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 proxi-mally. Thickened cuticle composed of several layers (onion-like) can be an unusual manifes-tation of factitious damage.

Hangnails may also result from occupational injuries, due to the hydration and dehydration caused by frequent wetting. However, usually hangnail has no obvious cause, though it may be self-induced.

Figure 5.12

Ragged cuticles: (a) unknown cause; (b) scleroderma.

Figure 5.12

Ragged cuticles: (a) unknown cause; (b) scleroderma.

Figure 5.13

Dermatomyositis with ragged cuticles.

Figure 5.13

Dermatomyositis with ragged cuticles.

Figure 5.14

Hangnail deformity of the lateral nail.

Figure 5.15

Dorsolateral fissures—usually very painful.

Figure 5.15

Dorsolateral fissures—usually very painful.

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