4.2.4 Nail Dystrophies
Grading & Level of Importance: B
Disturbances in nail growth (proliferation, differentiation and maturation).
Aetiology & Pathogenesis
Often idiopathic, may reflect manifestations of other diseases e.g. psoriasis, lichen planus, alopecia areata, GVHD, genetic disorders including twenty nail syndrome, different types of eczemas, metabolic disorders, toxic damage, infections, medications (e.g. chemotherapy). May also be due to mechanical irritation including nail manicure.
Signs & Symptoms
Changes in colour, structure and growth pattern of nails.
Finger- or toe-nails. Examine skin and hair for further signs.
Onychoschisis, onychorrhexis, onycholysis, onychomadesis.
Laboratory & other workups
Microbiological specimen to exclude onychomycosis, pseudomonas aeruginosa etc.
Not usually required.
Varies according to underlying cause. Often chronic.
Secondary fungal infections possible.
Clinical findings in context of associated findings.
Wide. Consider infections, psoriasis, atopic dermatitis, allergic or irritant contact dermatitis, lichen planus, hereditary causes etc.
Prevention & Therapy
Treatment of underlying disease. Podiatry review for severe toenail involvement impinging on walking.
- What disease do these nail changes indicate?
- Statement 1 Occasionally one observes onychodystrophy in a patient with chronic hand dermatitis
- What is the correct name for this nail change?
- An adult women consults you regarding multiple dystrophic nails. Which advice is appropriate?
- True or false?
- This cook has had a sore right thumb for weeks. Your diagnosis?
- With what disorder is this nail change usually associated?
- Which of these factors can contribute to onychogryposis in the elderly?
- 25-year-old patient presents with these changes of the left great toe which are painful when running. Your diagnosis?
- What is the name for this type of nail dystrophy?
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