Dermatology – Nail Complaints: By Lukasz Cygan D.O. and Abbas Husain M.D.

Dermatology – Nail Complaints: By Lukasz Cygan D.O. and Abbas Husain M.D.


Nail complaints are common and can include
traumatic, infective, neoplastic, or systemic causes. Here are three conditions you cannot
afford to miss! One. Carcinoma of the nail bed should always
be considered. Squamous cell carcinoma is the most common malignant tumor of the nail,
while melanoma is rare. For SCC, think of a history of trauma, radiation
exposure, or infection with human papillomavirus or HPV. Melanoma, however, typically presents
as a black to brown longitudinal line, also called a longitudinal melanonychia. Longitudinal
melanonychias are generally benign, but if elements in the history raise concern for
melanoma, further evaluation is needed. Think of the mnemonic ABCDEF. A is for age (peaking
from 5th to 7th decade) , B for border and black, C for change in the band, either color
or size, D for digit involvement (with thumb and index digit, most likely), E is for extension
of pigment into proximal or lateral nail fold , and F for family history. If carcinoma is
suspected, an urgent referral for biopsy is needed. It is important to be vigilant, since
a delay in diagnosing a malignant tumor of the nail can greatly affect a patient’s
prognosis. Two. Infections. Paronychia, is a purulent
collection located adjacent to the nail caused by bacteria or fungi. Treatment generally
requires drainage. Simple paronychia, meaning not extending under the nail plate, do not
require incision of the skin but simple lifting the nail plate and expressing out the purulent
material. Extension under the lateral or proximal nail plate requires more extensive incisions,
involving removal of portions of the nail. Chronic paronychia, as seen in immunocompromised
patients, requires surgical intervention. A history of herpes simplex virus infection
or occupation involving manipulation of the mouth such as a dental hygienist in the presence
of vesicular lesions is highly suggestive of herpatic withlow. Three. Systemic causes of nail complaints.
Splinter hemorrhages, which can be caused by local nail disorders such as trauma and
nail psoriasis, can also be suggestive of systemic illnesses such as endocarditis and
connective tissue disorders. Similarly, clubbing of nails can be seen in a variety of systemic
diseases including chronic suppurative pulmonary disease and congenital cyanotic heart disease. Therefore, it’s important to do a full history
and physical in all patients who come in with a potential sign of a systemic illness.

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