Figure 948

Nail shedding in a long-distance runner.

2 Nail shedding (Figure 9.48):

• self-inflicted anonychia of the toe nails is associated with small or absent nails and crushing due to traumatic bleeding

• periodic shedding of the nails can result from biomechanical causes and is frequently seen in runners.

Worn-down nail (Figures 9.49, 9.50) (see Chapter 2):

• koilonychia (toes of rickshaw pullers)

4 Brittle nails (see Chapter 6).

5 Onychogryphosis and hypertrophic nail (see Chapter 4).

6 Frictional melanonychia (Figure 9.51):

• frictional melanonychia of the toes can be initiated by repeated trauma from footwear

• friction and pressure are responsible for LM with pseudo-Hutchinson's sign in boxers.

Figure 9.49

Dystrophy due to chronic shoe rubbing.

Figure 9.49

Dystrophy due to chronic shoe rubbing.

Figure 9.50

Dystrophy from shoe pressure.

Figure 9.50

Dystrophy from shoe pressure.

Figure 9.51 Frictional melanonychia.

7 Multiple transverse leukonychia (Figure 9.52). Multiple transverse white bands margins separated by normal pink nail and paralleling the distal shape of the lunula result from repeated microtrauma. These appear in patients with marked visible free of the involved toe nails (usually the great toe or the second toe when longer), indicating a lack of trimming and impinging on the distal part of the shoe.

Figure 9.52

Transverse leukonychia from distal pressure on untrimmed nail.

Figure 9.52

Transverse leukonychia from distal pressure on untrimmed nail.

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