What are the most common nail disorders. How can you identify different nail problems. What treatments are available for various nail conditions. How do nail abnormalities relate to overall health.

Understanding Nail Anatomy and Function

Before delving into nail disorders, it’s crucial to understand the basic anatomy and function of nails. Nails are composed of layers of a protein called keratin and grow from the matrix at the base of the nail. They serve several important purposes, including protecting the sensitive fingertips, enhancing fine motor skills, and even acting as a diagnostic tool for various health conditions.

Key Components of Nail Structure

• Nail plate: The visible part of the nail
• Nail bed: The skin beneath the nail plate
• Cuticle: The protective rim of tissue around the base of the nail
• Lunula: The white, crescent-shaped area at the base of the nail
• Matrix: The hidden part under the skin that produces new nail cells

How do nails grow? Nails grow continuously throughout life, with fingernails growing an average of 3.5 mm per month and toenails about 1.6 mm per month. This growth rate can be affected by factors such as age, nutrition, and overall health.

Common Nail Disorders and Their Characteristics

Nail disorders can manifest in various ways, affecting the appearance, texture, and growth of nails. Some of the most prevalent nail conditions include:

Onychomycosis (Fungal Nail Infection)

Onychomycosis is a fungal infection that affects the nail plate and bed. It’s more common in toenails than fingernails and can cause:

• Thickening of the nail
• Discoloration (often yellow or brown)
• Brittleness and crumbling
• Separation of the nail from the nail bed (onycholysis)

How is onychomycosis treated? Treatment options include oral antifungal medications, topical treatments, and in severe cases, nail removal. The choice of treatment depends on the severity of the infection and the patient’s overall health.

Psoriatic Nail Disease

Psoriasis, a chronic inflammatory skin condition, can also affect the nails. Nail psoriasis is characterized by:

• Pitting (small depressions on the nail surface)
• Onycholysis
• “Oil drop” discoloration
• Thickening of the nail plate
• Splinter hemorrhages (thin, vertical lines of blood under the nail)

What treatment options are available for nail psoriasis? Treatment may include topical corticosteroids, vitamin D analogs, systemic medications for severe cases, and in some instances, light therapy.

Nail Abnormalities as Indicators of Systemic Diseases

Nail changes can sometimes be the first sign of an underlying health condition. Recognizing these changes can lead to early diagnosis and treatment of various systemic diseases.

Terry’s Nails

Terry’s nails appear mostly white with a dark band at the tip. They are associated with:

• Liver disease
• Congestive heart failure
• Kidney failure
• Diabetes

Why do Terry’s nails occur? The exact mechanism is not fully understood, but it’s thought to be related to decreased vascularity and increased connective tissue in the nail bed.

Beau’s Lines

Beau’s lines are horizontal depressions that run across the nails. They can be indicative of:

• Severe illness
• Malnutrition
• Chemotherapy
• Zinc deficiency

How do Beau’s lines form? These lines appear when nail growth is temporarily disrupted due to severe stress on the body, causing a visible line as growth resumes.

Traumatic Nail Injuries and Their Consequences

Nail trauma can lead to various deformities and complications. Common traumatic nail injuries include:

Subungual Hematoma

A subungual hematoma is a collection of blood under the nail, often due to acute injury. It causes:

• Intense pain
• Dark discoloration of the nail
• Potential separation of the nail from the bed

How is a subungual hematoma treated? Minor cases may resolve on their own, but larger hematomas often require drainage to relieve pain and prevent nail loss.

Onycholysis Due to Trauma

Onycholysis refers to the separation of the nail plate from the nail bed. Traumatic causes include:

• Repetitive microtrauma (e.g., from ill-fitting shoes)
• Chemical exposure
• Thermal burns

Can traumatic onycholysis be reversed? With proper care and avoidance of further trauma, the nail can often reattach as it grows out. However, severe cases may result in permanent nail deformity.

Infectious Nail Disorders Beyond Fungal Infections

While fungal infections are the most common infectious nail disorders, bacterial and viral infections can also affect nail health.

Paronychia

Paronychia is an infection of the soft tissue around the nail. It can be acute (usually bacterial) or chronic (often due to repeated irritation). Symptoms include:

• Redness and swelling around the nail
• Pain and tenderness
• Pus accumulation in severe cases

What causes paronychia? Acute paronychia is often caused by Staphylococcus aureus or Streptococcus pyogenes. Chronic paronychia is frequently associated with repeated exposure to irritants or moisture.

Viral Warts

Viral warts caused by human papillomavirus (HPV) can affect the nail area, leading to:

• Rough, raised growths around or under the nail
• Nail deformity
• Pain when pressure is applied

How are periungual warts treated? Treatment options include topical medications, cryotherapy, laser therapy, and surgical removal in resistant cases.

Congenital and Hereditary Nail Disorders

Some nail disorders are present from birth or have a genetic component. These conditions can range from mild cosmetic issues to more severe deformities affecting nail function.

Nail-Patella Syndrome

Nail-patella syndrome is a rare genetic disorder affecting nails, bones, and kidneys. Nail abnormalities include:

• Absent or underdeveloped nails, especially of the thumbs
• Triangular lunulae
• Ridging and splitting of nails

Is nail-patella syndrome treatable? While there’s no cure, management focuses on addressing individual symptoms and preventing complications, particularly those related to kidney function.

Congenital Malalignment of the Great Toenails

This condition causes the great toenails to grow at an angle to the long axis of the toe. Features include:

• Lateral deviation of the nail plate
• Thickening and discoloration of the nail
• Increased susceptibility to trauma and infection

Can congenital malalignment be corrected? Conservative treatments like proper nail care and footwear modifications can help. In severe cases, surgical correction may be considered.

