Nail Pathologies - Findings in or Near Nails

Paronychia ...
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Description

Nail Pathologies - Findings in or Near Nails



Paronychia 



A superficial infection of the proximal and lateral nail folds adjacent to the nail 

plate. The nail folds are often red, swollen, and tender. Represents the most 

common infection of the hand, usually from Staphylococcus aureus or Streptococcus 

species, and may spread until it completely surrounds the nail plate. Creates a felon 

if it extends into the pulp space of the finger. Arises from local trauma due to nail 

biting, manicuring, or frequent hand immersion in water. Chronic infections may 

be related to Candida. 



Clubbing of the Fingers 



Clinically a bulbous swelling of the soft tissue at the nail base, with loss of the 

normal angle between the nail and the proximal nail fold. The angle increases to 

180 degrees or more, and the nail bed feels spongy or floating. The mechanism is still 

unknown but involves vasodilatation with increased blood flow to the distal 

portion of the digits and changes in connective tissue, possibly from hypoxia, 

changes in innervation, genetics, or a platelet-derived growth factor from 

fragments of platelet clumps. Seen in congenital heart disease, interstitial lung 

disease and lung cancer, inflammatory bowel diseases, and malignancies. 



Onycholysis 

A painless separation of the whitened opaque nail plate from the pinker translucent 

nail bed. Starts distally and progresses proximally, enlarging the free edge Of the 

nail. Local causes include trauma from excess manicuring, psoriasis, fungal 

infection, and allergic reactions to nail cosmetics. Systemic causes include diabetes, 

anemia, photosensitive drug reactions, hyperthyroidism, peripheral ischemia, 

bronchiectasis, and syphilis. 



Terry's Nails 



Nail plate turns white with a ground-glass appearance, a distal band of reddish 

brown, and obliteration of the lunula. Commonly affects all fingers, although may 

appear in only one finger. Seen in liver disease, usually cirrhosis, heart failure, and 

diabetes. May arise from decreased vascularity and increased connective tissue in 

nail bed. 



White Spots (Leukonychia) 



Trauma to the nails is commonly followed by nonuniform white spots that grow 

slowly out with the nail. Spots in the pattern illustrated are typical of overly 

vigorous and repeated manicuring. The curves in this example resemble the curve 

of the cuticle and proximal nail fold. 



Transverse White Bands (Mees' Lines) 



Curving transverse white bands that cross the nail parallel to the lunula. Arising 

from the disrupted matrix of the proximal nail, they vary in width and move 

distally as the nail grows out. Seen in arsenic poisoning, heart failure, Hodgkin's 

disease, chemotherapy, carbon monoxide poisoning, and leprosy. 



Transverse Linear Depressions (Beau's Lines) 



Transverse depressions of the nail plates, usually bilateral, resulting from temporary 

disruption of proximal nail growth from systemic illness. As with Mees' lines, 

timing of the illness may be estimated by measuring the distance from the line to 

the nail bed (nails grow approximately 1 mm every 6 to 10 days). Seen in severe 

illness, trauma, and cold exposure if Raynaud's disease is present. 



Pitting 



Punctate depressions of the nail plate caused by defective layering of the superficial 

nail plate by the proximal nail matrix. Usually associated with psoriasis but also 

seen in Reiter's syndrome, sarcoidosis, alopecia areata, and localized atopic or 

chemical dermatitis.



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** GrepMed Recommended Text: Bates' Guide to Physical Examination and History Taking - https://amzn.to/2Z6LYmf
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