHANGES in RECENT and OLD LEPROSY PATIENTS José M
    NAIL CHANGES IN RECENT AND OLD LEPROSY PATIENTS José M. Ramos,1 Francisco Reyes,2 Isabel Belinchón3 1. Department of Internal Medicine, Hospital General Universitario de Alicante, Alicante, Spain; Associate Professor, Department of Medicine, Miguel Hernández University, Spain; Medical-coordinator, Gambo General Rural Hospital, Ethiopia 2. Medical Director, Gambo General Rural Hospital, Ethiopia 3. Department of Dermatology, Hospital General Universitario de Alicante, Alicante, Spain; Associate Professor, Department of Medicine, Miguel Hernández University, Spain Disclosure: No potential conflict of interest. Received: 27.09.13 Accepted: 21.10.13 Citation: EMJ Dermatol. 2013;1:44-52. ABSTRACT Nails are elements of skin that can often be omitted from the dermatological assessment of leprosy. However, there are common nail conditions that require special management. This article considers nail presentations in leprosy patients. General and specific conditions will be discussed. It also considers the common nail conditions seen in leprosy patients and provides a guide to diagnosis and management. Keywords: Leprosy, nails, neuropathy, multibacillary leprosy, paucibacillary leprosy, acro-osteolysis, bone atrophy, type 2 lepra reaction, anonychia, clofazimine, dapsone. INTRODUCTION Leprosy can cause damage to the nails, generally indirectly. There are few reviews about the Leprosy is a chronic granulomatous infection affectation of the nails due to leprosy. Nails are caused by Mycobacterium leprae, known keratin-based elements of the skin structure that since ancient times and with great historical are often omitted from the dermatological connotations.1 This infection is not fatal but affects assessment of leprosy. However, there are the skin and peripheral nerves. The disease causes common nail conditions that require diagnosis cutaneous lesions, skin lesions, and neuropathy, and management.
    [Show full text]
  • Hair and Nail Disorders
    Hair and Nail Disorders E.J. Mayeaux, Jr., M.D., FAAFP Professor of Family Medicine Professor of Obstetrics/Gynecology Louisiana State University Health Sciences Center Shreveport, LA Hair Classification • Terminal (large) hairs – Found on the head and beard – Larger diameters and roots that extend into sub q fat LSUCourtesy Health of SciencesDr. E.J. Mayeaux, Center Jr., – M.D.USA Hair Classification • Vellus hairs are smaller in length and diameter and have less pigment • Intermediate hairs have mixed characteristics CourtesyLSU Health of E.J. Sciences Mayeaux, Jr.,Center M.D. – USA Life cycle of a hair • Hair grows at 0.35 mm/day • Cycle is typically as follows: – Anagen phase (active growth) - 3 years – Catagen (transitional) - 2-3 weeks – Telogen (preshedding or rest) about 3 Mon. • > 85% of hairs of the scalp are in Anagen – Lose 75 – 100 hairs a day • Each hair follicle’s cycle is usually asynchronous with others around it LSU Health Sciences Center – USA Alopecia Definition • Defined as partial or complete loss of hair from where it would normally grow • Can be total, diffuse, patchy, or localized Courtesy of E.J. Mayeaux, Jr., M.D. CourtesyLSU of Healththe Color Sciences Atlas of Family Center Medicine – USA Classification of Alopecia Scarring Nonscarring Neoplastic Medications Nevoid Congenital Injury such as burns Infectious Systemic illnesses Genetic (male pattern) (LE) Toxic (arsenic) Congenital Nutritional Traumatic Endocrine Immunologic PhysiologicLSU Health Sciences Center – USA General Evaluation of Hair Loss • Hx is
    [Show full text]