Neoplastic Conditions Affecting Nails

While relatively rare, various benign and malignant tumors can affect the nail unit. Early recognition is crucial for proper management.

Subungual Melanoma

Subungual melanoma is a form of skin cancer that occurs under the nail. Key features include:

• A dark streak in the nail that gradually widens
• Hutchinson’s sign (pigmentation extending to the surrounding skin)
• Nail dystrophy or destruction in advanced cases

Why is early detection of subungual melanoma important? Like other melanomas, early diagnosis and treatment significantly improve prognosis. Any unexplained pigmented band in the nail warrants evaluation by a dermatologist.

Glomus Tumor

Glomus tumors are benign but painful tumors that often occur under the nail. Characteristics include:

• Intense pain, especially with pressure or temperature changes
• A visible blue-red spot under the nail
• Nail deformity in some cases

How are glomus tumors diagnosed and treated? Diagnosis often involves imaging studies like MRI. Treatment is typically surgical excision, which is usually curative.

Modern Diagnostic Techniques for Nail Disorders

Advancements in medical technology have improved the diagnosis and management of nail disorders. Some key diagnostic tools include:

Dermoscopy

Dermoscopy allows for detailed examination of nail features without invasive procedures. It’s particularly useful for:

• Differentiating between benign and malignant pigmented lesions
• Identifying subtle changes in nail bed vascularity
• Assessing the extent of fungal infections

How does dermoscopy improve nail disorder diagnosis? By providing high-magnification, in vivo images, dermoscopy can reveal patterns and structures not visible to the naked eye, aiding in early and accurate diagnosis.

Nail Biopsy

In cases where non-invasive methods are inconclusive, a nail biopsy may be necessary. Types of nail biopsies include:

• Nail plate biopsy
• Nail bed biopsy
• Matrix biopsy

When is a nail biopsy indicated? Biopsies are typically performed to diagnose suspected malignancies, confirm inflammatory conditions like psoriasis or lichen planus, or identify recalcitrant infections.

Understanding the various aspects of nail disorders, from common infections to rare genetic conditions, is crucial for both healthcare providers and patients. By recognizing the signs and symptoms of different nail abnormalities, individuals can seek timely medical attention, leading to better outcomes and improved nail health. As research in this field continues to advance, we can expect even more sophisticated diagnostic and treatment options to emerge, further enhancing our ability to manage nail disorders effectively.

types of nail diseases with pictures – jnsgyf3r81

8 hours

• 1 Types of nail diseases with pictures
  • 1.1 Nail disease chart Pictures symptoms and treatment
  • 1.2 Slide show 7 nail problems not to ignore – Mayo Clinic
  • 1.3 Nail abnormalities cause symptoms and pictures
  • 1.4 Nail disease Nails | MedlinePlus
  • 1.5 Nail blur image | DermNet
  • 1.6 Nail fungus – Symptoms and causes – Mayo Clinic
  • 1.7 Toenail Fungus Pictures What It Looks Like & Treatment Tips
  • 1.8 Slideshow What your nails say about your health – WebMD
  • 1.9 Nail health chart Common problems and how to treat them
  • 1.10 Nail Infection (Paronychia) – Cleveland Clinic
  • 1.11 Pictures of Common Foot Problems – WebMD

Nail disease chart Pictures symptoms and treatment

Common nail diseases include nail psoriasis, fungal infections, paronychia and more. Learn about the causes of symptoms and treatments for common nail diseases here.

Slide show 7 nail problems not to ignore – Mayo Clinic

Did you know that your nails can give clues about your overall health? For example, nail-like depressions (nail pitting) are common in people with psoriasis – a condition characterized by scaly patches on the skin.

Nail abnormalities cause symptoms and pictures

Nail abnormalities are common that affect the thickness, shape or color of the nails. In this article we look at possible abnormalities that affect the nails or toenails with a picture …

Nail disease Nails | MedlinePlus

Healthy nails are usually smooth and consistent in color. Specific types of nail discoloration and changes in growth rate can be signs of kidney and liver heart lung disease as well as diabetes and anemia. White spots and vertical ridges are harmless.

Nail blur image | DermNet

Digital myxoid cyst. Fusarium infection of the toenail. Intraepidermal squamous cell carcinoma. Koenen tumor in tuberous sclerosis. Simple lentigo of the nail. Lichen planus. Median canaliform Heller’s dystrophy. Median canaliform Heller nail dystrophy. Mixed connective tissue disease.

Nail fungus – Symptoms and causes – Mayo Clinic

Symptoms of nail fungus include a thick nail or nails; Discolored; Fragile frozen or ragged; Deformed; Separate from the nail bed; Feeling; Nail fungus can affect fingernails but is more common in toenails. Time to see a doctor

Toenail Fungus Pictures What It Looks Like & Treatment Tips

1/8 Toenail fungus is an infection that gets into cracks in your nails or cuts in your skin. It can cause your toenails to change color or become thicker. It can also hurt. Because toes are often…

Slideshow What your nails say about your health – WebMD

Did you know that your nails can reveal clues about your overall health? A touch of white here a rose color or some undulations or bumps can be a sign of disease in the body. The problem…

Nail health chart Common problems and how to treat them

List of common nail problems. Common nail problems and symptoms include the following 1. Nail psoriasis. According to the National Psoriasis Foundation approximately 50% of people with…

Nail Infection (Paronychia) – Cleveland Clinic

What type of paronychia? There are two types of paronychia. Both types have similar signs and symptoms Acute paronychia Symptoms of acute paronychia appear over hours or days. The infection is only in the fold of the nail and does not extend deeper inside the finger or toe. Symptoms disappear with treatment and last less than six weeks.

