Topical treatment

Topical agents include keratolytic agents, virucidal agents and immunomodulators. Keratolytic agents are the most popular first-line treatment of warts and are particularly suitable for young children, who can apply at home creams, ointments, tapes or quick-drying acrylate lacquers containing salicylic acid in concentrations ranging from 10 to 40 . Both glutaraldehyde and formaldehyde combine with keratin and produce skin desiccation with viral destruction. Effectiveness is comparable to that...

Congenital andor hereditary

Acrokeratosis verruciformis (Hopf) Associated with koilonychia (Figure 7.8) LEOPARD syndrome (lentigines, electrocardiographic changes, ocular hypertelorism, pulmonary stenosis, abnormalities of genitalia, retarded growth, deafness) Leukonychia totalis, multiple sebaceous cysts, renal calculi Darier's disease usually linear and longitudinal Acquired Pseudoleukonychia Diffuse form of distal and lateral subungual onychomycosis Proximal white subungual onychomycosis, especially in AIDS patients...

All the nail signs in Reithers syndrome may be present in severe psoriasis

Involvement suggesting inflammation of the proximal nail fold. Onycholysis, ridging, splitting, greenish-yellow or sometimes brownish-red discoloration and subungual hyperkeratosis may be present. Small yellow pustules may develop and slowly enlarge beneath the nail, often near the lunula. Their contents become dry and brown. The nails may be shed. Nail pitting may be seen in Reiter's syndrome, individual pits being deep and punched out. This nail pitting may reflect a predisposition to the...

Digital Herpes Simplex

Recurrent herpes simplex despite being rarely diagnosed is not infrequent. Any recurrent blistering process around a finger nail, particularly when accompanied by early lymphangitis and radiating pain, should prompt a cytological examination. The blister roof is opened and a Tzanck smear taken for microscopic investigation as well as for virus culture or molecular biological tests. Early blisters with clear watery contents exhibit mainly keratinocytes, some of which are giant and...

Magnetic Resonance Imaging

There have been a few reports of MRI investigations of subungual tumours, particularly glomus tumours. In practice the perionychium may be routinely imaged by MRI with the ability to obtain high spatial resolution images with small surface coils dedicated to wrist or finger (Figure 11.3). A voxel height close to 100 m, about the thickness of the epithelial layer of the nail bed, is necessary. Nevertheless, unlike the skin, which is a superficial structure, the nail unit may require evaluation...

Ragged Cuticles And Hangnail

Thickened, hyperkeratotic, irregular (ragged) cuticles (Figure 5.12) are most commonly seen in dermatomyositis (Figure 5.13). Perionychial tissues are constantly subjected to trauma. In nail biters and 'pickers' the cuticles and nail folds may show considerable damage, erosions, haemorrhage and crusting. The ulnar side of the nail fold and cuticle is most vulnerable and there may be small trian-gular tags of skin (hangnail, Figure 5.14) and separated spicules of nail, still attached...

Periungual Warts

Periungual and subungual warts are usually difficult to treat and frequently recur. The life span of periungual warts may be such that they and the various treatments may exceed the patience of both patient and physician Under such circumstances intelligent placebo therapy may well be appropriate. A great variety of treatments are listed in all pharmacopoeias, reflecting their individually limited success rates. The choice of treatment depends on location (periungual and subungual)

Green

'Old' haematoma (green-yellow) Pseudomonas aeruginosa (Figure 7.20) Red purple Angioma Glomus tumour (see Figures 3.8, 5.25) Congestive cardiac failure (lunula) (Figure 7.21) Benign tumours or cysts near proximal matrix Lupus erythematosus Porphyria (with fluorescent light) Rheumatoid arthritis Warfarin 2 Treatment for subungual melanoma may lead to overtreatment of a benign lesion and thus to unnecessary surgery. Excision biopsy is therefore crucial. Potassium permanganate was often used in...

Parrot Beak Nails Raynauds

Raynaud Syndrome And Toe Nails

Congenital koilonychia associated with total leukonychia. Table 2.2 Common causes of koilonychia Physiological Early childhood (Figures 2.12-2.13) Idiopathic Congenital LEOPARD syndrome Ectodermal dysplasias (Figure 2.15) Trichothiodystrophy Nail-patella syndrome Acquired Metabolic endocrine iron deficiency acromegaly haemochromatosis porphyria renal dialysis transplant thyroid disease Dermatoses alopecia areata Darier's disease lichen planus psoriasis contact with oils, e.g. engineering...

