Bump in nail bed: Nail Bed Irregularities – Should You Be Concerned?
Nail Bed Irregularities – Should You Be Concerned?
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Lichen planus Information | Mount Sinai
Lichen planus is a condition that forms a very itchy rash on the skin or in the mouth.
Lichen planus is an intensely itchy (pruritic) inflammatory lesion of the skin.
The lesions are generally violaceous (red-purple), slightly raised bumps (papules) with fine scales. The papules may run together (coalesce) to form a larger raised surface (plaque). This is a condition usually seen in adults, although it can occur in children.
Lichen nitidus consists of tiny flesh colored to pink raised lesions (papules). The papules are asymptomatic but persist for long periods of time. They generally occur only on the abdomen, flexor surfaces of the elbows and palms, and on the male genitalia.
The cause of lichen planus is unknown. It appears as raised, many-sided purple bumps (violaceous polygonal papules) with overlying white lines (Wickham’s striae). It commonly involves the wrists (flexor surface), lower back (lumbar region), shins, and ankles. The lesions often itch. Females are more frequently affected than males and the age range is approximately 30 to 60 years of age.
The cause of lichen planus is unknown.
It appears as raised, many-sided purple bumps (violaceous polygonal papules) with overlying white lines (Wickham’s striae). It commonly involves the wrists (flexor surface), lower back (lumbar region), shins, and ankles. The lesions often itch. Females are more frequently affected than males and the age range is approximately 30 to 60 years of age. This is a less common variant, shown here with scales.
Oral lichen planus occurs in about half of the people who have lichen planus on their skin. It consists of painless, whitish streaks on the mucous membranes. This may also produce ulcers, which are usually painful.
Lichen striatus begins similarly to lichen planus, with small bumps (papules), but over a period of days expands to form a long streak or band of affected skin. The condition clears spontaneously (without medication) over a period of months. This condition is seen frequently in children less than 16 years old, but may also occur in adults.
Lichen striatus begins similarly to lichen planus, with small bumps (papules), but over a period of days expands to form a long streak or band of affected skin. It clears over a period of months without needing treatment. This condition is seen frequently in children less than 16 years old but, also occurs in adults.
Lichen striatus begins similarly to lichen planus, with small bumps (papules), but over a period of days expands to form a long streak or band of affected skin. The condition clears spontaneously over a period of months. This condition is seen frequently in children less than 16 years old, but also occurs in adults.
Causes
The exact cause of lichen planus is unknown. It may be related to an allergic or immune reaction.
Risks for the condition include:
- Exposure to certain medicines, dyes, and other chemicals (including gold, antibiotics, arsenic, iodides, chloroquine, quinacrine, quinine, phenothiazines, and diuretics)
- Diseases such as hepatitis C
Lichen planus mostly affects middle-aged adults.
It is less common in children.
Symptoms
Mouth sores are one symptom of lichen planus. They:
- May be tender or painful (mild cases may not cause pain)
- Are located on the sides of the tongue, inside of the cheek, or on the gums
- Look like bluish-white spots or pimples
- Form lines in a lacy network
- Gradually increase in size
- Sometimes form painful ulcers
Skin sores are another symptom of lichen planus. They:
- Usually appear on the inner wrist, legs, torso, or genitals
- Are extremely itchy
- Have even sides (symmetrical) and sharp borders
- Occur alone or in clusters, often at the site of a skin injury
- May be covered with thin white streaks or scratch marks
- Are shiny or scaly looking
- Have a dark, violet color
- May develop blisters or ulcers
Other symptoms of lichen planus are:
- Dry mouth
- Hair loss
- Metallic taste in the mouth
- Ridges in the nails
Exams and Tests
Your health care provider may make the diagnosis based on the appearance of your skin or mouth lesions.
A skin lesion biopsy or biopsy of a mouth lesion can confirm the diagnosis.
Treatment
The goal of treatment is to reduce symptoms and speed healing. If your symptoms are mild, you may not need treatment.
