1. Nail Diseases 03-2009 Tom Paige MD Department of Dermatology CCRMC

16. How To Approach Nail Diseases Abnormalities of the nail plate surface Abnormalities of the nail plate surface Nail discoloration Nail discoloration Abnormalities of the cuticle and nail fold Abnormalities of the cuticle and nail fold Abnormalities of nail shape Abnormalities of nail shape Loss of nails Loss of nails Lesions around nails Lesions around nails

17. Nail Apparatus

23. Abnormalities of the nail plate surface Abnormalities of the nail plate surface Pitting seen in – –*Psoriasis – –Eczema – –Alopecia areata Beau’s lines – –*Trauma – –Dermatologic diseases – –Systemic conditions Median nail dystrophy –*Trauma –Familial –Drugs Onychogryphosis –*Elderly neglect –*Trauma –Peripheral vascular disease

25. Nail discoloration Nail discoloration Darier’s disease – –Hereditary disease Yellow nails – –Y N Syndrome associated w/ lymphedema and respiratory tract disease Green nails –Infection w/ Pseudomonas aeruginosa Salmon patches or “oil drop sign” –Psoriasis

27. Abnormalities of the cuticle and nail fold Abnormalities of the cuticle and nail fold Paronychia – –Acute Bacterial Viral – –Chronic Exposure to irritants and/or allergens Nailfold telangiectasias –Dermatomyositis Ragged cuticle Enlarged capillaries –Scleroderma Capillary changes like DM –SLE See wandering glomeruloid loops No skip areas

29. Abnormalities of nail shape Abnormalities of nail shape Enlarged nail – –Osteoid osteoma (bone tumor) Clubbing of nails – –Hereditary – –Acquired Koilonychia –Physiologic in children –Iron deficiency in adults Pachyonychia congenita –Hereditary –Autosomal dominant

31. Loss of nails Loss of nails Onychophagia – –Compulsive habit – –Up to 30% of kids bite their nails by some studies Lichen planus –10% of patients w/ LP have nail changes Nail thinning and fissuring most commonly seen Possible cicatricial outcome (dorsal pterygium formation and/or anonychia)

33. Lesions around nails Lesions around nails Paronychial warts – –HPV types 1, 2,and 4 Squamous cell carcinoma in situ – –Verrucous lesion – –Onycholysis – –Melanonychia – –Inflammation and crusting Purple toe syndrome –Many causes Subungal tumor –Osteoma

43. Assosciated conditions –Diabetes mellitus –Iron deficiency anemia –Trauma –End stage renal disease –None of the above

45. This entity is seen in –Warfarin intake –Cholesterol emboli –Smoking –Mercury poisoning –None of the above