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Dermatology 2 > Nail Disorders > Flashcards

Nail Disorders Flashcards

1
Q

acute paronychia

A
  • acute infection of proximal or lateral nail folds
  • nail fold is swollen, erythematous and painful +/- abscess formation
  • break in integrity of epidermis
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2
Q

MC infection in paronychia

A

staph aureas

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3
Q

tx of acute paronychia

A
  • topical abx
  • oral abs
  • I&D if abscess present
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4
Q

felon

A
  • abscess of the distal pad of the fingertip (MC w/ staph)

- may compromise blood flow and lead to necrosis of the skin, pad, or osteomyelitis

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5
Q

S/S of a felon

A
  • intense throbbing pain
  • erythema and swelling
  • +/- abscess
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6
Q

tx of felon

A
  • oral abx
  • tetanus if indicated
  • consider radiograph
  • I&D w/ abscess
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7
Q

green nails are caused by infection w/ what?

A

pseudomonas aeruginosa

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8
Q

green nails

A
  • green to green/black discoloration of the nail
  • often associated w/ onycholysis
  • likely to have hx of prolonged exposure to water or detergents, or an ungual trauma
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9
Q

tx of green nails

A
  • trim nail and soak 2-3 X/day in dilute bleach or vinegar solution
  • no systemic abx
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10
Q

onychomycosis / tinea unguium causative fungi

A
  • dermatophyte fungi, mainly trichophyton rubrum is the major cause
  • can be from many others
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11
Q

presentation of onychomycosis / tinea unguium

A
  • white/yellow discoloration of nail w/ subungual hyperkeratosis, onycholysis and thickened nail plate
  • +/- pain
  • tinea pedis often present
  • typically involves distal/lateral subungual portion
  • white superficial pattern
  • candida in the immune suppressed
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12
Q

dx of onychomycosis / tinea unguium

A
  • most sensitive: nail clipping in formalin - fungus stains + w/ PAS
  • fungal culture
  • KOH false negatives common
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13
Q

tx of onychomycosis / tinea unguium

A
  • fluconazole

- antifungal creams or powders after tx

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14
Q

nail psoriasis

A
  • nail pitting, onycholysis w/ erythematous border, subungual debris and salmon patches (oil drop sign)
  • appear as yellow - red areas of discoloration in the center of nail or border
  • can be isolated but is in 50% of those w/ cutaneous psoriasis
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15
Q

tx of nail psoriasis

A
  • hard to tx
  • topical high potency steroids
  • calcipotriol
  • tazarotene
  • IL Kenalog
  • acetretin
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16
Q

lichen planus of the nail

A
  • abrupt onset w/ longitudinal riging, thinning, fissuring and loss of nail palte
  • onycholysis and/or subungual hyperkeratosis also possible
17
Q

association of lichen planus of the nails and lichen planus

A
  • about 10% of pts w/ mucosal membrane or skin LP also have nail involvement
  • commonly occurs in isolation
18
Q

progression of lichen planus of the nails can lead to what?

A

-pterygium formation: scarring to nail matrix; v-shaped extension of the skin of proximal nail fold that adheres to nail bed

19
Q

tx of nail lichen planus

A
  • 1st line: systemic or intralesional corticosteroids
  • topical tacrolimus; combo tazarotene and clobetasol
  • urea
  • oral retinoids
20
Q

alopecia areata of nails

A
  • small, superficial nail pitting in a regularly distributed pattern
  • possible punctate leukonychia, mottled lunulae, acute onycholysis, sandpaper-like nails
  • nail changes can precede, occur w/, or after hair loss
21
Q

tx of alopecia areata of nails

A
  • oral or intralesional corticosteroids
  • possible spontaneous resolution
  • topical tazarotene
22
Q

onycholysis

A
  • detachement of nail plate from bed
  • appears white d/t air b/w
  • cause: traumatic, mechanical, or chemical damage
  • bacteria can cause color change such as green, black, blue
23
Q

tx of onycholysis

A
  • clipping of affected nail
  • keep dry
  • rarely meds and light exposure
24
Q

chronic paronychia MC affects which fingers?

A

first, second, and third fingers of the dominant hand

25
Q

presentation of chronic paronychia

A

-inflammation of nail fold w/ mild redness, edema and tenderness
cuticle missing or separated from nail plate
-cuticle damage and secondary bacterial or candida

26
Q

management of chronic paronychia

A
  • hand protection from environmental hazards is mandatory for remission
  • tx w/ topical steroids
27
Q

habit tic deformity

A

-thumb nail shows a central longitudinal furrow w/ multiple transverse parallel lines

28
Q

habit tic deformity is caused by?

A

nervous tic of pushing back the cuticle and the proximal nail fold of thumb w/ index finger

29
Q

tx of habit tic deformity

A
  • behavior modification is best
  • SSRIs or other tx for OCD
  • super glue to proximal nail fold 1-2 x/week as barrier
30
Q

nail signs of systemic dz

A
  • beau’s lines
  • onychomadesis
  • terry nails
  • koilonychia
  • clubbing
31
Q

beau’s lines

A
  • transverse furrows that begin in matrix and progress distally
  • d/t temporary arrest of functional nail matrix
  • usually b/l
32
Q

possible causes of beau’s lines

A
  • chemo
  • high fever
  • viral illness
  • surgery
33
Q

onychomadesis

A
  • shedding of nail plate from the proximal end
  • from temporary arrest of the nail matrix fxn
  • causes are same as for beau’s lines but more severe
34
Q

onychomadesis in children often relates to what?

A

-recent coxsackievirus infection (hand foot mouth)

35
Q

terry nails

A
  • distal 1-2 mm of nail shows nl pink and proximal nail has white appearance
  • liver dz, chronic CHF, very elderly
36
Q

koilonychia

A
  • spoon nails
  • thin and concave w/ edges everted
  • familial forms can occur
  • can be associated w/ faulty Fe metabolism, deficiency, and hypothyroid
37
Q

nail clubbing

A
  • overcurvature of nails
  • they bulge and are curved in a convex arc. transverse and longitudinal
  • soft tissues of terminal phalanx are bulbous
38
Q

what is schamroth’s sign

A
  • no diamond-shaped window when dorsal surfaces of corresponding finger of each hand are opposed
  • seen in nail clubbing
39
Q

causes of nail clubbing

A
  • pulmonary, cardiac, thyroid, hepatic, or GI dz
  • HIV
  • can be hereditary

Dermatology 2 (10 decks)

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