Treatments may include:
- Antihistamines
- Medicines that calm down the immune system (in severe cases)
- Lidocaine mouthwashes to numb the area and make eating more comfortable (for mouth sores)
- Topical corticosteroids or oral corticosteroids to reduce swelling and lower immune responses
- Corticosteroid shots into a sore
- Vitamin A as a cream or taken by mouth
- Other medicines that are applied to the skin
- Dressings placed over your skin with medicines to keep you from scratching
- Ultraviolet light therapy
Outlook (Prognosis)
Lichen planus is usually not harmful.
Most often, it gets better with treatment. The condition often clears up within 18 months, but may come and go for years.
If lichen planus is caused by a medicine you are taking, the rash should go away once you stop the medicine.
Possible Complications
Mouth ulcers that are present for a long time may develop into oral cancer.
When to Contact a Medical Professional
Contact your provider if:
- Your skin or mouth lesions change in appearance
- The condition continues or gets worse, even with treatment
- Your dentist recommends changing your medicines or treating conditions that trigger the disorder
James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM.
Lichen planus and related conditions. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews’ Diseases of the Skin: Clinical Dermatology. 13th ed. Philadelphia, PA: Elsevier; 2020:chap 12.
Patterson JW. An approach to the interpretation of skin biopsies. In: Patterson JW, ed. Weedon’s Skin Pathology. 5th ed. Philadelphia, PA: Elsevier; 2021:chap 2.
Last reviewed on: 11/18/2022
Reviewed by: Elika Hoss, MD, Assistant Professor of Dermatology, Mayo Clinic, Scottsdale, AZ. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
Exostosis – causes, symptoms, diagnosis and treatment
An article for patients with a disease diagnosed by a doctor. It does not replace a doctor’s appointment and cannot be used for self-diagnosis.
Causes of development
The main factor in the occurrence of pathology is regular damage to the fingertips.
In what cases does traumatization occur:
friction due to long-term wearing of narrow, ill-fitting shoes;
walking long distances;
long run;
ballet or cycling;
mechanical damage to the finger – blows, bruises;
prolonged use of artificial coatings on the nail plate;
surgical removal of the ingrown nail;
mycosis, as a result of which the nail plate becomes thinner.
Subungual exostosis often progresses in dancers, athletes and in people whose work is associated with increased stress on the limbs. Due to damage or thinning of the nail plate, the load on the finger increases, mainly when moving, walking or jogging. As a result, irritation of the surrounding tissues occurs, and the appearance of an osteochondral outgrowth serves as a protective response of the body.
Genetic factors also play an important role. Some patients are predisposed to developing a build-up due to their inherent predisposition to bone disease.
Osteocartilaginous exostosis is a common pathology at any age, but most often occurs in adolescents, during the period of the most intensive growth of the body. In young children, pathology is rarely observed.
Prerequisites for the development of exostosis are also:
endocrine disorders;
infectious and inflammatory processes;
excess calcium in the body;
developmental disorders of the periosteum.
Exostosis becomes larger over time, so you should not postpone treatment – try to visit an orthopedic traumatologist as soon as possible.
Pathogenesis
An osteochondral neoplasm develops under the skin in the area of the nail bed. Usually at the initial stage, this disease does not manifest itself for a long time.
At first, it is a cartilaginous growth, which subsequently hardens and transforms into a spongy short bone. A thin but strong capsule of bone tissue, similar to a shell, appears on the surface of the growth.
Outwardly, the growth can be elongated, mushroom-shaped, rounded or spike-shaped. The size varies – from a few millimeters to one or two centimeters. Usually exostosis develops on only one finger.
Over time, the pathology progresses, the growth becomes larger and more noticeable. Gradually, the nail begins to rest against it, but it cannot grow freely. As a result, the nail plate is deformed, painful sensations appear while walking on foot. A nail defect can be seen with the naked eye: it looks like a thickening under the free edge of the plate.
In some cases, the osteochondral overgrowth remains small in size and does not cause discomfort for many years.
Pathology can be detected by chance, for example, when viewing x-ray images or at a scheduled appointment with an orthopedic traumatologist.
