Nail Abnormalities and Systemic Pathologies
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Questions and Answers

What is the primary cause of pitting in nails, as described in the text?

  • Irregular distribution of melanocytes within the nail matrix
  • A temporary increase in mitotic function of the proximal matrix
  • A systemic infection causing inflammation of the nail bed
  • The shedding of parakeratotic cells from the stratum corneum of the proximal nail matrix (correct)

How does the text suggest determining the onset of a stressful event that leads to Beau lines?

  • By measuring the length from the eponychium to the Beau line (correct)
  • By measuring the width of the depressed line in the nail plate
  • By observing the number of pits distributed across the nail
  • By analyzing the depth of the indentations on the nail surface

What does the presence of multiple Beau lines indicate, according to the text?

  • A single, severe stressful event impacting nail growth
  • An acute reaction to a topical irritant
  • A repetitive or recurrent stressful event (correct)
  • A chronic deficiency in nail keratin production

Which of the following conditions is most commonly associated with nail pitting?

<p>Alopecia areata and psoriasis (B)</p> Signup and view all the answers

How does the severity of the stressor relate to the appearance of Beau lines?

<p>Severe stressors cause deeper indentations and possibly shedding of the nail plate (B)</p> Signup and view all the answers

What microscopic finding is characteristic of true leukonychia?

<p>Parakeratosis within the ventral nail plate and dissociated thickened keratin layers (B)</p> Signup and view all the answers

Which form of leukonychia is described as having completely white nails?

<p>Leukonychia totalis (C)</p> Signup and view all the answers

Mee lines are a variant of which type of leukonychia?

<p>Leukonychia striata (A)</p> Signup and view all the answers

Which of the following is NOT typically associated with the development of Mee lines?

<p>Minor nail trauma (D)</p> Signup and view all the answers

What causes the opaque white appearance in true leukonychia according to the text?

<p>Interference of light by parakeratotic cells in nail plate (C)</p> Signup and view all the answers

Which of the following is a benign nail variant that appears after minor trauma?

<p>Leukonychia punctata (A)</p> Signup and view all the answers

Which of the following conditions is NOT associated with Mee Lines?

<p>Herpes Zoster (A)</p> Signup and view all the answers

Based on the text, what is a common cause of leukonychia striata?

<p>Microtrauma to the nail (A)</p> Signup and view all the answers

A patient presents with multiple nails showing pigmentation. Which of the following conditions is MOST likely to be associated with this presentation?

<p>Hyperpigmented macules on the palms, soles and mucosa. (C)</p> Signup and view all the answers

A patient develops a gray discoloration of the nail. Clinical dermatoscopy reveals epithelial hyperplasia with focal melanocytic activation. Which of the following is the LEAST likely cause?

<p>A single isolated lentigo. (A)</p> Signup and view all the answers

A patient has a longitudinal gray band on their nail, characterized by regularly spaced, thin, and homogenous gray lines. What potential cause should be considered LEAST likely?

<p>Onychomycosis. (C)</p> Signup and view all the answers

A patient has polydactylous lentigines with nail discoloration, suggesting a systemic issue. What condition should be considered MOST likely?

<p>Laugier-Hunziker syndrome. (D)</p> Signup and view all the answers

Which of the following is LEAST likely to induce nail darkening in a patient, according to the provided text?

<p>Topical corticosteroids. (A)</p> Signup and view all the answers

A patient with a known rheumatological condition presents with abnormal nail-fold capillary morphology. What underlying process is MOST likely contributing?

<p>Impaired digital perfusion. (B)</p> Signup and view all the answers

A patient with AIDS develops nail pigmentation. According to the text, their prognosis is:

<p>Generally poor, with death within months. (C)</p> Signup and view all the answers

Which of the following factors is LEAST likely to contribute to the development of gray lines on multiple nails?

<p>Acute localized trauma to one toe. (C)</p> Signup and view all the answers

What is a commonly proposed mechanism for the development of splinter hemorrhages?

<p>Toxic damage to the capillary walls in the nail bed (A)</p> Signup and view all the answers

Besides minor trauma, which of the following conditions is LEAST likely to induce splinter hemorrhages?

<p>Lyme disease (B)</p> Signup and view all the answers

Which of the following is NOT listed as an arterial embolic disease associated with subungual hemorrhages?

<p>Thrombocytopenia (D)</p> Signup and view all the answers

What is the typical color progression of splinter hemorrhages after their onset?

<p>From red to brown or black (A)</p> Signup and view all the answers

Pyogenic granulomas may be induced by which type of trauma?

