4.2.4 Nail Dystrophies

Grading & Level of Importance: B

Review:
2021

W. Burgdorf, Munich; C. Ellis, A. Salam, J. McGrath, London,
Revised by J. White, V. del Marmol, Brussels

ICD-11

 EE10.5

Synonyms

Onychodystrophy

Definition

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.

Localisation

Finger- or toe-nails. Examine skin and hair for further signs.

Classification

Onychoschisis, onychorrhexis, onycholysis, onychomadesis.

Laboratory & other workups

Microbiological specimen to exclude onychomycosis, pseudomonas aeruginosa etc.

Dermatopathology

Not usually required.

Course

Varies according to underlying cause. Often chronic.

Complications

Secondary fungal infections possible.

Diagnosis

Clinical findings in context of associated findings.

Differential diagnosis

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.

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