Pictures of Common Foot Problems – WebMD

Drop. It is a form of arthritis that causes sudden pain, redness, swelling and stiffness. It usually affects the big toe joint, but it can also flare up in the ankle or knee…

Nail Deformities and Dystrophies – Dermatologic Disorders

Deformities are often considered together with dystrophies, but the two are slightly different; deformities are generally considered to be gross changes in nail shape, whereas dystrophies are changes in nail texture or composition (eg, onychomycosis Onychomycosis Onychomycosis is fungal infection of the nail plate, nail bed, or both. The nails typically are deformed and discolored white or yellow. Diagnosis is by appearance, wet mount, culture, polymerase… read more ).

About 50% of nail dystrophies result from fungal infection. The remainder result from various causes, including trauma, congenital abnormalities, psoriasis Psoriasis Psoriasis is an inflammatory disease that manifests most commonly as well-circumscribed, erythematous papules and plaques covered with silvery scales. Multiple factors contribute, including… read more , lichen planus Lichen Planus Lichen planus is a recurrent, pruritic, inflammatory eruption characterized by small, discrete, polygonal, flat-topped, violaceous papules that may coalesce into rough scaly plaques, often accompanied… read more , benign tumors, and occasionally cancer.

Onychomycosis as a cause of nail dystrophy may be obvious on examination, but often samples of the nail plate and subungual debris are taken and sent for histopathologic examination and periodic acid-Schiff (PAS) examination, culture, or, more recently, polymerase chain reaction (PCR) analysis (1 General references Deformities are often considered together with dystrophies, but the two are slightly different; deformities are generally considered to be gross changes in nail shape, whereas dystrophies are. .. read more , 2 General references Deformities are often considered together with dystrophies, but the two are slightly different; deformities are generally considered to be gross changes in nail shape, whereas dystrophies are… read more ).

Nonfungal dystrophies may require a tissue biopsy of the nail plate or nail matrix to make a diagnosis. Nail dystrophy may resolve with treatment of the cause, but, if not, manicurists may be able to mask nail changes with appropriate trimming and polishes.

(See also Overview of Nail Disorders Overview of Nail Disorders A variety of disorders can affect nails, including deformities, trauma, infections of the nail, paronychia, retronychia, and ingrown toenails. Nail changes may occur in many systemic conditions… read more .)

• 1. Hafirassou AZ, Valero C, Gassem N, et al: Usefulness of techniques based on real time PCR for the identification of onychomycosis-causing species. Mycoses 60(10):638–644, 2017. doi: 10.1111/myc.12629

• 2. Gupta AK, Nakrieko KA: Onychomycosis infections: Do polymerase chain reaction and culture reports agree? J Am Podiatr Med Assoc 107(4):280–286, 2017. doi: 10.7547/15-136

In some congenital ectodermal dysplasias, patients have no nails (anonychia). In pachyonychia congenita, the nail beds are thickened, discolored, and transversely hypercurved (pincer nail deformity). Nail-patella syndrome Nail-Patella Syndrome Nail-patella syndrome is a rare inherited disorder of mesenchymal tissue characterized by abnormalities of bones, joints, fingernails and toenails, and kidneys. Diagnosis is clinical. There… read more causes triangular lunulae and partially absent thumb nails. Patients with Darier disease can have nails with red and white streaks and a distal V-shaped nick.

In Plummer-Vinson syndrome Esophageal Web An esophageal web is a thin mucosal membrane that grows across the lumen of the upper esophagus and may cause dysphagia. (See also Overview of Esophageal and Swallowing Disorders.) This image… read more (esophageal webs caused by severe, untreated iron deficiency), 50% of patients have koilonychia (concave, spoon-shaped nails).

Yellow nail syndrome is a rare condition characterized by slow-growing, thickened, hypercurved, yellow nails. This condition typically occurs in patients with lymphedema and/or chronic respiratory disorders. Chronic bronchial infections are present in about half of reported cases.

Half-and-half nails (Lindsay nails) occur usually with renal failure Chronic Kidney Disease Chronic kidney disease (CKD) is long-standing, progressive deterioration of renal function. Symptoms develop slowly and in advanced stages include anorexia, nausea, vomiting, stomatitis, dysgeusia… read more ; the proximal half of the nail is white, and the distal half is pink or red-brown. Half-and-half nails occur in 20 to 50% of patients who have chronic kidney disease; however, this nail abnormality has been reported in various other chronic diseases including Crohn disease, cirrhosis, pellagra, and Kawasaki disease. This abnormality also occurs in healthy people (1 Systemic nail deformities and dystrophies reference Deformities are often considered together with dystrophies, but the two are slightly different; deformities are generally considered to be gross changes in nail shape, whereas dystrophies are… read more ).

Terry nails are characterized by whiteness of about 80% of the nail bed with a 0.5- to 3.0-mm brown-to-pink distal band. Terry nails are often associated with cirrhosis, chronic heart failure, and adult-onset diabetes mellitus. Differentiation from half-and-half nails can be difficult (1 Systemic nail deformities and dystrophies reference Deformities are often considered together with dystrophies, but the two are slightly different; deformities are generally considered to be gross changes in nail shape, whereas dystrophies are… read more ).

White nails occur with cirrhosis Cirrhosis Cirrhosis is a late stage of hepatic fibrosis that has resulted in widespread distortion of normal hepatic architecture. Cirrhosis is characterized by regenerative nodules surrounded by dense… read more , although the distal third may remain pinker. Intensely white nails, also called Terry nails, can be present in patients with chronic liver or kidney failure, heart failure, or diabetes. Terry nails are a type of leukonychia; the abnormality is not in the nail itself but rather the nail bed, causing the nail the appear white. In Terry nails, nearly the entire nail is opaque white and the lunula is not visible. There is a thin zone of normal pink nail bed at the distal edge of the nail. Terry nails may sometimes occur as part of normal aging (1 Systemic nail deformities and dystrophies reference Deformities are often considered together with dystrophies, but the two are slightly different; deformities are generally considered to be gross changes in nail shape, whereas dystrophies are… read more ).

