Showing posts with label nail disorders. Show all posts
Showing posts with label nail disorders. Show all posts

Monday, January 17, 2011

Nail Disorders









Anatomy of the Nail:

Nail Plate- Is the hard and translucent portion of the nail.

Nail Bed- Is the skin underneath the nail plate.

Matrix- Is the part in which the nail rests and is responsible for the production of the cells that become the nail plate.

Hyponychium- Distal nail groove which forms a seal that protects the nail bed.

Nail Grooves- Medial and Lateral

Lunula- The whitish crescent-shaped base of the nail.



Nail disorders are more common than people know. There are a number of different nail disorders that can be treated by your podiatrist. Nail abnormalities can show problems with the color, shape, texture, or thickness of the nails. Sometimes the nails can tell the health of a patient.


Here is a group of some common nail disorders:

Anonychia- This is the absence of the nail itself.

Beau's Lines- Is a depression across the nail plate which is caused by a stressful event.

Green Nail- A disorder of the nail that may be due to an infection caused by Pseudomonas.

Hapalonychia- A pliable nail plate that is usually caused by hyperhidrosis.

Clubbed nail- When the angle of the nail plate and proximal nail fold is greater than 180 degrees. This condition may occur in cardiac, pulmonary, or gastro-intestinal disease.

Koilonychia- This is known as a spoon nail. This condition is seen in iron deficiency anemia.

Leukonychia- Is a disorder of the nail where the nail exhibits white spots.

Lindsay's Nail- A condition that shows the far half of the nail discolored pink or brown and the near half dull and white. This disorder is seen in liver disease.

Macronychia- Is an abnormally large nail.

Mee's Line- A white band across the nail that is associated with arsenic poisoning or a stressful event.

Melanonychia- A disorder that demonstrates longitudinal, pigmented bands in the nails .

Micronychia- Is an abnormally small nail.

Onychatrophia- This disorder shows atrophy of the nail.

Onychauxic Nail- This disorder shows hypertrophy (Thickening) of the nail.

Onychia- A disorder where there is inflammation of the matrix.

Onychocryptosis- This is an ingrown nail.

Onychogryphosis (Rams horn nail) - Another disorder where there is thickening of the nail.

Onycholysis- This is a separation of the nail plate from the nail bed.

Onychomalacia- This is a softening of the nail plate.

Onychomycosis- Is a nail that is infected with a fungus.

Onychophosis- This type of nail is seen with a callus in the nail groove.

Onychopuntata- This disorder shows pitting of the nails as seen in lichen plannus, alopecia, and psoriasis.

Onychorrexia- Nails that are abnormally brittle.

Onychoschizia- This condition demonstrates splitting of the nail plate into layers.

Paronychia- Inflammation of the tissue folds around the nail. There may be infection with this type of nail.

Raquet Nail- A short and fat nail.

Subungual Hematoma- Associated with trauma. There is formation of a hematoma underneath the nail plate.

Terry's Nail- With this condition the proximal 2/3 of the nail plate is white. This disorder can be seen with hepatic cirrhosis.


So you see, there are many disorders of the nail. Some disorders may be more serious than others. If you suspect any nail disorders, make an appointment with your podiatrist to be properly evaluated.

Tuesday, April 20, 2010

Nail Disorders & Nail Surgery

Nails are excellent indicators of disease and provide diagnostic information.

Patients should look for some of the following nail presentations:
  • Discoloration
  • Brittleness
  • Uplifting nail
  • Pitting nail
  • Splitting
  • Striations
  • Nail thinning
  • Ridging
  • Change in nail consistency
  • Change in nail configuration
  • Nail clubbing

Common Nail Problems:


Ingrown nails- Result from an alteration in the proper fit of the nail plate in the usual nail groove. Sharp edges of the lateral nail margin become driven into the skin of the nail groove. The nail essentially becomes a foreign body. An inflammatory response occurs in the involved nail groove. This can lead to redness, swelling, drainage, and development of granulation tissue.



Onychomycosis
- Fungal infections are common, usually caused by dermatophytes.
Common causes: T. rubrum, T. mentogrophytes, and E. Floccosum.
Onychomycosis can be diagnosed by a fungal culture



Anonychia- Is the complete absence of the nail. This condition is a rare congenital anomaly.

Paronychia- Is an infection usually accompanying ingrown nails.

Beau's Lines- Transverse ridges in the nail plate.

Clubbed Digits- marked convexity of nails, with the nail becoming hard, and thick.

Eczematous Conditions- Many types of eczematous dermatitis such as atopic and contact dermatitis can affect the nail folds.

Glomus Tumor
- A purplish tumor that causes pain. The nail bed will appear as a blue-red distortion.

Green Nails- Usually caused by a local Pseudomonas infection

Koilonychia- This describes a spoon shaped nail and describes a characteristic deformity in the form of a concave shape.

Onychauxis-
This is the thickened, elongated, raised irregular nail.
Can be caused by trauma, fungal infection, and nutritional disturbances

Onychogryphosis
- Is an exaggeration of onychauctic condition.

Onychomalacia-
Refers to softness of the nails.

Onycholysis- Detachment of the nail bed from the overlying plate creates a space between nail plate and nail bed.

Splinter Hemorrhages- These are caused by capillary fragility in the longitudinal vessels of the nail bed.




Nail Anatomy


The matrix- is a stratified epithelium that produces hard keratin. The proximal matrix forms the superior nail and the distal matrix forms the lower nail.

Hyponychium- is an epithelial layer of the nail bed

Nail plate- can be separated into zones with predominantly different beginnings. The uppermost layer is generated by the proximal nail fold, the plate by the matrix, and the deepest section of the nail plate is contributed to by the nail folds and bed.

Lunula- is a white semi-lunar area corresponding to the anterior matrix.

Nail bed -consists of the hyponychium and corium over the matrix.



Surgical Nail Procedures:


Nail problems that dictate surgical intervention can include:
Abscess/ Paranychia

Persistent pain

Persistent ingrown nails

Some cases of fungal nails



Procedures:

Phenol and Alcohol Chemical Matrixectomy:

After the toe has been anesthetized, a portion or the whole nail is removed after a sterile preparation of the toe. Next 3 applications of phenol are used at the level of the matrix. The phenol is used to destroy the tissues of the matrix which will prevent further growth of the nail. The area is then flushed with alcohol and a dressing with antibiotic ointment is applied. The patient is given post operative soaking and dressing instructions.

Sodium Hydroxide Matrixectomy

Is a process similar to the phenol and alcohol chemical matrixectomy but uses sodium hydroxide and acetic acid to neutralize. The same criteria apply as for Phenol-Alcohol procedure.

                                                     Learn more at http://www.shenandoahpodiatry.com/