<p>Frictional, mechanical or inflammatory (A)</p> Signup and view all the answers

Which peripheral nerve injury is NOT explicitly mentioned as associated with pyogenic granulomas?

<p>Carpal tunnel syndrome (D)</p> Signup and view all the answers

Polydactylous pyogenic granulomas most often develop as a result of which condition?

<p>Inflammatory conditions or drug toxicities (A)</p> Signup and view all the answers

Which of the following is an inflammatory condition that may cause chronic paronychias that progress into pyogenic granulomas?

<p>Cutaneous sarcoidosis (A)</p> Signup and view all the answers

Which systemic process is NOT specifically associated with an increased nail growth rate in the provided text?

<p>Lichen planus (C)</p> Signup and view all the answers

Which of the following conditions is associated with a decreased nail growth rate, according to the text?

<p>Measles (A)</p> Signup and view all the answers

According to the content, which factor is most likely to influence nail growth rate?

<p>Changes in hormonal stimulation (D)</p> Signup and view all the answers

Which of the following cutaneous disorders has NOT been noted with an increased nail growth rate, according to the text?

<p>Atherosclerosis (A)</p> Signup and view all the answers

What underlying biological mechanism does the text suggest may be responsible for nail growth variations influenced by pathologies or medications?

<p>Alterations in mitotic kinetics (B)</p> Signup and view all the answers

Besides systemic conditions, the text implies growth rate of nails can be impacted by:

<p>Certain medications (D)</p> Signup and view all the answers

Which of the following is NOT explicitly mentioned as associated with decreased nail growth rate?

<p>Hyperthyroidism (A)</p> Signup and view all the answers

In addition to systemic processes, an increased nail growth rate is associated with:

<p>Onycholysis (A)</p> Signup and view all the answers

Which condition is least likely to be associated with leukonychia totalis?

<p>Metastatic carcinoma (A)</p> Signup and view all the answers

What distinguishes true leukonychia from apparent leukonychia?

<p>True leukonychia does not fade with pressure and moves distally with nail growth. (D)</p> Signup and view all the answers

Which of the following conditions is associated with Mee lines which are a form of leukonychia striata?

<p>Arsenic toxicity (C)</p> Signup and view all the answers

Leukonychia partialis is most often considered:

<p>An idiopathic condition. (A)</p> Signup and view all the answers

Which of the following is NOT a condition associated with leukonychia striata?

<p>Typhoid fever (D)</p> Signup and view all the answers

According to the text provided, what is a primary cause of apparent leukonychia?

<p>Compromised nail-bed vasculature or substance deposition within the nail plate (A)</p> Signup and view all the answers

Which subtype of leukonychia is most likely to be a part of a syndrome involving sebaceous cysts and renal calculi?

<p>Totalis (A)</p> Signup and view all the answers

Which of the following is least likely to present as leukonychia punctata?

<p>A severe case of eczema. (A)</p> Signup and view all the answers

Hansen disease is associated with which leukonychia subtype(s)?

<p>Striata, totalis and partialis (D)</p> Signup and view all the answers

A patient presents with transverse white bands on their nails that parallel their lunula. Which type of nail abnormality is this description most consistent with?

<p>Muehrcke's nails (D)</p> Signup and view all the answers

Which systemic condition is associated with both leukonychia striata and leukonychia totalis?

<p>Hodgkin lymphoma (A)</p> Signup and view all the answers

Which of the following is a drug-induced cause of leukonychia, according to the text provided?

<p>Corticosteroids (C)</p> Signup and view all the answers

Which clinical feature would help to distinguish apparent leukonychia from true leukonychia during physical examination?

<p>The change with application of pressure. (B)</p> Signup and view all the answers

A patient with a history of renal failure presents with leukonychia. Based on the provided information, which subtype(s) of leukonychia is/are most likely associated with their condition?

<p>Leukonychia striata and totalis (D)</p> Signup and view all the answers

Which condition among the following is least likely to be associated with leukonychia partialis?

<p>Renal allograft rejection (B)</p> Signup and view all the answers

Flashcards

True Leukonychia

A nail condition where the nail plate becomes opaque white due to a disturbance in keratinization within the nail matrix.

Leukonychia Punctata

A type of true leukonychia characterized by white spots on the nail.

Leukonychia Striata

A type of true leukonychia where transverse or longitudinal white bands appear on the nail.

Mee Lines

A form of leukonychia striata characterized by single or multiple white lines across the nail, often associated with acute toxicity.

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Leukonychia Totalis

A rare condition characterized by entirely white nails, often caused by trauma.

