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    Nails 140205092349 Phpapp01

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    This document provides an overview of nail abnormalities, signs, and associated conditions. It describes nail features such as color, shape, thickness and other characteristics. Common abnormalities are summarized including spooned nails, central nail ridge, clubbing, Beau's lines, and Muehrcke's lines. Associated conditions for each abnormality are outlined such as iron deficiency, diabetes, pulmonary/cardiac disease, and chemotherapy. Evaluation of nail changes can provide clues to underlying diseases and systemic processes.

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    Nails 140205092349 Phpapp01

    Uploaded by

    proximus
    34 views34 pages
    This document provides an overview of nail abnormalities, signs, and associated conditions. It describes nail features such as color, shape, thickness and other characteristics. Common abnormalities are summarized including spooned nails, central nail ridge, clubbing, Beau's lines, and Muehrcke's lines. Associated conditions for each abnormality are outlined such as iron deficiency, diabetes, pulmonary/cardiac disease, and chemotherapy. Evaluation of nail changes can provide clues to underlying diseases and systemic processes.

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    This document provides an overview of nail abnormalities, signs, and associated conditions. It describes nail features such as color, shape, thickness and other characteristics. Common abnormalities are summarized including spooned nails, central nail ridge, clubbing, Beau's lines, and Muehrcke's lines. Associated conditions for each abnormality are outlined such as iron deficiency, diabetes, pulmonary/cardiac disease, and chemotherapy. Evaluation of nail changes can provide clues to underlying diseases and systemic processes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    34 views34 pages

    Nails 140205092349 Phpapp01

    Uploaded by

    proximus
    This document provides an overview of nail abnormalities, signs, and associated conditions. It describes nail features such as color, shape, thickness and other characteristics. Common abnormalities are summarized including spooned nails, central nail ridge, clubbing, Beau's lines, and Muehrcke's lines. Associated conditions for each abnormality are outlined such as iron deficiency, diabetes, pulmonary/cardiac disease, and chemotherapy. Evaluation of nail changes can provide clues to underlying diseases and systemic processes.

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    © All Rights Reserved
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    of 34

    SPIESS MR

    NAIL EXAM

     Shape
     Color
     Flexbility
     Growth rate: ~6 months from the cuticle to free
    edge, 0.1mm/day
    COLORS

    Pink/Red: polycythemia, SLE, carbon monoxide


    poisoning, angioma, malnutrition
    White: anemia, cirrhosis, DM, chemo, renal failure
    Yellow: Amyloidosis, yellow nail syndrome, median/ulnar nerve
    injury, thermal injury, jaundice, DM
    Green/Black: solvents, trauma, chronic Pseudomonas infection
    SPOONED NAILS (KOILONYCHIA)

     Water drop test: imagine placing a drop of water on the nail. If


    it would not fall of f it is spooned
     Causes:
     Iron deficiency
     DM
     Protein deficiency especially in sulfur-containing amino acids
    (cysteine or methionine)
    CENTRAL NAIL RIDGE

     Causes:
     Iron deficiency, folic acid deficiency, protein deficiency
    CENTRAL NAIL CANAL/HELLER’S FIR
    TREE DEFORMIT Y
     Cuticle usually normal
     Associations:
     Severe arterial disease
     Severe malnutrition
     Repetitive trauma
    NAIL BEADING

     Endocrine Conditions: DM, thyroid disease, Addison’s


    ROUGH

     Sandpaper/dull appearance
     Seen in:
     Psoriasis
     Chemical exposures
     Lichen planus
     Autoimmune diseases
    NAIL THICKENING

     Slow growth produces thickness


     Causes:
     Onychomycosis
     Chronic eczema
     PVD
     Yellow nail syndrome
     Psoriasis
    ONYCHOLYSIS

     Associated with:
     Thyrotoxicosis, trauma, contact dermatitis, chemicals, porphyria
    cutanea tarda
    CLUBBING

     Angle between nail plate and fold greater than 180 degrees
    CLUBBING

     Causes:
     Cardiac/Pulmonary (80%): R to L
    shunts, endocarditis, pericarditis, lung CA, bronchiectasis, lung
    abscess, empyema, pulmonary fibrosis. NOT COPD
     GI (5%): IBD, celiac, neoplasms (esophagus, liver, bowel)
     Hyperthyroidism (1%)
    SPLINTER HEMORRHAGE

     A s s o c i a te d w i t h t r a u m a , I E , s c l e r o d e r m a , t r i c h i n o s i s , p i t y r i a s i s r u b r a
    p i l a r i s , p s o r i a s i s , r e n a l f a i l ur e
    TERRY’S NAILS

     Proximal paleness extending at least half -way up (often


    eliminating the lunula) with a dark band distally. Seen in
    states of stress (liver disease, CHF, DM2, advanced age)
    LINDSAY’S NAILS/HALF AND HALF NAILS

     Pale proximal (edema and anemia) in kidney and liver disease. In renal
    disease there is a brown transver se distal brown transver se band at the
    junction of the er ythema and free edge
    BEAU’S LINES
     Transverse depressed ridges caused by growth arrest. Seen in
    severe infection, MI, hypotension/shock, hypocalcemia, post-
    surgical, malnutrition, some chemotherapies
    MUEHRCKE’S LINES (LEUKONYCHIA
    STRIATA)

     Due to edema to the nail plate. Usually 2 or more on one nail.


    Seen in states of decreased protein synthesis or increased protein
    loss, hypoalbunemia (<2.2), nephrotic syndrome and certain
    chemotherapies. Don’t move and disappear when albumin
    increases.
    MEES’ LINES

     Transverse white lines (usually one per nail, no depressions) that


    often will disappear if pressure is applied. Heavy metal poisoning
    (strong association with arsenic and thallium), chemo, severe
    illness
    PITTING

     Non-specific sign for psoriasis, alopecia areata, eczema, lichen


    planus
    QUITTER’S NAIL

     Distal nicotine stains with demarcation and no staining


    proximally seen when a patient quits smoking or changes to a
    lower tar tobacco.
    PERIUNGAL

    Periungal telangiectasias: strong association with CVD:


    SLE, dermatomyositis, scleroderma
    Fibroma
    Mucus cyst

    Paronychia

    Herpetic Whitlow
    ACRAL LENTIGINOUS MELANOMA

     Seen on palms, soles, mouth but when occurs within the nail
    a clue is that it involves the periungal region
    HANDS

    Pope’s Hand (Hand of Benediction)

    What nerve is
    af fected?
    Claw Hand
    HANDS

    Bouchard’s and Heberden’s Nodes


    HANDS

    Boutonniere Deformity
    Swan Neck Deformity

    Ulnar Deviation
    WHAT WOULD YOU EXPECT THIS PERSON
    TO HAVE?
    A) Turner’s Syndrome
    B) Holt-Oram Syndrome
    C) Down’s Syndrome
    D) Edwards Syndrome
    E) Fragile X
    C) Down’s Syndrome
    62yo F with history of proximal muscle weakness, weight loss
    and dysphagia

    What is causing this?


    DERMATOMYOSITIS
    Periungal
    telangiectasias

    Gottron’s
    papules
    REFERENCES

     The Stanford 25 – stanfordmedicine25.stanford.edu


     Published presentation on nail exam – Mark Williams, MD at
    UVA

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