APPROACH TO NAIL DYSTROPHY FINAL..Everything about the nail.pptx

It covers everything about nails in dermatology

1. APPROACH TO NAIL DYSTROPHY Dr . Javeria Bushra Touqir Resident Dermatologist

2. UNDERSTANDING NAIL ANATOMY

3. LOCALIZED NAIL APPRATUS INVOLVEMENT

4. CHRONIC PARONYCHIA Damage to the cuticle mechanical or chemical DERMATOSIS : Psoriasis, dermatitis and lichen planus DRUGS : Oral retinoids, indinavir FOREIGN BODY: Hair, bristle and wood splinter

5. ONYCHOLYSIS Detachment of nail from it’s bed at distal and lateral attachments CAUSES idiopathic trauma dermatosis adjacent to nail bed photoonycholysis (doxycycline) congenital /hereditary

6. GREEN NAIL SYNDROME Usually associated with onycholysis P.aeruginosa most common cause Green pigment: PYOCYANIN

7. ONYCHAUXIX AND ONYCHOGRYPHOSIS ONNYCHAUXIS : Thickening of entire nail plate ONYCHOGRYPHOSIS : Onychauxis with ram’s horn like deformity . Commonly of great toe ETIOLOGY : Pressure from foot wear . Inherited autosomal dominant . Pachyonychia congenitica . Tuberous sclerosis

8. PSYCHIATRIC DISORDERS HABIT TIC DEFORMITY : Commonly on thumbnail Repeated picking at cuticle of thumbnail by index finger Cuticle pushed back with inflammation of proximal nail fold

9. COMPULSIVE NAIL PICKING: Repeated picking at paronychia leading to Lichen simplex chronicus

10. NAIL APPRATUS INVOLVEMENT IN CUTANEOUS DISEASES

11. NAIL PSORIASIS:A case report 48-year-old man with a 6-year history of stable localized plaque psoriasis at the extensor surfaces of knees and elbows, presented for nail dystrophy evolving since 1 year. It involved all his fingernails.No signs of psoriatic arthropathy were found.

12. The patient was treated with an injection of methotrexate (0.1 ml of a 5 mg/2 ml solution) into the proximal nail fold of the most affected nails in the first session. After a metacarpal block, a smaller volume of methotrexate is injected very slowly under the matrix.This procedure was repeated once a month for 3 months with injection in all nails in the second and third session. A progressive improvement of the nail dystrophy was noted after the first session and became significant after the third session. His nail lesions resolved completely 3 months after. No side effects were noted. No clinical relapse has been observed 1 year later.

13. 56-year-old woman presented with a 1-year history of altered nail growth and fragility, causing pain and cosmetic concern. Examination revealed onychodystrophy of multiple fingernails and toenails, with onycholysis , distal nail plate splitting, pterygium , longitudinal ridging, and subungual hyperkeratosis (Figure). She had a concomitant pruritic eruption on her chest and extremities and gingival ulceration. The scalp and vulva were uninvolved.

14. LICHEN PLANUS AND NAIL DYSTROPHY Longitudinal grooves and ridges Complete nail plate destruction Nail plate atrophy and pterygium Pup-tent sign

15. A 43-year-old man presented with long-standing trachyonychia of all 20 nails, noted worsening of his nail disease after the onset of hair loss over the scalp .The nail ridges along with geometric pitting have been present for 10 years but have worsened 18 months ago after the onset of hair loss over the scalp

16. ALOPECIA AEREATA AND NAIL DYSTROPHY Hammered brass appearance Geometric pitting Mottled erythema of lunulae

17. DARIER DISEASE AND NAIL DYSTROPHY Red and white longitudinal streaks V-nicking in the distal portion

18. CHEMICAL IRRITANT OR ALLERGIC DERMATITIS AND NAIL DYSTROPHY Discoloration Onychoschezia (splitting and lamination of nail plate at distal end)

19. CTDS AND NAIL DYSTROPHY Proximal nailfold is site of attention Nail fold telangiectasias most common Physical signs in DERMATOMYOSITIS (cuticles become shaggy) SYSTEMIC SCLEROSIS (over curvature of nail plates) SLE (red lunulae ,longitudinal ridging ,splinter heamorrhages ) RAYNAUDS PHENOMENA (thin nails ,ridging, onycholysis)