But most often, the symptoms of subungual exostosis are very pronounced, manifested by soreness and limited mobility of the toes.
Symptoms
The main signs of pathology:
irritation, swelling of the periungual zone, ingrown nail;
exfoliation and changes in the structure of the nail plate;
feeling of “bloating” of the nail plate;
ingrowths in the region of the edges.
With the progression of exostosis in the soft tissues, the edges and the central part of the nail plate rise. The nail is deformed to such an extent that it eventually twists – this not only causes discomfort, but also does not look aesthetically pleasing. The appearance of the affected nail changes.
Subungual exostosis has many symptoms similar to other pathologies of the nail, nail bed, periungual folds, and terminal phalanx of the finger. An accurate diagnosis can only be made by a qualified specialist – a podiatrist or an orthopedic traumatologist.
Danger
The main danger of osteochondral outgrowth is that at first it develops asymptomatically and does not bring the patient any discomfort other than aesthetic. Gradually, the formation grows to a large size and it is no longer possible to do without the intervention of a doctor.
Possible complications:
Pain syndrome. Subungual exostosis of large sizes puts pressure on the nail bed or surrounding tissues, therefore it provokes pain. The pain may be aggravated by walking or wearing uncomfortable shoes. In the future, there are difficulties in performing simple actions – walking, running and staying on your feet for a long period of time. At the same time, the motor function is limited, and the patient feels tired even after small physical exertion.
Deformation of the nail plate. If the pathology is not treated on time, there is a change in the color and structure of the nail. It becomes thickened or discolored.
development of infection. Subungual exostosis damages the nail bed and tissues, which increases the risk of infection. As a result, pain increases, swelling and redness appear. This condition requires the provision of medical care – taking antibiotics, and in difficult cases, surgical intervention.
Onychocryptosis is an ingrown toenail. In the area of the tumor, painful sensations appear, inflammation progresses. With an ingrown nail, the plate changes color and structure, and the risk of infection increases.
Even after surgery, subungual exostosis can recur, especially if the underlying cause of the pathology is not eliminated. Over time, the discomfort becomes constant, and it becomes more and more difficult for the patient to walk, run, play sports and physical education, and choose comfortable shoes for himself.
Exostosis is a benign formation that is not prone to degeneration into a malignant tumor.
Diagnostics
The pathology is diagnosed by a traumatologist-orthopedist. With the appearance of typical symptoms of subungual exostosis, it is necessary to consult a specialist. The doctor will review the history and pictures of previous x-rays. He will also ask you to talk about the symptoms and the time of their appearance, ask about cases of nail damage, previous diseases and surgical interventions.
It is possible to make a preliminary diagnosis already at the initial appointment, since the neoplasm is either palpable under the skin or noticeable to the naked eye. Palpation and visual examination of the toe are used as the main diagnostic methods.
Without special studies, it is impossible to determine the nature of the pathology.
Therefore, most often a specialist prescribes instrumental diagnostic methods, for example, x-rays. X-ray examination will help assess the condition of the bone structures. Diagnostics is informative when a lot of time has passed, and the growth has become ossified.
At an early stage, x-rays are ineffective, since cartilage tissue is usually not visible on x-rays.
For differential diagnosis, your doctor may recommend a computed tomography (CT) scan.
Treatment
Completely get rid of exostosis of the nails is possible only surgically. Conservative measures give only a temporary result and relieve symptoms for a short period. The most commonly used anti-inflammatory and analgesic drugs. They reduce inflammation and swelling, relieve acute pain and temporarily alleviate the patient’s well-being. But medicines cannot correct the destruction of the nail plate that has begun. As a rule, osteochondral growth continues to increase even during the use of drugs.
Therefore, it is necessary to solve the problem radically. After examination and diagnosis, the doctor may recommend surgical removal of the exostosis.
The operation is performed on an outpatient basis and is referred to as “surgery of one day”.
This means that you can carry out the procedures on the day of treatment and, after the manipulation, return home without going to the hospital.
