Nail changes may be primary where the disease is
affecting the nail or secondary to a systemic disease.
bacterial , fungal or in the course of different systemic
infections. These were discussed in the previous chapters.
Hypertrophy of the nails may be due to :
Congenital such as in Mal de Meleda .
Acquired - The nail becomes deformed with claw
like appearance .
Fig. 433. Hypertrophic Nails (Congenital)
Nail hypertrophy may be due to different factors
Failure to cut nails regularly and repeatedly .
Fig. 434. Mal de Meleda (Nail Hypertrophy)
Peripheral vascular disorders.
The nail becomes thin ,rudimentary and smaller
size .Nail atrophy may be congenital or acquired :
which can cause nail atrophy are the following:
Fig. 435. Nail Dystrophy (Lichen planus)
Fig. 436. Onychomycosis
Fig. 437. Nail Dystrophy (Fungal infections)
Nail changes in psoriasis :
Furrows and nail pitting .
Transverse depression of the nail .
Subungual debris and keratoses .
: Nail changes may be
associated with skin and mucous membrane manifestations of lichen
planus or the disease is localized to the nails only.
Fig. 438. Nail Shedding (Psoriasis)
Nail changes in lichen planus are :
Longitudinal grooving of the nail.
Bulging at the proximal nail folds.
Permanent loss of nails.
Clubbing of fingers is a manifestation of a large
number of systemic diseases.
Nail changes and that of the terminal phalanges
give the “drum stick“
appearance of nails.
Convex curved nail in both longitudinal and
Diseases associated with clubbing:
Respiratory diseases : bronchiectesis, chronic
bronchitis, bronchogenic carcinoma, emphysema, tuberculosis.
Liver diseases : biliary cirrhosis
Congenital heart diseases.
the course of chronic eczema: deformities, nail
brittling,atrophic and hypertrophic changes may occure.
Fig. 439b. Nail dystrophy with Alopecia
Fig. 439a. Nail changes and chronic
The nail is thin and concave from side to side
with everted edges.
Fig 439b. Spoon nails
Transverse lines and furrows at the nail lanula .
Systemic infections such as measles.
Vitamin deficiency: Vitamin A and B.
Nail biting (Onychophagia)
This is a common habit in children, biting and
clipping of the tip of the nails by teeth. All fingernails are often
bitten, but occasionally, one or more are spared. The nail is often
bitten right back to the point of separation from the nail.
The cuticles and lateral nail walls are often
bitten and so become irregular and broken. Peri ungual warts are
more common in nail biters.
Fig.439d. Pyogenic paronychia &Ingrowing nail
This is due
to different factors mainly : repeated trauma to nail, tight shoes,
bony malformation of the big toe and others.
This is essentially similar to the habit tic but
is more closely allied to parasitophobia as the patient picks off
pieces of nail fold and may claim that they contain parasites. A
rough and irregular nail and nail fold results.
The nail and cosmetics
Different nail preparations or paints of nails
may have local reaction affecting the nail and the adjacent tissues.
These products may affect babies and children indirectly from their
mothers due to contact of their skin with these applied cosmetics on
the mothers‘ nails. Nail cosmetics
include the nail polish and the nail removal, which is composed of
various solvents such as acetone.
Contact dermatitis to the adjacent tissue .
Dryness of the nails .
Brittled and fractured nails
NAIL COLOR CHANGES
White nails (congenital
Punctate type: occurs as a result of:
Systemic diseases as typhoid fever , nephritis .
Fungal infections .
Fig. 440. Nail Hyperpigmentation
Deep X-ray therapy
Infections especially due to pseudomonas .
Longitudinal black bands
These types of color changes of the nails occur
with pseudomonas aeruginosa infections.
Drugs and chemicals : such as chrysarobin ,
Resorcin , anthralines .
Infections : syphilis
Drugs : Mepacrine
Fig. 441. Blue Nail
Potassium permanganate soaks
Drug reaction: Anti-malarial drugs,
Fig. 442. Azure Nails
Blue discoloration of the lanula occurs in
chronic liver diseases such as hepatolenticular degeneration .
Fig. 443. Yellow Nails
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