[{"Title":"General references","UniqueID":"v44326242","Index":1.0,"Summary":"

1. Faergemann J, Baran R. Epidemiology, clinical presentation and diagnosis of onychomycosis. Br J Dermatol. 2003;149 Suppl 65:1-4. doi:10.1046/j.1365-2133.149.s65.4.x

","HeadType":"G_Head","SchemeItemProp":"","Children":[]},{"Title":"Congenital Nail Disorders","UniqueID":"v103464229","Index":2.0,"Summary":"

In some congenital ectodermal dysplasias, patients have no nails (anonychia).

","HeadType":"F_Head","SchemeItemProp":"","Children":[]},{"Title":"Nail Disorders and Dystrophies Associated With Systemic Disease or Exposures","UniqueID":"v103464237","Index":3.0,"Summary":"

Plummer-Vinson syndrome (esophageal webs caused by severe, untreated iron deficiency) is often associated with koilonychia (concave, spoon-shaped nails). Patients should be followed for the development of aerodigestive malignancies.

","HeadType":"F_Head","SchemeItemProp":"","Children":[{"Title":"Systemic nail dystrophies references","UniqueID":"v103464258","Index":1.0,"Summary":"

","HeadType":"G_Head","SchemeItemProp":"","Children":[]}]},{"Title":"Nail Dystrophies Associated With Dermatologic Conditions","UniqueID":"v103464270","Index":4.0,"Summary":"

In psoriasis , nails may have a number of changes, including irregular pits, oil spots (localized areas of tan-brown discoloration), separation of a part of the nail from the nail bed ( onycholysis ), thickening and crumbling of the nail plate, red spots in the lunula, and splinter hemorrhages. Nail psoriasis may occur as an isolated phenomenon or as a feature of cutaneous psoriasis. Nail psoriasis is also a risk factor for development of psoriatic arthritis .

","HeadType":"F_Head","SchemeItemProp":"","Children":[{"Title":"Dermatologic conditions references","UniqueID":"v103464297","Index":1.0,"Summary":"

","HeadType":"G_Head","SchemeItemProp":"","Children":[]}]},{"Title":"Nail Discoloration","UniqueID":"v103464324","Index":5.0,"Summary":"

Chemotherapeutic cancer medications (especially the taxanes) can cause melanonychia (nail plate pigmentation), which can be diffuse or may occur in transverse bands. Some medications can cause characteristic changes in nail coloration:

","HeadType":"F_Head","SchemeItemProp":"","Children":[{"Title":"Nail discoloration references","UniqueID":"v103464353","Index":1.0,"Summary":"

","HeadType":"G_Head","SchemeItemProp":"","Children":[]}]},{"Title":"Median Nail Dystrophy (Median Canaliform Dystrophy)","UniqueID":"v103464362","Index":6.0,"Summary":"

Median nail dystrophy is characterized by small cracks in the nail that extend laterally and look like the branches of an evergreen tree. The cracks and ridges are similar to those seen in habit-tic nail deformity (which is dystrophy of the central nail caused by repetitive trauma to the nail matrix resulting from rubbing or picking with another finger). The cause of median nail dystrophy is unknown in some cases, but trauma is thought to play a role. Frequent use of personal digital devices that subject the nails to repetitive striking has been implicated in several cases. Tacrolimus 0.1% at bedtime without occlusion has been successful when patients stop all activities that might lead to repetitive low-level trauma.

","HeadType":"F_Head","SchemeItemProp":"","Children":[]},{"Title":"Melanonychia Striata","UniqueID":"v103464366","Index":7.0,"Summary":"

Melanonychia striata are hyperpigmented bands that are longitudinal and extend from the proximal nail fold and cuticle to the free distal end of the nail plate. Pigmentation results from deposition of melanin by melanocytes in the nail matrix. Deposition of melanin is increased by melanocyte activation (increased production of melanin in the nail cells) or by melanocytic hyperplasia (increased production of melanocytes in the nail matrix).

","HeadType":"F_Head","SchemeItemProp":"","Children":[{"Title":"Melanonychia striata references","UniqueID":"v103464376","Index":1.0,"Summary":"

","HeadType":"G_Head","SchemeItemProp":"","Children":[]}]},{"Title":"Onycholysis","UniqueID":"v103464385","Index":8.0,"Summary":"

Onycholysis is separation of the nail plate from the nail bed or complete nail plate loss. It can occur as a drug reaction in patients treated with tetracyclines (photo-onycholysis), doxorubicin, 5-fluorouracil, cardiovascular medications (particularly practolol and captopril), cloxacillin and cephaloridine (rarely), trimethoprim/sulfamethoxazole, diflunisal, etretinate, indomethacin, isoniazid, griseofulvin, and isotretinoin. Simple (ie, not associated with another nail or skin disorder) onycholysis may also result from exposure to irritants, such as frequent exposure to water, citrus fruits, or chemicals. Irritant contact dermatitis of the hands and fingers may also lead to onycholysis ( 1 ). Colonization of the nail bed with Candida albicans may occur, but treating the underlying irritant exposure leads to resolution of the onycholysis, with or without treating the Candida.

","HeadType":"F_Head","SchemeItemProp":"","Children":[{"Title":"Onycholysis reference","UniqueID":"v103464394","Index":1.0,"Summary":"

","HeadType":"G_Head","SchemeItemProp":"","Children":[]}]},{"Title":"Pincer Nail Deformity","UniqueID":"v103464400","Index":9.0,"Summary":"

Pincer nail deformity is a transverse overcurvature of the nail plate. It is most often caused by onychomycosis , psoriasis , tumors of the nail apparatus, osteoarthritis, and poorly fitting shoes. It has also been reported in patients with systemic lupus erythematosus , Kawasaki disease , end-stage renal disease , and some genetic syndromes (eg, paronychia congenita). Patients often have pain at the borders of the nail where the nail plate curves into the tips of the fingers or toes. There is no established treatment of choice, but a number of surgical techniques have been successful ( 1 , 2 , 3 ).

","HeadType":"F_Head","SchemeItemProp":"","Children":[{"Title":"Pincer nail deformity references","UniqueID":"v103464412","Index":1.0,"Summary":"

","HeadType":"G_Head","SchemeItemProp":"","Children":[]}]},{"Title":"Trachyonychia","UniqueID":"v103464424","Index":10.0,"Summary":"

Trachyonychia (rough, opaque nails) may occur with alopecia areata , lichen planus , atopic dermatitis , and psoriasis . It is most common among children. When present in all nails, trachyonychia is often called 20-nail dystrophy. When it occurs in children, it tends to resolve spontaneously. When it occurs in adults, treatment is aimed at the underlying disorder. A clue to the diagnosis is the nails feel like sandpaper.

","HeadType":"F_Head","SchemeItemProp":"","Children":[]},{"Title":"Nail Tumors","UniqueID":"v103464432","Index":11.0,"Summary":"

Benign and malignant tumors can affect the nail unit, causing onychodystrophy. Benign tumors include myxoid cysts, pyogenic granulomas , and glomus tumors. Malignant tumors include Bowen disease , squamous cell carcinoma , and malignant melanoma . When malignancy is suspected, expeditious biopsy or referral for biopsy is strongly advised.

","HeadType":"F_Head","SchemeItemProp":"","Children":[]}]