Before the operation, it is desirable to remove the varnish or gel coating on the nails. Take care in advance about how you will get home after the procedure. On this day, you should not drive yourself or ride in crowded public transport. Prepare shoes in which the foot will be free. Narrow and tight shoes, closed shoes or boots are not suitable, as there will be a thick bandage on the phalanx. Most suitable open flip-flops, comfortable sandals, Velcro shoes, soft moccasins
How is the surgical removal of exostosis
Manipulation involves minimally invasive percutaneous intervention. The doctor makes micro-incisions in soft tissues in the area of osteophyte localization. Next, the tissues are separated in layers, and the protrusion itself is eliminated using a special tool – an orthopedic bur. The operation is performed under local anesthesia and takes no more than half an hour.
At the end of the procedure, sutures and a sterile aseptic bandage are applied to the operated area.
No further hospital stay is required – you can leave the clinic on the same day. The stitches are removed after 8-10 days.
Benefits of operation:
preservation of the nail plate;
absence of scars and scars;
cosmetic sutures;
minimal tissue damage and no blood loss;
the ability to move without pain and return to normal life in the shortest possible time.
Contraindications for surgery
Surgical percutaneous intervention is not recommended for exacerbations of chronic diseases, acute infections, colds, blood clotting disorders and purulent-inflammatory processes. If there are wounds and injuries on the feet, the operation will have to be postponed to a later date.
Rehabilitation
The recovery period takes about two weeks.
The first day it is important to protect the legs from any stress and damage. Reduce physical activity, try not to run and carry weights. During the rehabilitation period, it may be necessary to treat postoperative wounds with antiseptics prescribed by the surgeon. When the nail grows back, contact a podologist – a course to restore the nail plate may be required. A special corrective system will help restore the natural and attractive look to your nails.
Prevention
One of the ways to prevent osteocartilaginous exostosis is regular examinations by a traumatologist for early diagnosis of pathology. Scheduled examinations are especially needed if you have previously received injuries of the musculoskeletal system.
Wear comfortable shoes that fit your size and don’t pinch your toes. Tight shoes made of low-quality materials lead to the appearance of subungual exostosis, deformity of the toes, the appearance of a “bump”, and the development of flat feet. As long-term consequences, pathologies of the hip and knee joints may appear.
Also control the level of calcium in the body – with its excess, the process of active formation of bone and cartilage growths begins. If you experience any pain or pathological changes in the phalanx of the finger, you should not self-medicate. It is better to immediately contact a qualified orthopedic traumatologist.
Forecast
Exostosis is not a dangerous pathology. For a long time, it develops asymptomatically and does not cause discomfort. It is necessary to remove the osteochondral outgrowth if the formation has reached a large size and causes pain. After the operation, a stable recovery occurs, and the patient can return to his usual way of life as soon as possible.
Answers to frequently asked questions
Osteophytes – what is it?
This is a characteristic manifestation of exostosis – a bone or bone-cartilaginous outgrowth of a benign nature on the surface of the bone. In shape, osteophytes can be linear, spherical, mushroom-like.
Subungual exostosis – what is it? How to define it yourself?
Even before a visit to the doctor, you can carefully examine the toe and listen to your feelings. The most common symptoms of bone exostosis are pain with slight pressure on the fingertip or nail plate, delamination of the nail, discomfort when walking and running, redness, inflammation, swelling and swelling of the periungual fold. If you find one or more characteristic signs in yourself, do not delay contacting a doctor. Without treatment, exostosis progresses, increases in size and causes even more discomfort.
What can exostosis be confused with?
Nail exostosis in its signs and symptoms is similar to fungal diseases of the nails. Due to the similarity of symptoms, patients begin to use antifungal agents on their own, without a doctor’s prescription. As a result, the drugs do not have a positive effect. If you notice deformation of the nail plate, soreness and other changes, contact a specialist.
There are a number of pathologies that change the appearance of the nail, so differential diagnosis is often needed. The doctor will conduct an examination, prescribe additional studies and develop an individual treatment regimen.
Is there a possibility of a recurrence of the disease?