Beau lines are horizontal grooves in the nail plate that occur when nail growth temporarily slows, which can occur after infection, trauma, systemic illness, or during cycles of chemotherapy. Onychomadesis similarly results from temporary growth arrest of the nail matrix and differs from Beau lines in that the full thickness of the nail is involved, causing a proximal separation of the nail plate from the nail bed. Onychomadesis most frequently occurs several months after hand-foot-and-mouth disease Hand-Foot-and-Mouth Disease (HFMD) Hand-foot-and-mouth disease (HFMD) is a febrile disorder usually caused by coxsackievirus A16, enterovirus 71, or other enteroviruses. Infection causes a vesicular eruption on the hands, feet… read more but can occur after other viral infections. Nails affected by Beau lines or onychomadesis regrow normally with time.

Koilonychia

DR P. MARAZZI/SCIENCE PHOTO LIBRARY

Yellow Nail Syndrome

This image shows yellow nails with increased thickening and hypercurvature characteristic of yellow nail syndrome.

© Springer Science+Business Media

Terry Nails

In this image of Terry nails, almost all of the nail is opaque white except for a narrow brown-to-pink band at the distal edge of the nail.

© Springer Science+Business Media

Beau Lines Due to Chemotherapy

This image shows Beau lines in a patient undergoing multiple cycles of chemotherapy. Each line corresponds to a cycle of treatment.

© Springer Science+Business Media

Beau Lines

The transverse depression of the nail plate is easily appreciated looking at the nail from the side.

© Springer Science+Business Media

• 1. Pitukweerakul S, Pilla S: Terry’s nails and Lindsay’s nails: Two nail abnormalities in chronic systemic diseases. J Gen Intern Med 31(8):970, 2016. doi: 10.1007/s11606-016-3628-z

In psoriasis Psoriasis Psoriasis is an inflammatory disease that manifests most commonly as well-circumscribed, erythematous papules and plaques covered with silvery scales. Multiple factors contribute, including… read more , nails may have a number of changes, including irregular pits, oil spots (localized areas of tan-brown discoloration), separation of part of the nail from the nail bed (onycholysis Onycholysis Deformities are often considered together with dystrophies, but the two are slightly different; deformities are generally considered to be gross changes in nail shape, whereas dystrophies are. .. read more ), and thickening and crumbling of the nail plate. Nail psoriasis is independently associated with treatment-resistant psoriatic disease and is a risk factor for development of psoriatic arthritis Psoriatic Arthritis Psoriatic arthritis is a seronegative spondyloarthropathy and chronic inflammatory arthritis that occurs in people with psoriasis of the skin or nails. The arthritis is often asymmetric, and… read more . Treatment of nail psoriasis is challenging, but immunomodulatory agents are the most effective (1 Dermatologic nail deformities references Deformities are often considered together with dystrophies, but the two are slightly different; deformities are generally considered to be gross changes in nail shape, whereas dystrophies are… read more , 2 Dermatologic nail deformities references Deformities are often considered together with dystrophies, but the two are slightly different; deformities are generally considered to be gross changes in nail shape, whereas dystrophies are. .. read more ). Topical therapies can lead to modest improvement. Device-based therapies (eg, laser, light) need more study to judge their effectiveness.

Lichen planus Lichen Planus Lichen planus is a recurrent, pruritic, inflammatory eruption characterized by small, discrete, polygonal, flat-topped, violaceous papules that may coalesce into rough scaly plaques, often accompanied… read more of the nail matrix initially causes potentially reversible nail changes, including longitudinal ridging, fissuring, erythema of the lunula, and distal splitting of the nail. Over time, scarring and irreversible changes may occur, including nail atrophy, pterygium formation, and total nail loss. Lichen planus of the nail unit requires management early in the disease to prevent permanent disfigurement. Treatment options include topical, intralesional, and systemic corticosteroids. However, relapse may occur after therapy in some patients. Pterygium of the nail, which is caused by lichen planus, is characterized by scarring from the proximal nail outward in a V formation, which leads ultimately to nail loss.

Alopecia areata Alopecia Areata Alopecia areata is typically sudden patchy nonscarring hair loss in people with no obvious skin or systemic disorder. Diagnosis is typically by inspection, although sometimes a skin biopsy is… read more can be accompanied by regular pits that form a geometric pattern. Pits are small and fine. Alopecia areata may also be associated with severe onychorrhexis (brittleness with nail breakage). Treatment options include intralesional and topical corticosteroids and topical sensitizers such as squaric acid dibutylester. Newer therapies including tofacitinib and apremilast have shown some promise.

Nail Psoriasis With Pitting and Discoloration

This photo shows irregular pits and areas of yellow-brown discoloration (oil spots) in a person with psoriasis.

© Springer Science+Business Media

Nail Bed Psoriasis With Onycholysis

Nail bed psoriasis causes onycholysis (as evidenced by the white discoloration of the distal nails with erythematous border and absence of distal nail on the ring and little fingers). The underlying nail bed is hyperkeratotic.

© Springer Science+Business Media

Nail Psoriasis With Thickening and Crumbling of the Nail Plate

The photo on the left shows thickening and crumbling of the nail of the great toe. Pitting and onycholysis are visible on the hand (right), suggesting nail psoriasis as the diagnosis.