20. NEOPLASMS OF NAIL APPRATUS

21. MYXOID CYSTS OF DIGITS Originates in DIP Associated with OA Lesion involving proximal nail fold Extends to involve matrix causing longitudinal groove

22. LONGITUDNAL MELANONYCHIA Brown black longitudinal streaks within nail plate Congenital or acquired Most originate in distal matrix Junctional nevus present in nail matrix result in longitudinal stripe :JUNCTIONAL NEVOMELANOCYTIC NEVUS

23. ACROLENTIGINOUS MELANOMA vs SUBUNGAL HEMORRHAGE ALM SUBUNGAL HEMORRHAGE Arise in nail matrix, no history of trauma Arise in proximal nail after trauma Extension into proximal nail fold Extension into longitudinal dermal ridges Results in nail plate dystrophy No nail plate dystrophy

24. GLOMUS TUMOR Benign vascular tumor derived from the modified smooth muscle cells Most common site is the subungual region of the finger

25. INFECTIONS AND NAIL DYSTROPHY

26. ACUTE PARONYCHIA Acute infection of lateral or proximal nail fold Break in integrity of epidermis Throbbing pain, erythema, swelling and abcess formation

27. FELON Soft tissue infection of pulp space Thumb and index finger Complications: osteitis Osteomyelitis Septic arthritis tenosynovitis

28. CA NDIDAL NAIL INFECTION DERMATOPHYTIC NAIL INFECTION Secondary to paronychia No paronychia No yellow discoloration of nail Yellow discoloration of nail plate No subungal hyperkeratosis Subungal hyperkeratosis Loss of nail cuticle Nail cuticle intact H/o wet water work No such factors

29. NAIL SIGNS OF MULTISYSTEM DISEASES

30. BEAU LINES Temporary arrest of proximal nail matrix proliferation Appears as transverse grooves All nails affected __Systemic problem CAUSES: Fever Dermatological diseases Cytotoxic drugs Adverse drug reaction Peripheral ischemia

31. LEUKONYCHIA True leukonychia : discolouration due to abnormal nail plate keratinisation . The white nail will not be hidden by pressure application of the nail plate to the bed. Apparent leukonychia : secondary to disease of the nail bed. This appearance disappears with pressure application on the nail.

32. TRUE LEUKONYCHIA PUNCTATE LEUKONYCHIA Psoriasis and trauma TRANSVERSE LEUKONYCHIA 1– 2 mm wide arcuate bands LONGITUDINAL LEUKONYCHIA Darier disease

33. APPARENT LEUKONYCHIA HALF AND HALF NAILS OF LINDSAY: Renal disorders TERRY TYPE NAILS: Hepatic disorders MUEHRCKE LINES Hypoalbuminemia Chemotherapy

34. YELLOW NAIL SYNDROME All 20 nails involved Excessively curved from side to side Diffuse yellow discoloration ASSOCIATIONS Lymphedema Bronchiectasis Rheumatoid arthritis Internal malignancies

35. PERIUNGAL FIBROMA or KOENEN TUMORS Multiple small to large, elongated to nodular tumors Longitudnal groove in nail plate Associated with tuberous sclerosis

36. SPLINTER HEMORRHAGES PROXIMAL SPLINTER HEMORRHAGES: Sideropenic anemia Bacterial endocarditis Trichinosis APLS Altitude sickness DISTAL SPLINTER HEMORRHAGES: Trauma Psoriasis and atopic dermatitis

37. PTERYGIUM INVERSUM UNGUIUM Rare nail abnormality in which the distal nail bed adheres to the ventral surface of the nail plate, with obliteration of the distal groove CAUSES: Idiopathic CTDS Stroke Leprosy Neurofibromatosis Causalgia of median nerve

38. KOILONYCHIA Spoon shaped nails Plummer Vinson syndrome Iron deficiency anemia Dysphagia Glossitis

39. CLUBBED NAILS

40. DRUGS INDUCED NAIL CHANGES

41. Bluish discoloration of nail in a patient of SLE treated with quinacrine

42. Nail discoloration and Muehrcke lines in a patient of breast cancer treated with 5 Flurouracil

43. Argyria , blue grey lanula in patient of gastritis taking silver nitrate