Clinical Notes : Dermatology
92. Nail plate abnormalities
Onychorrhexis (longitudinal ridging)
Onychogryphosis (Ram's horn nails)
Longitudinal splitting of nails
Trachyonychia of nails (twenty-nail dystrophy)
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 :
-
hyperthyroidism
-
sarcoidosis
-
trauma
-
amyloidosis
-
connective tissue disorders
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.
Ameen M, et al Br
British Association of Dermatologists' guidelines for the management of onychomycosis 2014.
J Dermatol 2014; 171: 937-58.
Robert S, et al
Nail Abnormalities: Clues to Systemic Disease
Am Fam Physician. 2004 Mar 15;69(6):1417-1424.
Baran R, Schoon D.
Nail fragility syndrome and its treatment
J Cosmet Dermatol. 2004 Jul;3(3):131-7.
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
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