The risk of re-formation of the build-up remains even after surgical treatment. The main way to prevent recurrence is to carefully follow the doctor’s recommendations after surgery:
wear comfortable shoes that do not press on the fingertips;
do not give strong loads on the operated phalanx – this can lead to re-injury;
limit physical activity in general;
in the early days, abandon thermal and water procedures.
If you adhere to medical prescriptions and adjust your lifestyle, the likelihood of re-development of subungual exostosis is minimal.
There are contraindications.
It is necessary to consult with a specialist
The materials posted on this page are for informational purposes and are intended for educational purposes.
Site visitors should not use them as medical advice.
Determining the diagnosis and choosing a treatment method remains the exclusive prerogative of your doctor!
Subungual melanoma: is gel polish as scary as it is painted
Subungual melanoma is a rather rare, but extremely aggressive form of malignant neoplasm. And most of all, lovers of manicure with gel polish are afraid of her most of all – after all, the Internet is full of horror stories that this procedure provokes cancer.
What does subungual melanoma look like, what causes it and how is it related to gel polish?
Strip under the nail
Subungual melanoma is a form of acral lentiginous melanoma, which is a type of cutaneous melanoma, an aggressive cancer with a high mortality rate.
“The proportion of acral lentiginous melanoma varies in different regions of the world and averages 5% of all types of melanoma.
Tumors are more often localized in the area of the feet, of which a quarter are subungual melanomas,” notes Grigory Zinoviev, Candidate of Medical Science, oncologist, surgeon, head of the surgical department of tumors of bones, soft tissues and skin of the N.N. N. N. Petrova.
Evil under the sun: how to save yourself from the most common type of cancer
Subungual melanoma has two stages of development: horizontal and vertical. At first, the tumor looks like a strip of brown or black color under the nail. Then the free edge of the nail, the nail fold and the skin are gradually pigmented. In a third of cases, pigmentless melanoma occurs, which is difficult to notice.
The first symptoms develop at the vertical stage, when the tumor grows into neighboring tissues: the nail is deformed, the nail plate becomes dull, thinner and breaks. When the nail cracks, you can see a bumpy, bleeding brown or black surface under it.
As the tumor progresses, it may spread to the fingers, feet, or hands.
The patient experiences weakness, loses weight, his temperature rises. The rate of development of the disease is different – metastases can appear in a year or several years.
How to treat?
Timely diagnosis is difficult, because the tumor resembles a subungual hematoma. Dermoscopy and epiluminescent microscopy help to understand – a visual assessment of altered tissues with the help of magnification and examination of them in an immersion environment. The final diagnosis is made after a histological conclusion, but it is not advised to take a biopsy – metastases may occur.
The main method in the treatment of melanoma is amputation at the level of the middle phalanx of the finger. Radiation therapy is used to irradiate tumor recurrence in the area of the postoperative scar and lymph nodes – to prevent metastases. Chemotherapy reduces the size of the tumor and destroys the remnants of malignant cells.
But, unfortunately, to date, the effect of these methods can only be achieved in 15-20% of patients – all because subungual melanoma is characterized by an aggressive course.
Most often, metastases are later found in the lungs and liver.
There are no “former” cancer patients
The prognosis depends on the thickness of the tumor, the level of invasion and the presence of distant metastases. Five-year life expectancy without metastases is about 60%, half of the patients die after 4.5 years. If there are metastases, death can occur in 7-8 months.
Melanoma triggers and gel polish
In subungual melanoma, solar radiation almost does not play the role of a trigger – the neoplasm often affects toes covered by shoes. Risk factors include mechanical trauma to the nail, cosmetic and surgical interventions that are performed for nail diseases. Frostbite and burns, the use of a laser to treat or remove nails, exposure to chemical carcinogens on nails, for example, in a chemical plant – all this also plays a provoking role.
Both hereditary factors and a large number of dysplastic nevi and moles are important. At risk are people over 60 and those with fair skin, red hair, and freckles.
