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Flashcards in Nail Disease Deck (66)
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1

The nail unit consists of what 5 structures?

  • Nail matrix
  • Nail bed
  • Hyponychium
  • Proximal nail folds
  • Lateral nail folds.

2

What is this and what does it represent?

The Lanula.

It is the white part of the nail matrix.

 

3

What is this and what does it represent?

Is it pathological?

Beau's Lines

  • It represeents a slow down in the growth of the nail matrix.
  • In newborns they are not pathological
  • In adults, they can come due to: allergic reaction, surgery, medical illness.

4

What is this?

What pathology should you consider?

Koilonychia

(Spoon shaped nails)

  • In adults, consider:
    • Iron deficiency
    • Thyroid problems
    • Connective tissue disease?

5

What is this?

Is it pathological?

What conditions is it associated with?

Onychorrhexis

  • Normal in the elderly
  • In adults consider:
    • Lichen planus
    • Darier’s disease
    • Circulatory disorders

6

What is this?

Who gets it?

Melanonynia

(Naevus in the nail matrix)

Darker skin types.

7

What is this?

Onychoschizia

  • Usually due to water exposure. (i.e. sucking thumb)

8

What are these?

Onychogryphosis

  • Hyperkeratotic thickened nail plates.
  • Elderly due to mobility issues and poor nail grooming.

9

What are the most causative pathogens in Onychomycosis?

  • Trichophyton rubrum
  • Trichophyton mentagrophytes

10

What conditions can mimic Onychomycosis?

  • Psoriasis
  • Lichen Planus
  • Congenital Nail disease

11

What are the topical treatments for onychomycosis?

When would you consider them?

  • <2 nails are affect or <50% of the nail plate.
  • Amorolfine 5% lacquer.
    • Apply twice weekly for 6-12 months.
    • File the nail before hand.
  • Alternative topicals include:
    • Ciclopirox 8% OD for 48 weeks.
    • Tioconazol
    • Newer Triazol Eficonaconazol.
  • Consider 40% urea to help penetration enhancement.

12

What are systemic therapies for onychomycosis?

  • Terbinafine (First line)
    • S/E - Nausea, Diarrhoea, hepatic dysfunction & permanent taste distrubances..
    • Baseline LFTs and FBC are needed. 
    • Do not give if alcohol misuse or hepatitis

13

What are the most effective oral treatments for Candida infections?

Azoles (Itraconazole)

14

What is useful against yeasts, dermatophytes and non-dermatophyte moulds?

Itraconazole

15

What are the side effects of itraconazole?

  • Headaches
  • GI Upset.

 

16

If someone is on the COCP, why should you be careful about prescribing Itraconazole?

It is a potent p450 inhibitor

17

Who is itraconazole contraindicated in?

  • Congestive heart failure
  • Arrythmias

18

Describe the 2 treatment approaches with Itraconazole?

 

  1. Continuous: 200mg daily for 12 weeks
  2. Pulsed: 400mg/d for 1 week per month
    • 2 pulses for fingernails
    • 3 for toenails.

19

What should you take with itraconazole?

food

20

What is the relapse rate for onychomycosis?

40-70%

21

What should patients do to avoid reinfection?

  • Minimise trauma
  • Keep the nails short
  • Treat affect family members
  • Wear protective footwear.
  • Reduce fungal elements from shoes
    • Antifungal powders
    • Napthalene mothballs.

22

What is this?

Acute Paronychia

23

What causes acute paronychia?

  • Staph. Aureus
  • Beta-haemolytic Streptococcus

24

What is this?

HSV infection causing an herpetic whitlow

25

What is this?

Distal Blistering Dactylitis

26

What is this and what is the treatment?

  • Periungual warts.
  • DO not cryotherapy
  • Salicylic acid with scraping - once or twice weekly for several months should be considered.
  • If more challenging:
    • Imiquimod 5% cream
    • Diphencyprone immunotherapy

27

What % of psoriasis sufferers have nail changes?

50%

28

Nail changes in psoriasis are strongly linked to what other psoriatic related problems?

  • Psoriatic arthritis
  • Enthesitis

29

What nail changes can psoriasis sufferers have?

  • Main ones:
    • Irregular pitting
    • Salmon patches of the nail bed (óil drop')
    • Onycholysis + irregular border.
  • Others
    • Splinter haemorrhages
    • Subungual hyperkeratosis
    • Onychorrhexis
    • Paronychia

30

What does nail psoriasis often resemble?

Onychomycosis