Nail Anatomy and Pathology

Question 1

What is Onychauxis (Hypertrophied Nail)

Answer 1

Uniform thickening of the nail plate from nail base to free edge
Aetiology - Damage to the nail Matrix with one or more causes
1. Fungal infection of the nail
2. Poor peripheral circulation
3. Single major trauma from a heavy blow
4. repeated minor trauma from ill fitting footwear
Pathology
* Changes in the nail fold main cause of hypertrophy

Question 2

Onychogryphosis

Answer 2

• Thickened nail with a distortion in the direction of growth
• Longitudinal transverse ridges
• Rams Horn

Aetiology:
* same as Onychauxis
* fungal infection
* Single trauma
* poor peripheral circulation

Question 3

What is Onycholysis

Answer 3

• Seperation of nail from the nail bed often Distal to Proximal
• white apperance from air getting underneath the nail
  Aetiology:
• Onychomycosis
• Trauma
• Systemic involvement possible ie poor circulation
  Pathology:
• increased pressure of the nail bed can cause infection and inflamattion
• Hard keratinogenous material gather underneath the nail
  Treatment
• Cut nail back in stages
• referal to GP if systemic
• Treat any fungal involvement

Question 4

Whatv is Onychomadesis

Answer 4

Seperationn of nail form nail bed proximal to distal

Question 5

What is Onychocryptosis

Answer 5

• Ingrowing toe nail - A spike or splinter edge of the nail penetrates the sulcus entring the dermal tissue
• Bi Lateral or unilateral
  Aetiology:
• cutting nails too short
• Cutting obliquely
• Hyperdydrosis causes surrounding tissue to become macerated/soaked in mositure making the surrounding tissue less resistant to pressure form the nail
• Pressure form ill fitting footwear

Question 6

What is Involution

Answer 6

Increased transverse curvature of the nail plate unilateral or bi lateral
Aetiology:
* ill fitting footwear
* Trauma
* poor nail cutting
* systemic diseases
Pathoogy:
* Trauma to the nail plate causes increased transverse curvature
* Sysetmic/malnutriton disease of the extremities leads to alteration of the cell division between layer in the nail plate causing distortion in growth
Treatment:
* Cut the nail accordingly to release pressure in the sulci
* Partial or total nail removal may be long term option

Question 7

What is a Splinter Heamorage

Answer 7

Longitudinal plum coloured linear haemorage under the nail plate

Question 8

What is Paronychia

Answer 8

Inflamattion of the tissue surrounding the nail

Question 9

What is Onychomycosis

Answer 9

Fungal Infection of the nail plate caused by Dermatophytes, non dermatophytes and yeasts

Question 10

What is Chromonychia

Answer 10

Abnormal colouration of the nail tissue

Question 11

What is Koilonychia

Answer 11

Transverse and longitudinal concave nail dystrophy
Spoon shaped nail

Question 12

What are Dermatophytes

Answer 12

Pathogenic Fungus that can invade the nail infecting keratinous tissue

Question 13

List three types of dermaphytes

Answer 13

Trichophyton
Epidermophyton
Microsporum

Question 14

What are the most common Dermatophytes associated with Onychomycosis

Answer 14

Trichophyton rubrum and T interdigitale

Question 15

What are the non dermataphytes that cause Onychomycosis

Answer 15

Moulds - Scorpularis Brevicaulis
Yeasts - Candida Albicans

Question 16

What are the predisposing factors causing Onychmycosis

Answer 16

Old age
Trauma
Diabetes
Immunosupresed patients
Previous history of nail psoriasis and tinea pedis

Question 17

Pneumonic for classifications of onychomycosis

Answer 17

Endor
Died Last Sunday
Susan Whepped
Propper Suprised
Totally Distraught

Question 18

List the 5 types/ classifications of Onychomycosis

Answer 18

Endonyx
Distal & Lateral Subungal Onychomycosis
Superficial white Onychomycosis
Proximal Subungal Onychomycosis
Total Dytrophic Onychomycosis