But what role does gel polish play in the development of melanoma? After all, during a manicure, the upper part of the nail is cut off (mechanical damage), covered with a base and varnish (chemical agents) and irradiated under a lamp to harden the coating (UV radiation). And this procedure takes place with female fingers quite regularly – at least once a month.
Comparing these factors, some integrative medicine physicians blogging on social networks sounded the alarm and recorded gel polish as a factor in subungual melanoma. So, the physician Victoria Orlinskaya, whose authority in the medical community has been repeatedly called into question, claims that the occurrence of melanoma is possible due to a combination of several factors: nail injury, application of a chemical composition to the injured surface and UV radiation. In addition, according to her, the nails do not breathe, lose their ability to be nourished, and the gel polish itself masks melanoma, delaying the time of early diagnosis.
No confirmation
None of the experts interviewed by the Rosbalt correspondent confirmed that there is a direct or indirect connection between gel polish and subungual melanoma. So, this assumption was refuted by oncologist Grigory Zinoviev:
“There are no statistically reliable studies showing the relationship between shellac and acral melanoma. If the light source in the technology of applying gel polishes is an LED lamp, and not an ultraviolet lamp, as, for example, in a solarium, this procedure should not affect the likelihood of melanoma.
Cancer is a 100% family crisis
Elena Likhova, master of the federal network of manicure and pedicure salons, shares the same opinion: according to her, LED lamps have been used in the industry for a long time.
“The LED lamp cannot provoke the growth of cancer cells and hyperpigmentation of the skin. The light is different from the ultraviolet radiation we are exposed to in direct sunlight.
Lamps for polymerization are safe, they only accelerate the process of hardening of the polymer coating,” Likhova noted.
Manicurist Tatyana Smirnova notes that even old UV lamps operated at only 9 watts, which is not enough for serious consequences:
“This is a very weak power, and the client kept his hands directly in the lamp for a maximum of 15-20 minutes once a month . For comparison: the lamps in the solarium have a power of at least 180 watts and above.
Elena Likhova suggested to all those who had doubts to put sunscreen on their hands just before covering or to use special manicure gloves that open only the nails. But the composition of the gel polish should pay closer attention.
“At a minimum, formulation must be 3FREE and free of toluene, formaldehyde and dibutyl phthalate, parabens and camphor. In principle, now all normal manufacturers have already removed this from the compositions, so if you use proven brands, there will be no consequences, ”says the master.
Tatyana Smirnova agrees with her, noting that for the majority of modern materials that are sold in stores and have a quality certificate, raw materials are purchased from factories in Europe. However, on the Internet you can find many fakes, which can contain anything. And it is also worth paying attention to the professionalism of the master: if he removed the coating with the device poorly or applied a lot of material to the nail, this can lead to burns, onycholysis, cuts and damage.
Hit below the belt
When to say “stop” to gel polish?
And although we are convinced that there is no direct connection between nail cancer and gel polish, this does not mean that it can be applied uncontrollably. We remember that subungual melanoma occurs, among other things, due to frequent mechanical and chemical damage to the nail, which means that if the nail is weakened, it is not worth “finishing” it. So, it is not recommended to cover the nails with gel polish if the nail plate is damaged – it will take longer to heal.
If you have been diagnosed with onycholysis, fungus and psoriasis, you should also refuse a manicure. With a pedicure, the story is more complicated: experienced craftsmen advise not to apply gel polish in the cold season.
“Summer is ending, the season of closed shoes begins. From autumn to spring, you can’t cover your nails with gel polish, otherwise you risk being left without nails, says manicure master Marina Kolesnik on her blog. – The fact is that gel polish creates hardness and thickness, and the nail does not cushion as it should when walking in shoes. The nail plate begins to deform and move away from the nail bed, and voids form under the nails, which can increase until the nail plate falls off. And the voids are an excellent environment for the appearance of fungi and other various infections.
To summarize: it seems that temporary aesthetics is not worth such sacrifices, and any cosmetic procedure should be approached wisely. At the same time, if you are completely healthy, and your master is a true professional, continue, as Pushkin bequeathed, to think about the beauty of nails and do not be afraid of cancer horror stories.