Modifications of the nail surface

Median Canaliform Dystrophy Heller

Antonella Tosti, Robert Baran, Rodney PR Dawber, Eckart Haneke Longitudinal lines Herringbone nails Transverse lines Pitting and rippling Trachyonychia (rough nails) Onychoschizia (lamellar splitting) Further reading Longitudinal lines, or striations, may appear as indented grooves or projecting ridges (Figures 3.1-3.16). Longitudinal grooves represent long-lasting abnormalities and can develop under the following conditions A Single longitudinal nail fissure is most likely due to minor trauma...

Common

Psoriasis (Figures 3.26, 3.27, 3.29, 3.30) Alopecia areata (Figure 3.31) Eczema Occupational trauma Parakeratosis pustulosa Uncommon Normal Pityriasis rosea Secondary syphilis Sarcoidosis Reiter's syndrome Lichen planus Large, deep and irregular pits are common in psoriasis and eczema Small, superficial and regular pits are typical of alopecia areata An isolated pit is not diagnostic and may be dye to minor trauma Multiple nail pits due to psoriasis. Diffuse pitting of the whole nail in...

Cutaneous diseases

Psoriasis, Reiter's disease, vesicular or bullous disease, lichen planus, alopecia areata, multicentric reticulohistiocytosis Atopic dermatitis, contact dermatitis (accidental or occupational), mycosis fungoides, actinic reticuloid Hyperhidrosis tumours of the nail bed Drugs Bleomycin, docetaxel, doxorubicin, fluorouracil, retinoids, captopril, paclitaxel, mitozantrone Drug-induced photo-onycholysis trypaflavin, chlorpromazine, chloramphenicol, cephaloridine, icodextrin, clorazepate...

Nail plate and soft tissue abnormalities

Robert Baran, Rodney PR Dawber, Eckart Haneke, Antonella Tosti Onycholysis Onychomadesis and shedding Hypertrophic nail and subungual hyperkeratosis Splinter haemorrhages and haematomas Dorsal and ventral pterygium Further reading Onycholysis refers to the detachment of the nail from its bed at its distal and or lateral attachments (Figure 4.1). The pattern of separation of the plate from the nail bed takes many forms. Sometimes it resembles closely the damage from a splinter under the nail,...

Traumatic disorders of the nail

Repeated microtrauma of the nail apparatus The painful nail Further reading This chapter looks at three distinct aspects of trauma, under the headings 1 Major trauma (involving any digit). This section considers major trauma, single overwhelming injury, necessitating only minor 'office' surgery. Complex laceration and most of the traumatic abnormalities are beyond the intended scope of this book. Damage from acute trauma may have immediate and or delayed effects. Acute subungual haematoma is...

Herpes simplex

Distal digital herpes simplex infection may affect the terminal phalanx as a primary herpetic 'whitlow' or start as an acute, intensely painful paronychia (Figures 5.37, 5.38). It is relatively common in dental staff, anaesthetists and those involved with the care of the mouth and upper respiratory tract in unconscious patients. Recurrent forms are generally less severe and have a milder clinical course than the initial infection. After an incubation period of 3-7 days, during which local...

Acrokeratosis paraneoplastica of Bazex and Dupre

Acrokeratosis paraneoplastica occurs in association with malignant epithelial tumours of the upper respiratory or digestive tracts, in particular the pharyngolaryngeal area piriform fossa, tonsillar area, epiglottis, hard and soft palate, vocal cords, tongue, lower lip, oesophagus and the upper third of the lungs. It also occurs with metastases to the cervical and upper mediastinal lymph nodes. This 'paraneoplasia' may precede the signs of the associated malignancy, disappear when the tumour is...

Table 46 Causes of splinter haemorrhages

Antiphospholipid syndrome Arterial emboli Arthritis (notably rheumatoid arthritis and rheumatic fever) Beh et's syndrome Blood dyscrasias (severe anaemia, high-altitude purpura) Collagen vascular disease Cryoglobulinemia (with purpura) Darier's disease Drug reactions (especially tetracyclines) Eczema Haemochromatosis Haemodialysis and peritoneal dialysis Heart disease (notably uncomplicated mitral stenosis and subacute bacterial Idiopathic (probably traumatic) up to 20 of normal population...

Blistering distal dactylitis

Blistering distal dactylitis is a variant of streptococcal skin infection. It presents as a superficial, tender, blistering beta-haemolytic streptococcal infection over the anterior fat pad of the distal phalanx of the finger (Figure 5.40). The lesion may or may not have a paronychial extension. This blister, containing thin, white pus, has a predilection for the tip of the digit and extends to the subungual area of the free edge of the nail plate. The area may provide a nidus for the...

Acquired longitudinal melanonychia after puberty in a whiteskinned individual requires urgent biopsy

Approximately 2-3 of melanomas in whites, and 15-20 in blacks are located in the nail unit. However, malignant melanoma is rare in black people thus the number of nail melanomas does not significantly differ between these population groups. Most white patients have a fair complexion, light hair, and blue or hazel eyes. There is no sex predominance, although some reports show variable female or male predominance. The mean age at onset is 55-60 years. Most tumours are found in the thumbs or great...

