1 / 24

CASE CONFERENCE: Nail Disorders

CASE CONFERENCE: Nail Disorders. KAREN ESTRELLA 05/12/2010. Do you check the nails of your patients?. History. 3y/o M seen at SBC for 1 st WCC -no acute concerns except for: changes in nail bed of left 2 nd nail for 1 year. Normal nail. EMBRIOLOGY : starts to develop at 10-11 wks

chika
Download Presentation

CASE CONFERENCE: Nail Disorders

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. CASE CONFERENCE:Nail Disorders KAREN ESTRELLA 05/12/2010

  2. Do you check the nails of your patients?

  3. History 3y/o M seen at SBC for 1st WCC -no acute concerns except for: changes in nail bed of left 2nd nail for 1 year

  4. Normal nail • EMBRIOLOGY: • starts to develop at 10-11 wks • keratinizes from 15 wk • fully formed by birth

  5. Normal nail • ANATOMY:

  6. Consult DERMATOLOGY: • Dark linear, uniform, well demarcated linear ban along the nail bed, involving proximal nail fold Melanonichiastriata

  7. What is melanonychia? • Tan, brown or black pigmentation from the proximal nail fold and cuticle to the free distal end of the nail plate • Usually affects 1 or 2 digits • Due to: melanocyte activation (physiologic), benignmelanocyte hyperplasia (nevi), or melanoma. • Most common in african-american or hispanics

  8. Melanonychia etiology: benign • LOCAL • Trauma • Radiation • Nail bitting • Foreign body • Infection Single bands • SYSTEMIC • Addison, Cushing, Hyperthyroidism, • Hemosiderosis • Alcaptonuria • Psoriasis • LES, scleroderma • Malnutrition Multiple bands

  9. Melanonychia etiology: iatrogenic • CHEMOTHERAPY • Metotrexatem • Bleomycin • Doxorubicin • Ciclophosphamide • 5-fluoruracil • OTHERS • Steroids, • Ibuprofen • Phenytoin • Zidovudine, lamivudine • Ketokonazole, fluconazole

  10. Melanonychia etiology: malignancy • Age: adults • Brown-black band greater than 3 mm • Change in nail band morphology despite treatment • Digit involved: The thumb is more likely to be affected by subungual melanoma than the great toe; the great toe is more likely than the index finger to be affected by subungual melanoma. • Extension onto the adjacent cuticle and proximal and/or lateral nail folds (Hutchinson sign) • Family or personal history of dysplastic nevus or melanoma

  11. Melanonychia work-up • Dermatoscopic evaluation: • Of the free edge of nail bed

  12. Melanonychia: Dermatoscopic evaluation continued

  13. Melanonychia: work-up continued • Nail bed Sampling: • Punch bx: 3mm, from proximal matrix • Risk of permanent nail dystrophy • Nail-shave bx: 4-6mm, central portion of nail bed • lateral-longitudinal • If suspicion for subungueal melanoma: full thickness

  14. Melanonychia Treatment • Tx of underlying condition • Removal of agent • If melanoma: complete removal of hyperpigmented section

  15. OTHER NAIL DISORDERS

  16. Congenital disorders:(Ectodermal defects) • ANONYCHIA • Associated with nail-patella sd., deafness • PACHONYCHIA • Associated with: hyperhidrosis, leukokeratosis: TM, cornea, mucosas

  17. Congenital disorders continued • HYPOPLASTIC • Phenytoin • Warfarin • Fetal alcohol syndrome

  18. Associated with systemic disorders • CLUBBING • hypoxic stages • KOILONYCHIA (spoon nails) • Iron deficiency

  19. Associated with systemic disorders • HALF & HALF NAILS • liver, kidney failure • SPLINTER HEMORRHAGES • endocarditis • RIDGING-TRANSVERSE LINES • - malnourishment

  20. Acquired nail disorders: infection • ONYCHOMYCOSIS • yellowish, brittle • Unusual before puberty • - Systemic antifungal tx • PARONYCHIA • Red, tender, swelling of prox or lateral fold • Acute: S. aureus • Chronic: Candida albincans

  21. Acquired nail disorders: dystrophy(distortion, discoloration) • TRAUMA • Subungual hematoma • PSORIASIS

  22. Acquired nail disorders: dystrophycontinued • TRACHYONYCHIA (Twenty nail dystrophy) • School children • Yellow or gray color nails, (+) pitting, friable • Progresses in 6-18 months, self-limited • Some cases associated with alopecia areata, atopic dermatitis

  23. Thank you : )

  24. References • Cohen, B. pediatric Dermatology. Mosby LTD, Spain: 1999. pg 201-208 • www.dermaimaging.com/?cat=39 • http://www.ncbi.nlm.nih.gov/pubmed/10411404 • http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0365-05962009000200013&lng=en&nrm=iso>. ISSN 0365-0596.  doi: 10.1590/S0365-05962009000200013. • http://emedicine.medscape.com/article/1375850-overview • http://www.medscape.com/viewarticle/718695_7

More Related