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nails

Terms in this set (50)

eponychium
cuticle
distal matrix made by
ventral nail plate
proximal matrix made by
dorsal nail plate
nail growth
3mm/month fingernails, 1mm/month toenails
hyponychium
under nail plate
nail bed
nail plate adhesion
unguis/onyx
nail (latin/greek)
abnormal nail matrix signs
beau's lines, pitting, trachyonychia, true leukonychia, koilonychia (spoon nails),
beau's lines
transverse depression (nail plate), secondary to disruption of formation by matrix, traumatic (all same level on all nails--systemic cause)
pitting
puncate depression in nail plate, migrate w/ growth, foci of abnl keratinization of proximal nail matrix-->alopecia areata, eczema, psoriasis
trachyonychia
rough, rigid surface, proximal matrix--> alopecia areata, lichen planus, psoriasis, eczema
true leukonychia
white opaque discoloration-->damage distal matrix, traumatic-->mee's lines, press on nail : unchanged w/ pressure
mee's lines
true leukonychia, transverse white bands, arsenic/thallium toxicity
test true vs apparent leukonychia
apparent disappears w/ pressure (abnl nail bed, nl plate)
koilonychia
thin, flat, spoon-shaped nail, hereditiary/Fe deficiency anemia
abnormal nail bed signs
oncholysis, apparent leukonychia, splinter hemorrhage,
oncholysis
distal nail plate detachment form nail bed, abnl colored nail-->psoriasis/fungus (open for secondary infection)
apparent leukonychia
white discoloration (fades w/ P), nail transparency maintained-->drugs (chemotx/hypoalbuminemia)
splinter hemorrhage
sliver of extravasated bld beneath nail--> longitudinal (capillaries)-->trauma (isolated)/bacterial endocarditis
Deposition of pigment signs
longitudinal melanonychia, green nail syndrome
longitudinal melonychia
brown-black longitudinal bands, multiple: drugs/systemic dz/ single:melanoma; 90% AA, Hutchinson's sign
Hutchinson's sign
extension of pigment on to nail folds-->concern for melanoma
green nail syndrome
greenish-black/blue nail discoloration--> pyocyanin (pigment) Pseudomonas aeruginosa--> water/detergent/soap exposure (dishwashers)
Psoriasis nails
irreglar pitting, salmon patches (oil drop), onycholysis (erythematous border), Koebner phenomenon (induced by trauma)
lichen planus nails
several nails, thinning/fissuring, dorsal pterygium (scarring of proximal nail fold over nail plate)
alopecia areata nails
geometric pitting in children, trachyonychia (rough nails)
eczema nails
irregular pitting, Beau's lines, subungual hyperkeratosis (debris under nail), chronic paronychia (candidia infection under nail fold)
clubbing
lovibond's angle >180 (nl 160)--> cardiopulmonary dz, sarcoidosis, cirrhosis, GI dz, toxins, trauma
Muehrcke's lines
apparent leukonychia w/ transverse white bands (disappear w/ P)--> hypoalbuminism
Lindsay's nails
(1/2 and 1/2 nails)--> proximally white and distally brown/red-->chronic renal dz
Terry's nails
white proximally w/ few mm of brown-red distally-->cirrhosis
autoimmune CT dz nails
nail fold capillary abnl, cuticular hemorrhages, dermatomyosistis, scleroderma
acute paronychia @ nail
swollen, red, painful digit-->pus drainage, due to bacteria (S. aureus>S. pyogenes)
chronic paronychia @ nail
proximal nail fold inflammation, no cuticle, fingernail affected secondary to Candida infection, no pus--> recurrent paronychia, suspect HSV infection
warts of nail
HPV, periungal keratotic papules (thick & crunchy), hypekeratosis of cuticle, recalcitrant lesions-->SCC risk
onychomycosis (fungal infections)
tinea unguium (secondary to dermatophyte infection)--> trichophyton rubrum; 4 patterns: distal subungal, white superficial, proximal subungal (PSA-->HIV/immunosuppression), candidal onychomycosis (not dermatophyte)
onychoschizia
brittle nails, distal superficial splitting (horizonal) of nail plate--> dehydration (frequent hand-washing)
Onychotillomania
cuticle absent/proximal fold inflamed, nail plate surface abnl (longitudinal central depression), melanonychia, hemorrhages, crusts (personal injury)
subungal hematoma
hx acute trauma (bld accumulates under nail)-->purple-red-black color--> pigmentation moves distally w/ growth
onychogryphosis
ram's horn nails (asymmetric growth), thick/hard/yellow plate, hallux (big toe via chronic trauma), elderly
pincer nails (trumpet nails)
over curvature of the distal nail plate, hereditary/acquired (poorly-fitting shoes) and end stage renal disease
onchocryptosis
in-grown nail (congenital malalignment), improper cutting, painful inflammed lateral fold, granulation tissue (red/juicy response to trauma)
pyogenic granuloma
bleeding, angiomatous nodule, (peri/subungal)-->taumatic (benign)
periungual fibroma
pink-skin colored papule from proximal nail fold--> compress matrix--> longitudinal groove in plate--> sign of tuberous sclerosis (Koenen's tumors)
myxoid cysts
proximal nail fold swelling, plate depression/groove, cysts cxn w/ DOP (drain fluid)--> w/o removing capsule-->refill
subungal exostosis
benign, bony proliferation, hard nodule-->precipitated by trauma (toenails)-->confirm w/ Xray
benign nail tumors
pyogenic granuloma, periungal fibroma, myxoid cysts, subungal exostosis
malignant nail tumors
melanoma, SCC
SCC of nail
most frequent malignant nail tumor--> HPV16--> verrucous lesion, ulverated nodule, onycholysis, nail plate destruction
melanoma of nail
5yr survival 15% (0.7-3.5% of melanomas), longitudinal melanonychia, thumb, nail plate destruction, hutchinson's sign, amelanotic (non-pigmented) 25%
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