© Springer Science+Business Media

Lichen Planus of the Nail

DR P. MARAZZI/SCIENCE PHOTO LIBRARY

Pterygium of the Nail

© Springer Science+Business Media

• 1. van de Kerkhof P, Guenther L, Gottlieb AB, et al: Ixekizumab treatment improves fingernail psoriasis in patients with moderate-to-severe psoriasis: Results from the randomized, controlled and open-label phases of UNCOVER-3. J Eur Acad Dermatol Venereol 31(3):477–482, 2017. doi: 10.1111/jdv.14033

• 2. Merola JF, Elewski B, Tatulych S, et al: Efficacy of tofacitinib for the treatment of nail psoriasis: Two 52-week, randomized, controlled phase 3 studies in patients with moderate-to-severe plaque psoriasis. J Am Acad Dermatol 77(1):79–87, 2017. doi: 10.1016/j.jaad.2017.01.053

Cancer chemotherapy drugs (especially the taxanes) can cause melanonychia (nail plate pigmentation), which can be diffuse or may occur in transverse bands. Some drugs can cause characteristic changes in nail coloration:

• Quinacrine: Nails appear greenish yellow or white under ultraviolet light.

• Cyclophosphamide: The onychodermal bands (seal formed at the junction of the nail plate and distal nail bed at the free edge of the nail plate) become slate-gray or bluish.

• Arsenic: Nails may turn diffusely brown.

• Tetracyclines, ketoconazole, phenothiazines, sulfonamides, and phenindione: Nails may have brownish or blue discoloration.

• Gold therapy: Nails may be light or dark brown.

• Silver salts (argyria): Nails may be diffusely blue-gray.

Tobacco smoking or nail polish can result in yellow or brownish discoloration of nails and fingertips.

White transverse lines of the nails (Mees lines) may occur with chemotherapy, acute arsenic intoxication, malignant tumors, myocardial infarction, thallium and antimony intoxication, fluorosis, and even during etretinate therapy. These lines are not due to changes in the nail bed, but are a true leukonychia, and the nails can grow out normally if the insulting exposure has been removed. Mees lines also develop with trauma to the finger, although traumatic white lines usually do not span the entire nail.

The fungus Trichophyton mentagrophytes causes a chalky white discoloration of the surface of the nail plate.

Green-nail syndrome is caused by infection with Pseudomonas. It is generally a harmless infection, usually of 1 or 2 nails, and is noteworthy for its striking blue-green color. It often occurs in patients with onycholysis Onycholysis Deformities are often considered together with dystrophies, but the two are slightly different; deformities are generally considered to be gross changes in nail shape, whereas dystrophies are. .. read more or chronic paronychia Chronic Paronychia Chronic paronychia is recurrent or persistent nail fold inflammation, typically of the fingers. (See also Overview of Nail Disorders.) Chronic paronychia is an inflammatory disorder of the nail… read more whose nails have been exposed to irritants or have had excessive exposure to water. If the onycholysis or chronic paronychia is treated effectively, the Pseudomonas infection will resolve. Alternatively, topical gentamycin ointment can be effective in chronic cases. Patients should avoid irritants and excess moisture. Frequent clipping of the nail increases the response to treatment.

Median nail dystrophy is characterized by small cracks in the nail that extend laterally and look like the branches of an evergreen tree (eg, fir tree, such as a Christmas tree). The cracks and ridges are similar to those seen in habit-tic nail deformity (which is dystrophy of the central nail caused by repetitive trauma to the nail matrix resulting from rubbing or picking with another finger). The cause of median nail dystrophy is unknown in some cases, but trauma is thought to play a role. Frequent use of personal digital devices that subject the nails to repetitive striking has been implicated in several cases. Tacrolimus 0.1% at bedtime without occlusion has been successful when patients stop all activities that might lead to repetitive low-level trauma.

Melanonychia striata are hyperpigmented bands that are longitudinal and extend from the proximal nail fold and cuticle to the free distal end of the nail plate. Pigmentation results from deposition of melanin by melanocytes in the nail matrix. Deposition of melanin is increased by melanocyte activation (increased production of melanin in the nail cells) or by melanocytic hyperplasia (increased production of melanocytes in the nail matrix).

Melanocyte activation may be a normal physiologic variant in people with darker skin. This variant, often called ethnic melanonychia, requires no treatment. Other causes of melanocyte activation include trauma, pregnancy, Addison disease and other endocrine disorders, infections, postinflammatory hyperpigmentation, and the use of certain drugs, including doxorubicin, 5-fluorouracil, zidovudine, and psoralens.

Melanocytic hyperplasia can be caused by benign conditions, such as nail matrix melanocytic nevus or nail lentigo, or by malignant melanoma. Factors more often associated with malignant melanoma of the nail matrix include new onset after middle age, presence of pigmentation on the dominant thumb or hallux, rapid growth or darkening, bandwidth > 3 mm, associated nail plate dystrophy, or Hutchinson sign (extension of hyperpigmentation onto the proximal and/or lateral nail fold). Rapid biopsy and treatment are essential in cases of suspected melanoma Treatment Malignant melanoma arises from melanocytes in a pigmented area (eg, skin, mucous membranes, eyes, or central nervous system). Metastasis is correlated with depth of dermal invasion. With spread… read more (1 Melanonychia striata reference Deformities are often considered together with dystrophies, but the two are slightly different; deformities are generally considered to be gross changes in nail shape, whereas dystrophies are. .. read more ).

