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Diseases of Nail Plate

Pits

Psoriasis, alopecia areata, hand dermatitis, nail biting, lichen planus, idiopathic

Horizontal ridges

Beau's lines, any inflammation affecting soft tissues around nails

Longitudinal ridges:

a. Single   b. Multiple

Pressure effect e.g. tumour in nail fold
Psoriasis, lichen planus, alopecia areata, Darier's disease

Thickening

Psoriasis, onychomycosis, pachyonychia congenita

Onycholysis separation of nail plate from nail bed distally)

Idiopathic, psoriasis, onychomycosis, trauma, thyroid acropachy, drug induced photo-onycholysis e.g. tetracyclines

Subungual hyperkeratosis

Psoriasis, onychomycosis, trauma, ischaemia

Koilonychia

Iron deficiency, lichen planus, idiopathic

Colour changes

Infection: Pseudomonas (green) 
Drugs: Tetracycline (yellow)  
          Antimalarial (blue)     
        Chlorpromazine (brown)  
Topical agents:  Potassium permanganate  
                 Dyes   
Systemic diseases:  Cirrhosis  hypoproteinaemia

               (white)    
Others:  Cigarette smoking (brown)   
             Subungual haematoma (reddish blue)  
           Melanoma (black)         

Leuconychia
(whiteness of nail):
True (affect nail plate)
Apparent (affect
subungual tissues)

Onychomycosis, trauma, congenital
Anaemia, hypoproteinaemia

Pigmented streaks

Normal in pigmented skin, malignant melanoma, benign melanocytic naevi, Addison's disease

  1. Diseases of Nail Fold

Paronychia (inflammation of nail fold): 

Acute

Chronic

Trauma

Trauma, wet work, drugs e.g. etretinate

Pterygium formation (cuticle appears to grow out over the nail with loss of proximal nail fold)

Lichen planus, circulatory disorders, pemphigus

Palisading of dilated nail fold capillaries

Dermatomyositis, lupus erythematosus, scleroderma

Infarcts at posterior or lateral folds

Vasculitis, e.g. rheumatoid diseases

Nail fold masses

Viral warts, myxoid cyst, periungual, fibromata, malignant melanoma

  1. Diseases of Nail Bed and Matrix

Tumour

Subungual exostosis

Glomus tumour

Naevus

Malignant melanoma

Infection

Subungual wart

 
Causes of Nail pitting
  1. Skin disorders: 
    • Psoriasis
    • Lichen planus
    • Alopecia areata  
    • Reiter's syndrome
    • Eczema
    • Incontinentia pigmenti
  2. Infections
    • Onychomycosis
    • Tinea unguiumo Paronychia
  3. Congenital/Hereditary
    • Ectodermal dysplasia
    • Nail patella syndrome
  4. Endocrine
    • Hypothyroidism
    • Hyperthyroidism
    • Hypoparathyroidism




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