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. #FingerNails #Nail #Diseases #Abnormal #Pathology #Diagnosis #Clinical #Signs #PhysicalExam #Atlas #Beaus #Mees #Terrys ** GrepMed Recommended Text: Bates' Guide to Physical Examination and History Taking - https://amzn.to/2Z6LYmf
