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Dermatology Diploma > Nail Disease > Flashcards

Nail Disease Flashcards

1
Q

The nail unit consists of what 5 structures?

A
  • Nail matrix
  • Nail bed
  • Hyponychium
  • Proximal nail folds
  • Lateral nail folds.
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2
Q

What is this and what does it represent?

A

The Lanula.

It is the white part of the nail matrix.

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3
Q

What is this and what does it represent?

Is it pathological?

A

Beau’s Lines

  • It represeents a slow down in the growth of the nail matrix.
  • In newborns they are not pathological
  • In adults, they can come due to: allergic reaction, surgery, medical illness.
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4
Q

What is this?

What pathology should you consider?

A

Koilonychia

(Spoon shaped nails)

  • In adults, consider:
    • Iron deficiency
    • Thyroid problems
    • Connective tissue disease?
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5
Q

What is this?

Is it pathological?

What conditions is it associated with?

A

Onychorrhexis

  • Normal in the elderly
  • In adults consider:
    • Lichen planus
    • Darier’s disease
    • Circulatory disorders
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6
Q

What is this?

Who gets it?

A

Melanonynia

(Naevus in the nail matrix)

Darker skin types.

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7
Q

What is this?

A

Onychoschizia

  • Usually due to water exposure. (i.e. sucking thumb)
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8
Q

What are these?

A

Onychogryphosis

  • Hyperkeratotic thickened nail plates.
  • Elderly due to mobility issues and poor nail grooming.
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9
Q

What are the most causative pathogens in Onychomycosis?

A
  • Trichophyton rubrum
  • Trichophyton mentagrophytes
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10
Q

What conditions can mimic Onychomycosis?

A
  • Psoriasis
  • Lichen Planus
  • Congenital Nail disease
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11
Q

What are the topical treatments for onychomycosis?

When would you consider them?

A
  • <2 nails are affect or <50% of the nail plate.
  • Amorolfine 5% lacquer.
    • Apply twice weekly for 6-12 months.
    • File the nail before hand.
  • Alternative topicals include:
    • Ciclopirox 8% OD for 48 weeks.
    • Tioconazol
    • Newer Triazol Eficonaconazol.
  • Consider 40% urea to help penetration enhancement.
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12
Q

What are systemic therapies for onychomycosis?

A
  • Terbinafine (First line)
    • S/E - Nausea, Diarrhoea, hepatic dysfunction & permanent taste distrubances..
    • Baseline LFTs and FBC are needed.
    • Do not give if alcohol misuse or hepatitis
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13
Q

What are the most effective oral treatments for Candida infections?

A

Azoles (Itraconazole)

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14
Q

What is useful against yeasts, dermatophytes and non-dermatophyte moulds?

A

Itraconazole

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15
Q

What are the side effects of itraconazole?

A
  • Headaches
  • GI Upset.
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16
Q

If someone is on the COCP, why should you be careful about prescribing Itraconazole?

A

It is a potent p450 inhibitor

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17
Q

Who is itraconazole contraindicated in?

A
  • Congestive heart failure
  • Arrythmias
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18
Q

Describe the 2 treatment approaches with Itraconazole?

A
  1. Continuous: 200mg daily for 12 weeks
  2. Pulsed: 400mg/d for 1 week per month
    • 2 pulses for fingernails
    • 3 for toenails.
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19
Q

What should you take with itraconazole?

A

food

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20
Q

What is the relapse rate for onychomycosis?

A

40-70%

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21
Q

What should patients do to avoid reinfection?

A
  • Minimise trauma
  • Keep the nails short
  • Treat affect family members
  • Wear protective footwear.
  • Reduce fungal elements from shoes
    • Antifungal powders
    • Napthalene mothballs.
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22
Q

What is this?

A

Acute Paronychia

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23
Q

What causes acute paronychia?

A
  • Staph. Aureus
  • Beta-haemolytic Streptococcus
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24
Q

What is this?

A

HSV infection causing an herpetic whitlow

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25
Q

What is this?

A

Distal Blistering Dactylitis

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26
Q

What is this and what is the treatment?

A
  • ​Periungual warts.
  • DO not cryotherapy
  • Salicylic acid with scraping - once or twice weekly for several months should be considered.
  • If more challenging:
    • Imiquimod 5% cream
    • Diphencyprone immunotherapy
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27
Q

What % of psoriasis sufferers have nail changes?

A

50%

28
Q

Nail changes in psoriasis are strongly linked to what other psoriatic related problems?

A
  • Psoriatic arthritis
  • Enthesitis
29
Q

What nail changes can psoriasis sufferers have?

A
  • Main ones:
    • Irregular pitting
    • Salmon patches of the nail bed (óil drop’)
    • Onycholysis + irregular border.
  • Others
    • Splinter haemorrhages
    • Subungual hyperkeratosis
    • Onychorrhexis
    • Paronychia
30
Q

What does nail psoriasis often resemble?

A

Onychomycosis

31
Q

What is the name of the scoring system for assessing psoriasis severity?

A

NAPSI (Nail Psoriasis Severity Index)

NOTE:

PASI

(Psoriasis Severity Index)

32
Q

What is this nail change and what condition is it seen in?

