Clinical Notes : Dermatology

92. Nail plate abnormalities

 

Transverse Ridging of nails 

Associated with :

  • atopic dermatitis

  • psoriasis

  • paronychia (infection of the perionychium)

  • parakeratosis pustulosa

Atopic dermatitis

Psoriasis

Parakeratosis pustulosa

 

Onychorrhexis (longitudinal ridging)

Also known as "brittle nails"

Associated with :

  • excessive strong soap and water exposure

  • nail polish remover

  • hypothyroidism

  • anemia

  • anorexia nervosa or bulimia

  • after retinoid therapy

  • Darier's disease

  • Ageing (Vertical beaded ridges resembling a candle’s wax drippings)

Darier's disease

Anemia

Ageing

 

Pitting of nails

Associated with :

  • alopecia areata

  • psoriasis

  • Reiter’s Syndrome

  • eczema

Nail pitting

 

Onychogryphosis

The nail will become thick and curved upwards like a Ram’s horn.

Associated with ;

  • trauma

  • aging

  • psoriasis

Onychogryphosis

 

Onychauxis

Thickening of nails.

Associated with :

  • psoriasis

  • ungual nail infection

  • trauma

Onychauxis

 

Crumbling of nail plate

Associated with :

  • psoriasis

  • fungal nail infection

Psoriasis

Fungal

Psoriasis

 

Longitudinal splitting of nails

Associated with :

  • psoriasis

  • fungal nail infection

  • lichen planus

Psoriasis

Fungal

 

Trachyonychia of nails

Also known as "twenty-nail dystrophy"

characterised by longitudinal ridging (alternating elevation and depression), pitting, loss of lustre, and roughening (similar to sandpaper) of the nail surface

Associated with

  • lichen planus

  • tight shoes/heels

  • other cases are of unknown origin and begin gradually in early childhood. These cases tend to be self-limiting and may resolve slowly with age.

Trachyonychia

 

Erosion of nail plate

Associated with cancers : 

  • melanoma

  • squamous cell carcinoma

Melanoma

Squamous cell carcinoma

 

Onycholysis (separation of nail plate from nail bed)

Associated with :

Onycholysis

Onycholysis

Onycholysis

Treatment

In the OOH setting treatment would be directed at immediate symptoms of underlying pathology.

Refer back to the patient's own GP and specialist dermatologist where appropriate.

 
journals.png

Ameen M, et al Br

British Association of Dermatologists' guidelines for the management of onychomycosis 2014.

J Dermatol 2014; 171: 937-58.

Access

Robert S, et al

Nail Abnormalities: Clues to Systemic Disease

Am Fam Physician. 2004 Mar 15;69(6):1417-1424.

Access

          

Baran R, Schoon D.

Nail fragility syndrome and its treatment

J Cosmet Dermatol. 2004 Jul;3(3):131-7.

Access

Tosti, A; Piraccini, BM

"Chapter 70 – Nail Disorders". In Bolognia, JL; Jorizzo, JL; Rapini, RP. Dermatology. 1 (2nd ed.). St. Louis: Mosby Elsevier. (2008).

 

de Berker DAR, et al

Clinical guidelines for the recognition of melanoma of the foot and nail unit

Journal of Foot and Ankle Research 2010 3:25

Access

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