• 1. Leung AKC, Lam JM, Leong KF, Sergi CM: Melanonychia striata: Clarifying behind the black curtain. A review on clinical evaluation and management of the 21st century. Int J Dermatol 58(11):1239–1245, 2019. doi: 10.1111/ijd.14464

Onycholysis is separation of the nail plate from the nail bed or complete nail plate loss. It can occur as a drug reaction in patients treated with tetracyclines (photo-onycholysis), doxorubicin, 5-fluorouracil, cardiovascular drugs (particularly practolol and captopril), cloxacillin and cephaloridine (rarely), trimethoprim/sulfamethoxazole, diflunisal, etretinate, indomethacin, isoniazid, griseofulvin, and isotretinoin. Simple (ie, not associated with another nail or skin disorder) onycholysis may also result from exposure to irritants, such as frequent exposure to water, citrus fruits, or chemicals. Irritant contact dermatitis Irritant contact dermatitis (ICD) Contact dermatitis is inflammation of the skin caused by direct contact with irritants (irritant contact dermatitis) or allergens (allergic contact dermatitis). Symptoms include pruritus and… read more of the hands and fingers may lead to onycholysis (1 Onycholysis reference Deformities are often considered together with dystrophies, but the two are slightly different; deformities are generally considered to be gross changes in nail shape, whereas dystrophies are… read more ). Colonization of the nail bed with Candida albicans may occur, but treating the underlying irritant exposure leads to resolution of the onycholysis, with or without treating the Candida.

Partial onycholysis may also occur in patients with psoriasis Psoriasis Psoriasis is an inflammatory disease that manifests most commonly as well-circumscribed, erythematous papules and plaques covered with silvery scales. Multiple factors contribute, including… read more or thyrotoxicosis Hyperthyroidism Hyperthyroidism is characterized by hypermetabolism and elevated serum levels of free thyroid hormones. Symptoms include palpitations, fatigue, weight loss, heat intolerance, anxiety, and tremor. .. read more .

• 1. Vélez NF, Jellinek NJ: Simple onycholysis: A diagnosis of exclusion. J Am Acad Dermatol 70(4):793–794, 2014. doi: 10.1016/j.jaad.2013.09.061

Pincer nail deformity is a transverse over-curvature of the nail plate. It is most often caused by onychomycosis Onychomycosis Onychomycosis is fungal infection of the nail plate, nail bed, or both. The nails typically are deformed and discolored white or yellow. Diagnosis is by appearance, wet mount, culture, polymerase… read more , psoriasis Psoriasis Psoriasis is an inflammatory disease that manifests most commonly as well-circumscribed, erythematous papules and plaques covered with silvery scales. Multiple factors contribute, including… read more , tumors of the nail apparatus, and poorly fitting shoes. It has also been reported in patients with systemic lupus erythematosus Systemic Lupus Erythematosus (SLE) Systemic lupus erythematosus is a chronic, multisystem, inflammatory disorder of autoimmune etiology, occurring predominantly in young women. Common manifestations may include arthralgias and… read more , Kawasaki disease Kawasaki Disease Kawasaki disease is a vasculitis, sometimes involving the coronary arteries, that tends to occur in infants and children between the ages of 1 year and 8 years. It is characterized by prolonged… read more , end-stage renal disease Chronic Kidney Disease Chronic kidney disease (CKD) is long-standing, progressive deterioration of renal function. Symptoms develop slowly and in advanced stages include anorexia, nausea, vomiting, stomatitis, dysgeusia… read more , and some genetic syndromes (eg, paronychia congenita). Patients often have pain at the borders of the nail where the nail plate curves into the tips of the fingers or toes. There is no established treatment of choice, but a number of surgical techniques have been successful (1 Pincer nail deformity references Deformities are often considered together with dystrophies, but the two are slightly different; deformities are generally considered to be gross changes in nail shape, whereas dystrophies are. .. read more , 2 Pincer nail deformity references Deformities are often considered together with dystrophies, but the two are slightly different; deformities are generally considered to be gross changes in nail shape, whereas dystrophies are… read more , 3 Pincer nail deformity references Deformities are often considered together with dystrophies, but the two are slightly different; deformities are generally considered to be gross changes in nail shape, whereas dystrophies are… read more ).

• 1. Demirkıran ND: Suture treatment for pincer nail deformity: An inexpensive and simple technique. Dermatol Surg 46(4):573–576, 2019. doi: 10.1097/DSS.0000000000001818

• 2. Shin WJ, Chang BK, Shim JW, et al: Nail plate and bed reconstruction for pincer nail deformity. Clin Orthop Surg 10(3):385–388, 2018. doi: 10.4055/cios.2018.10.3.385

• 3. Won JH, Chun JS, Park YH, et al: Treatment of pincer nail deformity using dental correction principles. J Am Acad Dermatol 78(5):1002–1004, 2018. doi: 10.1016/j.jaad.2017.08.014

Trachyonychia (rough, opaque nails) may occur with alopecia areata Alopecia Areata Alopecia areata is typically sudden patchy nonscarring hair loss in people with no obvious skin or systemic disorder. Diagnosis is typically by inspection, although sometimes a skin biopsy is… read more , lichen planus Lichen Planus Lichen planus is a recurrent, pruritic, inflammatory eruption characterized by small, discrete, polygonal, flat-topped, violaceous papules that may coalesce into rough scaly plaques, often accompanied… read more , atopic dermatitis Atopic Dermatitis (Eczema) Atopic dermatitis is a chronic relapsing inflammatory skin disorder with a complex pathogenesis involving genetic susceptibility, immunologic and epidermal barrier dysfunction, and environmental… read more , and psoriasis Psoriasis Psoriasis is an inflammatory disease that manifests most commonly as well-circumscribed, erythematous papules and plaques covered with silvery scales. Multiple factors contribute, including… read more . It is most common among children. When present in all nails, trachyonychia is often called 20-nail dystrophy. When it occurs in children, it tends to resolve spontaneously. When it occurs in adults, treatment is aimed at the underlying disorder.