Question 19

What are the features of Superficial White Onychomycosis

Answer 19

Mainly affects the toe nails
White patches on the superficial part of the toenail
Doesnt respond well to topical treatment

Question 20

What are the features of Proximal subungal onychomycosis

Answer 20

More common in toenails than fingernails
Area of infection Proximal nail fold and nail plate
White appearance spreading distally
dermaphytes involved commonly T - Rubrum
No thickening of the nail plate
High prevelance in HIV and Aids patients

Question 21

What are the features of Endonyx Onychomycosis

Answer 21

Caused by T Soudansense
Area of infection = margian of the nail plate
White in apperance no seperation of the nail from the nail bed (onycholysis) or no chalky substance underneath the nail (subungal Hyperkeratosis)

Question 22

What are the clinical features of Onychmycosis

Answer 22

Thickened Naill
Crumbly Nial
Rough/Irregular appearance
Varying in colour white, yellow, brown black
Can be painful but usually affects patient confidence due to apperance

Question 23

Give the name of a topical anti fungal treantment used to treat Onychomycosis

Answer 23

Amoroline - Loycerel, Curanail

Question 24

Define Pathology

Answer 24

Science of the casuses and effects of disease

Question 25

What is the Perionychium

Answer 25

The tissue surrounding the nail

Question 26

What is the nail plate

Answer 26

* The nail plate is a hard protective structure made from transluscent keratin * Contains a rich vascular network

Question 27

What is the Eponychium

Answer 27

Also reffered to as the cuticle helps to prevent the entry of bacteria to the Ventral Proximal Nail fold

Question 28

What is the Hyponichium

Answer 28

* Distal to the nail bed underneath the free edge of the nail plate * It forms a seal that protects the nail bed

Question 29

What is the lunula

Answer 29

White half moon apperance due to the reflection of the light between the nail and the nail bed Nail plate is thinner here

Question 30

What is the Nail Matrix

Answer 30

The nail matrix produces new cells which become the nail plate It also determines the width and thickness of the nail

Question 31

What is the germinal matrix

Answer 31

* The germinal matrix is collective term given to the root and sinus of the nail * The growth of the nail starts here

Question 32

What is the Nial Bed

Answer 32

* Also reffered to as the sterile matrix * lies underneath the nail plate has a rich vascular supply * Extends from the nail matrix to the Hyponichium * No subcutaneus tissue beneath the nail bed so it attaches directly to the periosteum of the distal phalanx

Question 33

What is Total Nail Dystrophic Onychomycosis

Answer 33

* Infection of the whole nail plate * Yellow irregular appearance causing total destruction of the nail * Usually a cobination of Candida and dermatophytes * Seen in immunosupressed patients

Question 34

What are the conservative management treatments for onychmycosis

Answer 34

Conservattive - Topical treatments include: * Amorolfine * Terbinafine * Triconazole

Question 35

What are the Systemic oral treatments for Onychomycosis

Answer 35

Systemic - Oral treatments * Grisofulvin - in children * Terbinafine and Itraconazole * Fluconazole - for Candida infection

Question 36

Describe the pathology of Onychocryptosis

Answer 36

Pathology: * Normal healing is distrupted by the continued penetration of the spike causing hypergranulation * This excessive growth of tissue results in the nail fold overlapping the nail plate * Pus is frequentley presnet and can exude for the sulcus or pool in the pocket lying beneath the sulcus

Question 37

What are the three stages of Onychocryptosis

Answer 37

Stage 1 - minimal injury to sulcus symptoms of pain, slight swelling oedema (fluid build up) Stage 2 - Acute Pain, erythema (redness) hyperhydrolosis, granulation tissue with odour Stage 3 - Consistent with stage 2 plus epidermal overgrowth, hypergranulation

Question 38

What is Subungal Extosis

Answer 38

Small outgrowth of bone underneath the nail plate distally near the free edge **Symptoms** - Include Pain and nail plate deformation **Aetiology **- Unknown although it is thought that a history of trauma and microtrauma may play a part **Treatment:** * Protective padding and advice on footwear * Surgical Excision