Damage to the nail as a result of trauma or specific disease results in nail dystrophy. Nail dystrophy is the presence of misshapen or partially destroyed nail plates defined. Soft, yellow keratin often accumulates between the dystrophic nail plate and nail bed, which is equal to the former. Various aspects of nail dystrophy are discussed below.
Trauma
Trauma to the tips of the fingers sometimes leads to the formation of a subungual hematoma. The severe pain thataccompanied, this problem can be relieved by piercing the nail plate with a hot needle or paper clip. Large subungual hematomas cause detachment of the nail plate until weeks later months. Permanent scarring with nail plate thickening and ridging sometimes accompanies trauma. Scarred nails seem particularly predisposed to the further development of onychomycosis. Unfortunately, the surgical removal of the scarred nail plate is simply followed by the regrowth of an equally dystrophicNail.
Onychomycosis
Fungal infection is a very common cause of nail dystrophy. The big toenail, seems particularly vulnerable to infections. Infections of the fingernails occurs only in the previously traumatized nails or tinea manum with subsequent involvement of the nail. The probability of onychomycosis increases with age, children are rarely, if at all affected.
The first sign of onychomycosis is the development of a small area of onycholysis (separation of nail plate from theNail bed) at the distal tip of the nail. Shortly thereafter, there is an accumulation of yellow to soft keratin in the space created by the onycholysis. This will be accompanied by further lifting of the proximal nail fold. Finally, the process leads to a partially destroyed, heaped up, misshapen yellow nail. The entire process is asymptomatic unless a thickened toenail begins to press against the tip of the shoe.
Most of onychomycosis is due to infection with Trichophyton rubrum, but in a few casesFlocwsum Epidermophyton and Trichophyton mentagrophytes may be recovered. Infection with mentagrophytes is usually associated with a mild form of onychomycosis, in which parts to lighten the superficial nail plate. The treatment is the same regardless of the organism causing the disease. Orally administered griseofulvin (or in rare cases, ketoconazole) is necessary if treatment is desired. For all practical purposes, a topical therapy with currently available agents is never curative.
Most of the fingernailInfections will clear after 3 to 6 months of continuous therapy. Toenails, which requires due to its slower growth, 9 to 12 months of treatment. Nearly all fingernail infections respond to therapy, but the response rate for toenail infections is much lower. In addition, the relapse rate after treatment is stopped, is extremely high. Consequently, many clinicians discourage treatment of toenail onychomycosis.
Psoriasis
Nail dystrophy occurs a considerableProportion of patients with psoriasis. In most cases, nail changes follow the development of skin lesions, but in rare cases it may precede any other clinical signs of disease. Various types of nail dystrophy are recognized. The specific clinical appearance depends on whether the disease occurs in the nail matrix or nail bed.
Onycholysis occurs as a result of including the nail bed. In early lesions of the distal normally smooth, curved junction of the nail plate withThe nail bed is irregular, appear later lower levels of separation. In advanced disease, soft yellow keratin accumulates between the nail plate and nail bed clinically indistinguishable in a manner of what is happening in onychomycosis.
Another type of psoriatic lesion between the plate and bed. This results in the appearance of sharply demarcated, yellow-brown, non-palpable changes in the color of the nail plate. These changes were compared to "oil spots."
The earliestReflection of the nail matrix disease is the development of ice pic stippling or pitting on the surface of the nail plate. This type of pitting occurs primarily in patients with psoriasis, but it can also be seen with eczema disease of the hand and in alopecia areata. Advanced involvement of the nail matrix, in consultation with the nail bed disease leads to the development of grossly deformed nails. This serious nail dystrophies are often accompanied by inflammatory, arthriticChanges in the coffin joint.
There is no universally acceptable, effective treatment for psoriatic nail dystrophy. Topical steroid therapy using finger cot under occlusion may be attempted, but the degree of improvement is disappointing in general. Steroids injected into the nail matrix are more effective, but the major complaints with multiple injections discourages most patients. Improving the debate on the long-term use of topically applied fluorouracil wasreported in few patients. Systemic therapy with methotrexate and etretinate usually leads to clearing of the nails, but the benefits of these substances must be weighed against its toxicity. The simultaneous improvement in nail dystrophy often occurs during spontaneous or therapeutically induced remission of the associated skin lesions.
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