Benign and malignant tumors can affect the nail unit, causing deformity. Benign tumors include myxoid cysts, pyogenic granulomas Pyogenic Granulomas Pyogenic granulomas are fleshy, moist or crusty, usually scarlet vascular nodules composed of proliferating capillaries in an edematous stroma. The lesion, composed of vascular tissue, is neither… read more , and glomus tumors. Malignant tumors include Bowen disease Bowen Disease Bowen disease is a superficial squamous cell carcinoma in situ. Diagnosis is by biopsy. Treatment depends on the tumor’s characteristics and may involve curettage and electrodesiccation, surgical… read more , squamous cell carcinoma Squamous Cell Carcinoma Squamous cell carcinoma is a malignant tumor of epidermal keratinocytes that invades the dermis; this cancer usually occurs in sun-exposed areas. Local destruction may be extensive, and metastases… read more , and malignant melanoma Melanoma Malignant melanoma arises from melanocytes in a pigmented area (eg, skin, mucous membranes, eyes, or central nervous system). Metastasis is correlated with depth of dermal invasion. With spread… read more . When cancer is suspected, expeditious biopsy followed by referral to a surgeon is strongly advised.

Biting nails, pulling out hair, eating skin.

Check: you may have this mental disorder, and you did not know about it

If your child – a preschooler or teenager – bites his nails under the root or pulls out his body hair, you should not write it off as a bad habit. These actions may be a manifestation of a mental disorder that often persists into adulthood.

Chances are you’ve never heard of trichotillomania, onychophagia, or neurotic excoriation. All of these are mental disorders in which a person (child or adult) causes damage – consciously or automatically, without thinking – to his body.

There is little research on the diseases listed below. Therefore, we asked Oleg Aizberg, , Associate Professor of the Department of Psychiatry and Narcology at BelMAPO , to help us understand what each of them is, who should be contacted for help, and whether it is realistic to cure such disorders once and for all.

Oleg Aizberg, psychiatrist, Associate Professor, Department of Psychiatry and Narcology, BelMAPO

Trichotillomania

This is a mental disorder in which a person pulls out body hair : most often from the head, but also from the eyelashes, nose, eyebrows, sometimes from the pubis. Often it is combined with anxiety, depression, obsessive-compulsive disorder.

As a rule, the disease begins in childhood or adolescence, the two main peaks are 6-9 and 12-13 years. In some children, it goes away as spontaneously as it started, while in others, the disorder remains into adulthood.

According to Oleg Aizberg, such patients often mistakenly turn to a dermatologist: patches of baldness appear on some parts of the body, the cause of which they are trying to find.

“There are cases,” says the specialist, “when a child who is not allowed to pull out the hair on his body begins to pull it out from dolls or, worse, from a younger brother or sister. But in preschool age, this disease is benign in nature – as a way to explore your own body. It usually goes away on its own over time.

And this is how the disease trichotillomania begins to develop a little later – at the age of 9-13, and in this case, as a rule, it passes into adulthood, acquires a chronic course. If trichotillomania began to develop in adulthood, then most often the person already has any concomitant mental disorders.

Often trichotillomania is not some kind of action on which the person focuses and concentrates, but occurs in a trance-like state: the patient pulls out his hair and does not notice it.

And here is a documentary about trichotillomania, which in 2003 won the international Health & Medical Media Award for the best film in the field of psychiatry.

Neurotic excoriation

Condition in which patients in any way injure their skin: scratching, picking, scratching, pinching , sometimes squeezing out acne elements. The danger of such a disorder is that a person can infect the wounds he creates, which in some cases leads to sepsis.

Many patients with excoriation choose one area of ​​the body and then move on to another so that the first one has time to heal. Most often, the choice of location depends on the presence of irregularities on the body, which a person detects with his fingers.

– Many researchers believe that the development of excoriation is associated with an increased level of anxiety, arousal or stress in a person, with psychological trauma suffered at an early age, the specialist explains. – In children – with the suppression of anger towards domineering and strict parents.

Also, some scientists consider excoriation as a type of obsessive-compulsive disorder. They are similar in that both involve repetitive activities that are out of control, and both are generally able to reduce anxiety.

Unfortunately, people with excoriation, as with some of the other conditions listed here, rarely seek treatment because of embarrassment, alienation, lack of awareness or belief that the disorder can be cured.

Dermatophagia

This is a disorder in which a person compulsively bites, chews, gnaws or eats their skin (most often on the fingers). Such actions, as in trichotillomania, may be conscious or unconscious.

Most often, patients with this disorder bite the skin around the nails, some on the knuckles, leading to bleeding, pain and calluses. There are cases when the patient chews on the mucous membrane on the inside of the mouth, cheeks or lips, which causes blisters to appear inside and outside the mouth. At the same time, blisters can cause a desire to tear off or bite off the affected skin, which is quite dangerous: an infection can get into the wound.

Most often, dermatophagia occurs in children, but sometimes it also manifests itself in adulthood and may be associated with the manifestation of increased anxiety in a person or the appearance of unpleasant forebodings, says Oleg Aizberg.

Onychophagia

With onychophagy, a person bites his nails – this compulsive habit is quite common, especially among children. More severe forms of this condition are classified as obsessive-compulsive and related disorders.

In patients with onychophagia, most often all ten nails of the hand are bitten to approximately the same extent. In this case, a person can, against this background, damage the skin on the cuticle. The danger of such a disorder, like the previous ones, is the possible infection in the wound.

Most often, onychophagia is accompanied by other disorders that we mentioned above: excoriation, dermatophagia and trichotillomania. In children, nail biting is often associated with attention deficit hyperactivity disorder and other psychiatric disorders, including obsessive-compulsive disorder.

Here’s what you need to know about these disorders

– Are these disorders standalone diseases or are they just symptoms?