A

oil drops

Psoriasis

33
Q

What is this nail change and what condition is it seen in?

A

Subungual Hyperkeratosis

Psoriasis

34
Q

What is this nail change and what condition is it seen in?

A

Irregular Pitting

Psoriasis

35
Q

What condition is this?

A

Acrodermatitis Continua of Halopeau

(Pustular eruption of the nail bed)

36
Q

What condition is Acrodermatitis Continue of Hallopeau seen in?

What is the treatment?

A

Variant of pustular psoriasis

  • Topical VitaminD3 analogues
  • +/- betamethasone
  • If severe consider systemic retinoids (acitretin)
37
Q

What is the treatment for psoriatic nail changes?

A
  • Topical
    • Vitamin D3 analogues
    • Betamethasone
    • Tazarotene
  • Injections - Trimacinolone injections.
  • Systemic
    • MTX
    • Acitretin
    • Cyclopsorine
  • Conseal with coloured nail varnish
38
Q

What % of patients with lichen planus have nail changes?

A

10%

39
Q

What condition is this?

A

Lichen Planus

(Longitudinal fissuring)

40
Q

What is the treatment of lichen planus?

A
  • Topical or intralesional steroids.
  • Systemic corticosteroids can be considered if multiple nail involvement.
41
Q

In what condition is this sort of pattern seen?

A

Alopecia Areata

(REGULAR Geometric pitting as opposed to the irregular pitting of psoriasis)

42
Q

What condition is this seen in?

A

Eczema

(Transverse ridges)

43
Q

What condition is this seen in?

A

Eczema

(Irregular pitting)

44
Q

What are the treatments for eczematous nails?

A
  • Emollients
  • Moderate to high potency topical steroids
  • Avoid triggers
45
Q

What conditions is this seen in?

A
  • Congenital
  • Acquired
    • Lung cancer
    • Bronchiectasis
    • IBD
    • Thyroid disease
46
Q

Does COPD cause clubbing?

A

NO

47
Q

In what condition, is this seen?

A

Scleroderma

(Loss/ulceration of the pulp of the finger)

48
Q

This is a form of Leukonychia called “Terry’s nails’ (Almost full withening of the nails.)

What condition is this seen in?

A

80% of patients with liver cirrhosis

49
Q

This is a form of Leukonychia called ‘Muehrcke’s nails’.

(Multiple transverse whitae bands)

A

Hypoalbuminemia

50
Q

This is a form of Leukonychia called ‘half and halfnails’.

What condition is it seen in?

A

Chronic Renal failure

51
Q

What is this?

A

Subungual haematoma

52
Q

How can you differentiate a subungual haematoma at the nail bed from a melanoma?

A

Place a nick at the base of the nail.

As the haematoma grows out the nick will stay at the distal end of the haematoma.

53
Q

What is this?

What conditions is it seen in?

A

Splinter Haemorrhage

  • Common: trauma, psoriasis & onychomycosis
  • Rare(usually located proximally):
    • Endocarditis
    • Vasculitis
    • SLE
54
Q

What is this?

What condition is this seen in?

A

Onychotillomania

  • Self inflicted nail abnormality.
55
Q

What is this?

A

Subungual exostosis

  • (A localized outgrowth of bone that manifests as a flesh-coloured papule or nodule)
  • Painful
  • Young people
  • Occurs due to trauma
  • Surgical Excision required.
56
Q

What is this?

A

Digital mucous cyst (aka Myxoid pseudocysts)

  • End of the finger
  • Painless
  • Accumulation of mucin in the dermis.
  • Women.
  • Tx: Squeezing, Cryotherapy, intralesional steroids, surgical removal.
    • All have a high relpase rate.
57
Q

What is this?

A

Pyogenic granuloma

  • Due to trauma (or infection, systemic drugs) or pregnancy.
  • Occursi n the nail apparatus
  • Treat with curettage, cautery or surgical excision.
58
Q

What is this?

A

Glomus Tumour

  • Very painful
  • Lesion of the nail bed dermis
  • Pink or Blue Macule.
  • Due to trauma
  • Treatment: Surgical excision.
59
Q

What is the most prevalent malignancy of the nail apparatus?

A

SCC

(HPV can be a cause)

60
Q

What is this?

A

Nail Melanoma

61
Q

In 25% of cases of nail melanoma, what does it look like?

A

Pyogenic granuloma

62
Q

What is the difference in nail melanoma rates between caucasians and Asians/African-Americans?

A

1-2% in Caucasians

25% in African-Americans

63
Q

What is Hutchinson’s sign of the nail?

A

it is where the melanoma of the nail grows into the nail periungual skin.

This is part of the radial phase of the melanoma.

64
Q

What is this most common cause of ingrown toenails?

A

Congenital Malignment of the great toenails

65
Q

What is this?

A

Racquet Thumbs (Brachyonychia)

  • Inherited in an autosomal-dominant fashion.
66
Q

What inherited condition does this represent?

A

Darrier’s Disease

(Follicular dyskeratosis) - autosomal dominant.

White and red longitudinal lines with notching in the nail.

Dermatology Diploma (39 decks)

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