CHAPTER 49

 
Nail changes may be primary where the disease is affecting the nail or secondary to a systemic disease.

Infections :either bacterial , fungal or in the course of different systemic infections. These were discussed in the previous chapters.

Leprosy

Peripheral vascular disorders.

The nail becomes thin ,rudimentary and smaller size .Nail atrophy may be congenital or acquired :

Diseases which can cause nail atrophy are the following:

Etiology

• Penicillin allergy

• Keratosis punctata

• Skin diseases

• Paronychia: paronychia may be bacterial or fungal.

• Psoriasis of nails

Furrows and nail pitting .

Transverse depression of the nail .

Splinter hemorrhage.

Subungual debris and keratoses .

Onycholysis.

Lichen planus : Nail changes may be associated with skin and mucous membrane manifestations of lichen planus or the disease is localized to the nails only.

Longitudinal grooving of the nail.

Bulging at the proximal nail folds.

Pterygium

Nail atrophy

Permanent loss of nails.

Clubbing of fingers is a manifestation of a large number of systemic diseases.

Nail changes and that of the terminal phalanges give the “drum stick“ appearance of nails.

Nail bulging

Convex curved nail in both longitudinal and transverse directions.

Thickened eponychium.

Respiratory diseases : bronchiectesis, chronic bronchitis, bronchogenic carcinoma, emphysema, tuberculosis.

Liver diseases : biliary cirrhosis

Congenital heart diseases.

Nails in the course of chronic eczema: deformities, nail brittling,atrophic and hypertrophic changes may occure.

                                           Fig. 439b. Nail dystrophy with Alopecia 

The nail is thin and concave from side to side with everted edges.

                                                                                   Fig 439b. Spoon nails

• Iron deficiency anaemia

• Polycythema

• Coronary disease

• Syphilis

• Acanthosis nigricans

• Plummer-Vinson‘s syndrome.

• Strong alkalis as soaps

• Petroleum products .

Transverse lines and furrows at the nail lanula .

Trauma

Systemic infections such as measles.

Drug reaction.

Strong soaps

Nail polish

Vitamin deficiency: Vitamin A and B.

Psoriasis

Lichen planus

Nail biting (Onychophagia)

This is a common habit in children, biting and clipping of the tip of the nails by teeth. All fingernails are often bitten, but occasionally, one or more are spared. The nail is often bitten right back to the point of separation from the nail.

                            Fig.439c. Nail biting

The cuticles and lateral nail walls are often bitten and so become irregular and broken. Peri ungual warts are more common in nail biters.

Ingrowing nail 

                                                                                                              Fig.439d. Pyogenic paronychia &Ingrowing nail

This is due to different factors mainly : repeated trauma to nail, tight shoes, bony malformation of the big toe and others.

This is essentially similar to the habit tic but is more closely allied to parasitophobia as the patient picks off pieces of nail fold and may claim that they contain parasites. A rough and irregular nail and nail fold results.

Different nail preparations or paints of nails may have local reaction affecting the nail and the adjacent tissues. These products may affect babies and children indirectly from their mothers due to contact of their skin with these applied cosmetics on the mothers‘ nails. Nail cosmetics include the nail polish and the nail removal, which is composed of various solvents such as acetone.

Clinical Manifestations:

Contact dermatitis to the adjacent tissue .

Dryness of the nails .

Brittled and fractured nails .

Paronychia

Punctate type: occurs as a result of:

Trauma.

Systemic diseases as typhoid fever , nephritis .

Deep X-ray therapy

Infections especially due to pseudomonas .

Adrenalectomy

Junction nevus

These types of color changes of the nails occur with pseudomonas aeruginosa infections.

Drugs and chemicals : such as chrysarobin , Resorcin , anthralines .

Infections : syphilis

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3. Barlow AJE, Chattaway FW, Holgate ML et al. Chronic paronychia. Br J Dermatol 1970; 82: 448-53.

4. Baran R, Dawber RPR, eds. Diseases of the Nail and their Management. Oxford: Blackwell Scientific Publications, 1984; chapter 4, 105-20.

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6. Colomb D. Antimalarial nails pigmentation. Bull Soc Fr Dermatol Syphiligr 1975; 82: 319-22.

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8. Daniel CR. Pigmentation abnormalities. In: Scher RK, Daniel CR, eds. Nails: Therapy, Diagnosis, Surgery. Philadelphia: WB Saunders Co, 1990: 153-66.

9. Eastwood JB, Curtin JR, Smith EKM et al. Shedding of the nails apparently induced by large amounts of cephoridine and cloxacillin in 2 anephric patients. Br J Dermatol 1969; 81: 750-2.

10. Franks SB, Coton HJ, Mirkin W. Photo-onycholysis due to tetracycline. Arch Dermatol 1971; 103: 520.

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13. Samman PD. The Nails in Disease 3rd edn. London: Heinemann, 1978: 14.

14. Turano AF. Beau‘s lines in infancy. Pediatrics 1968; 41: 996-4.

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