nail disease
digital mucous cyst
-benign ganglion cyst -DIP joint or promimal nail -solitary round/oval containing gelatinous fluid, asymp
melanonychia
-black/brown pigmentation diffuse or band, increased production of melanin -caused by systemic disease, trama, melanoma* -MC darkly pigmented, increase with age -asymp -A (old), B (black/brown greater 3mm), C (blurred borders), D (single digit), E (hutchinson sign), F (Af Amer) -perform biopsy if suspicious of melanoma (surgery)
subungual hematoma
-blood underneath nail -male, injury to finger tip, fracture (x-ray) -black/blue discoloration -small painless-no treatment -trepination: drill hole to release pressure -electric cautery, no antibiotics needed -nail deformity, nail loss -soak in warm soapy water
candidal onychomycosis
-candida yeast invade fingernails in people who frequently immerse hand in water -toenail and fingernail, maifest as paronychia or onycholysis
proximal subungual onychomycosis
-fungal penetration through proximal nail fold, least common -nail becomes white proximally, extend to deeper layers
paronychia
-hand infection, superficial infection, seal broken between nail fold and nail plate -acute: nail biting, trama, S. aureus; one nail, purulent material; warm soak, oral antibiotics, incision/drainage -chronic: multi-factorial, irritant, C. albicans; many nails, swollen boggy finger >6wk; avoid irritant, antifungal -culture, KOH if chronic expected -monitor, can result in infection
white superficial onychomycosis
-invasion superficial layers of nail plate -toenail, white speckled patches
clubbing of the nails
-loss of normal angle between nail and nail fold -idiopathic (lung cancer, heart disease)
distal subungal onychomycosis
-most common, fungus invades nail bed and under nail plate, T. rubrum, thickened nail, debris, seperation -hyperkeratosis, yellow/brown, dermatophyte
onychomycosis
-nail disease in adults, toenails, may have athlete foot, immunosuppression, diabetes, male, family hist, warm, communal bathing -caused by dermatophytes*, yeast and molds -asymp, cosmetic -determine fungal affected before treatment (fungal culture or KOH) -topical antifungals for mild or oral antifungal (3 mon, monitor liver enzyme) -terbinafine 250 mg -neg fungal culture or abnormal refer -surgical nail avulsion -risk of cellulitis, sepsis, nercrosis -high reoccurance, fingernail favorable -approp footwear, nail gone up to 1y
ingrown toe nail
-poor fitted shoes, improper nail trimming, trama -nail pierces lateral nail fold, foreign body, develop erythema, purulent substance, granulation tissue -pain, swelling, great toe -mild/moderate: wide toe box, cut nail, warm soak, elevate offending edge w/ cotton, foot elevated -moderate/severe: remove nail with wedge resection
pitting of nails
-punctate depressions nail plate, defective layer of proximal nail matrix -psoriasis, alopecia areata, lichen planus
splinter hemorrhages
-red-brown lines, distal nail plate -trama, inflammatory conditions, infections -clots that damage the small capillaries
onycholysis
-seperation of nail plate from nail bed (distal to proximal), non-adherent portion yellow/white/green -trama, bacteria, yeast, irritant, hyperthyroidism -asymp, smooth/firm w/o inflammation, discoloration -eliminating cause, corticosteroid, antifungal -nails short, wear gloves, left untreated: scarring
pincer nails
-transverse over curvature -toe nails, aymp -caused by meds, psoriasis, tumor, disease, onychomycosis
periungual wart
-wart in nail margin affect shape and attachment -assoc with HPV -non resolving, SCC-biopsy -nail bitters, occupations, immunocomp -keratolytic agents (salicyclic acid), immunotherapy (imiquimod)