– Trichotillomania and excoriations are really separate independent diseases, – says Oleg Aizberg. But they are often combined with other diagnoses. For example, trichotillomania often occurs with manifestations of obsessive-compulsive disorder (OCD), when a person has intrusive or frightening thoughts, and with them anxiety, which he tries to get rid of with the help of obsessive actions.

Some researchers believe that these conditions are manifestations of OCD, but in fact they are not. The fact is that with OCD, a person, experiencing anxiety, drowns it out with so-called rituals (frequent washing of hands, checking electrical appliances).

In trichotillomania, there are two development mechanisms: the presence of anxiety when the condition really resembles OCD, and getting pleasure (similar to gambling, when a person gets high from his actions). Therefore, it is possible to make an accurate diagnosis only with individual work with a psychotherapist.

The remaining disorders that have been listed are more difficult: unfortunately, today they are little studied. There are isolated cases of treatment all over the world, so it is difficult to find studies as such.

– How does a person feel when they injure themselves in this way?

– Before performing these actions, the patient feels tension, after – relief: either the removal of anxiety, or pleasure. For some time, the manifestations of these disorders may stop, and then begin again.

– Where should I go for help with these disorders?

– If they begin to interfere with a person, then you can first contact a psychotherapist in your clinic. If parents notice such manifestations in their child, then first of all it is worth paying attention to whether there are any provoking factors for this.

In children, these disorders are most often caused by an unfavorable family climate (for example, when one of the parents has an anxiety disorder or there are conflicts between mom and dad to which the child reacts), difficult relationships with teachers at school or classmates.

Next, you should try to resolve the current situation in the family or school, or contact a child psychologist. And I note that most often the disorders that we have considered begin to manifest themselves precisely in childhood or adolescence, often spilling over into adulthood. But, as mentioned above, few dare to turn to a specialist with such diseases.

– Is it really possible to get rid of such conditions once and for all?

– In some cases, even no treatment is needed: they can pass as suddenly as they begin. If the disorder still interferes with a person and he decides to contact a psychotherapist, the doctor may prescribe antidepressants for him.

What to read on the topic: How to understand that you have nervous exhaustion Details here.

Photo: Alexander Vasyukovich, Names, independent.co.uk, wikipedia.org, dermatophagiaddiction.tumblr.com, heaclub.ru.

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Micronychia – how to treat shortened nails, how to prevent the problem

July 25, 2021

Beautiful nails – the ultimate dream of almost every woman, but, unfortunately, careful care can not always solve all problems. There are a number of pathologies in which the nail plates are deformed and bear little resemblance to the ideal. Microchia is one of them. Pathology manifests itself in a change in the area of ​​​​the nail plate, that is, it becomes shorter, as if growing into a finger.

What is micronychia?

Micronychia is a pathology in which the nail plates are reduced in size. In some cases, changes also affect the thickness of the nail, which becomes thinner, and sometimes other defects appear in parallel – changes in color and surface topography. Micronichia is not a disease. A similar pathology can be seen in many people on the little toes, but sometimes the problem becomes serious and spreads to all fingers.

Shortened fingernails, which cannot be hidden anywhere, cause the greatest discomfort. A person’s hands are almost always in sight, so micronichia negatively affects their appearance. Pathology can develop in both adults and children. Sometimes it acts as a symptom of serious diseases, the development of which a person does not even know.

Types (stages) and symptoms

Micronychia is classified into only two types:

Congenital

Acquired

The first variant is much less common and is directly associated with diseases that are inherited. However, congenital micronichia of the toes is not considered a deviation from the norm. According to statistics, this is more common in women than in men. Micronichia can affect both all and only one finger, which is caused by the cause of the pathology.

Causes

In almost half of cases, micronychia develops as a result of onychophagia – the habit of biting nails. According to the medical classification, it refers to mental disorders. Most often, onychophagia develops in children and in most cases the bad habit disappears with age, but in some it persists or reappears only in moments of strong feelings, emotional upheavals and stress.

Regular biting of the nail plates leads not only to their shortening, but also provokes the appearance of microtraumas. Both the nails and their surrounding tissues are injured. Onychophagia can also cause secondary infections. Micronychia that develops against the background of this disorder does not require special treatment. If a person gives up a bad habit and no longer bites his nails, then they themselves are restored in record time – from two weeks to a month.

Pathology can manifest itself as a result of other more dangerous diseases:

Angioma

This is a vascular tumor that needs to be removed. It consists only of vessels. Micronichia in this case occurs only on one finger.

Systemic scleroderma

This term unites a whole group of connective tissue diseases.

Klippel-Trenaunay-Weber-Rubashov syndrome

It is characterized by impaired blood flow to the limb, which leads to varicose veins.

Onychodystrophy

Fungal infection of the nail plate.

Genuine epilepsy and trophoneurosis can also cause micronichia.

Methods of treatment for micronichia

There is no cure for micronichia as such, because changes in the nail plate are just a symptom. To put the nails in order, you need to find the root cause against which this pathology develops. Most often, shortened nails are the result of onychophagia. You can deal with this problem on your own or see a neurologist who will help get rid of a bad habit. It is difficult for a manicure master to work with shortened nails, since with micronichia there is no free edge at all.

It is very difficult to get a beautiful manicure here. Covering such nails with colored varnish is not the best option. Nail extensions are also not recommended. The nail plate is already injured, and such a procedure will only aggravate the situation and help to carry out a temporary recovery. The best option is a therapeutic manicure.

The master should carefully buff the nails with a buff and pay special attention to the side rollers. Shortened nails will look better when the skin around them is well-groomed and moisturized. As an option, you can consider a Japanese manicure. This procedure is aimed at restoring the nail plate using a special wax-based powder and mineral paste.