Onychomycosis

Fungal infections of the nail organ are the most common nail disorders. Even though they are usually easily diagnosable they may be indistinguishable from nail psoriasis and the conditions may in fact occur together. Superficial white onychomycosis is easy to diagnose a tangential biopsy of the nail plate is taken with a no. 15 scalpel and sent to the laboratory. Formalin fixation is not necessary. The thin nail slice is processed and cut as usual and stained with periodic acid-Schiff reagent...

Acropustulosis and pustular psoriasis

Tumore Della Pelle

In pustular psoriasis and acrodermatitis continua (Hallopeau's disease), involvement of a single digit is common. It is often misdiagnosed when the pustule appears beneath the nail plate with necrosis of tissue resulting in desiccation and crust formation. New pustule formation may develop at the periphery or within the lesions. The nail is lifted off by the crust and lakes of pus and new pustules may form on the denuded nail bed (Figures 5.425.44). Permanent loss is possible. Acral pustular...

Parakeratosis pustulosa Hjorth Sabouraud syndrome

This parakeratotic condition of the finger tip was first described more than 50 years ago. It usually occurs in girls of approximately 7 years of age, typically affecting only one digit, usually a finger (Figure 5.45). The lesions start close to the free margin of the nail of a finger or toe. In some cases, a few isolated pustules or vesicles may be observed in the initial phase these usually disappear before the patient presents to the doctor. Confluent eczematoid changes cover the skin...

Table 43 Causes and associations of onychogryphosis Dermatological

Ichthyosis Psoriasis Onychomycosis Syphilis, pemphigus, variola Local causes Isolated injury to the nail apparatus Repeated minor trauma caused by footwear Foot faults such as hallux valgus Regional causes Associated varicose veins Thrombophlebitis (even in the upper limb) Aneurysms Elephantiasis Disease involving the peripheral nervous system General causes Old age Vagrancy and senile dementia Disease involving the central nervous system Hyperuricaemia Idiopathic forms Subungual hyperkeratosis...

Chronic paronychia is not a primary infection Chronic paronychia of the hands is typically intiated by frequent

Retracting Nail Fold

Clinically, the proximal and lateral nail folds show erythema and swelling. The cuticle is lost and the ventral portion of the proximal nail fold becomes separated from the nail plate. This newly formed space has an important additional role in maintaining and aggravating chronic paronychia it becomes a receptacle for microorganisms and environmental particles that potentiate the chronic inflammation. With time the nail fold retracts and becomes thickened and rounded. The course of...

Table 34 Causes and associations of trachyonychia

Idiopathic (twenty-nail dystrophy) (Figure 3.34) Alopecia areata (Figure 3.32) Lichen planus (Figures 3.37, 3.38) Eczematous histology Chemicals and alopecia areata makes it common to observe trachyonychia in other conditions frequently associated with alopecia areata, such as atopic dermatitis, ichthyosis or Down's syndrome. Table 3.4 lists the known causes and associations of trachyonychia. In onychoschizis the distal portion of the nail splits horizontally. The nail is formed in layers...

Onychomycosis and its treatment

Proximal Subungual Onychomycosis

Antonella Tosti, Robert Baran, Rodney PR Dawber, Eckart Haneke Candida onychomycosis Further reading Fungi may invade the nails in four different ways, leading to four separate types of onychomycosis with specific clinical features, prognosis and response to treatment. The type of nail invasion depends on the fungus responsible and the host susceptibility. Invasion occurs 1 Via the distal subungual area and the lateral nail groove, leading to distal lateral subungual onychomycosis (Figure 8.1)....

Alteration to surrounding tissue

Pincer Toenail Home Treatment

Tennis (or sportman's) toe is a brown-black discoloration due to subungual haemorrhage caused by special stresses on the longest toe (great toe and or the second toe). Pain is associated with the appearance of the damage. In tennis, this occurs because the player frequently stops abruptly the forward motion of the body propels the toes into the toe box and tip of the footwear. Hard playing surfaces contribute to the injury. In distinction to tennis toe, jogger's toe tends to involve the third,...

Periungual and subungual warts

Recalcitrant Wart

Common warts are caused by human papillo-maviruses of different biological types (Figures 5.16-5.18). They are benign, weakly infective, fibre-epithelial tumours with a rough keratotic surface. Usually periungual warts are asymptomatic, although fissuring may cause pain. Subungual warts initially affect the hyponychium, growing slowly toward the nail bed and finally elevating the nail plate. Bone erosion from verruca vulgaris occasionally occurs although some of these cases may have been...