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Leukonychia Partialis

A condition where only parts of the nail are white, suggesting incomplete whitening.

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Leukonychia Totalis

A type of true leukonychia that affects the entire nail, often caused by idiopathic factors.

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Leukonychia Partialis

A type of true leukonychia that only affects portions of the nail, typically caused by incomplete involvement of the nail matrix.

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Nail pigmentation

Abnormal pigmentation on multiple nails, often associated with systemic conditions like immunosuppression, endocrine disorders, or drug toxicity.

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Longitudinal gray band

A longitudinal gray band on the nail, often caused by lichen planus, onychomycosis, or systemic lupus erythematosus.

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Medication-induced nail discoloration

Darkening of the nail caused by medications or radiation therapy. Common culprits include antimalarials, antiretrovirals, and chemotherapeutics.

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Nail discoloration due to trauma or fungi

Discoloration caused by subungual hematomas or fungal infections. These conditions fade with time and treatment.

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Gray nail discoloration

A type of nail discoloration that may be associated with systemic problems like endocrine disorders or HIV/AIDS.

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Laugier-Hunziker syndrome

A disorder characterized by hyperpigmented macules on the palms, soles, and mucosa, often accompanied by pigmentation on multiple nails.

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Nail-fold capillary changes

Abnormal nail-fold capillary morphology can occur due to impaired digital perfusion, as seen in connective tissue diseases and peripheral vasculopathies.

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Gray nail discoloration under dermatoscopy

Black nail discoloration can sometimes appear gray due to epithelial hyperplasia with only focal melanocytic activation.

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Beau's Line

A horizontal groove or indentation in the nail plate, caused by a temporary disruption of nail matrix growth. It often appears as a line across the nail.

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Nail Pitting

A condition where the nail surface has small, often numerous indentations or pits. It is a common symptom of psoriasis and alopecia areata.

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Proximal Nail Matrix

The part of the nail bed that produces the nail plate. It is located at the base of the nail, under the cuticle.

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Mitosis

The process of cell division, where one cell divides into two identical daughter cells.

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Stratum Corneum

The outer layer of the nail plate, composed of dead cells that are filled with keratin.

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Concave nail plate

A nail plate that is curved inward and has edges that are bent outwards.

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Increased nail growth rate

A condition where the nails grow at an accelerated rate.

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Decreased nail growth rate

A condition where the nails grow at a slower rate.

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Hormonal influence on nail growth

Changes in hormone levels can influence the growth rate of nails.

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Mitosis and nail growth

The rate of cell division in the nail matrix can affect nail growth.

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Vascular supply and nail growth

The amount of blood supply to the nail matrix can impact nail growth.

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Clubbing and nail growth

Clubbing, a condition where the fingertips are enlarged, is associated with increased nail growth.

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Atherosclerosis and nail growth

Atherosclerosis, a condition where plaque builds up in arteries, can lead to decreased nail growth.

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Splinter Hemorrhages

Reddish-brown or black streaks under the fingernail caused by bleeding into the small blood vessels.

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Pyogenic Granulomas

Small, raised, flesh-colored or reddish bumps on the skin, often near the nail.

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Causes of Splinter Hemorrhages

Caused by trauma, inflammation or blood vessel abnormalities.

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Causes of Pyogenic Granulomas

Friction, mechanical damage (like manicures) or inflammation.

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Emboli in Splinter Hemorrhages

Emboli are small blood clots that block blood vessels.

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Arterial Embolic Diseases

Examples include bacterial endocarditis, marantic endocarditis, atrial myxoma, and pulmonary emboli.

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Underlying Conditions for Splinter Hemorrhages

These conditions can weaken blood vessels and lead to Splinter Hemorrhages.

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Drug-Induced Pyogenic Granulomas

Drugs like antiretroviral therapies, chemotherapeutics, and systemic retinoids.

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Apparent Leukonychia

A condition that appears as white streaks across the nail due to an altered nail bed structure.

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Difference Between True and Apparent Leukonychia

True leukonychia arises from the absence of pigmentation in the nail plate, while apparent leukonychia occurs due to alterations in nail plate structure.

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Leukonychia: Systemic Pathology Indicator

Leukonychia can be a sign of underlying health conditions such as cirrhosis, congestive heart failure, kidney failure, Hodgkin lymphoma, and more.

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Muehrcke's Lines

A group of white lines across the nail, parallel to the lunula, often associated with decreased albumin levels in the blood, suggesting systemic issues.

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Leukonychia Totalis: Familial Trait

The inherited predisposition to leukonychia totalis, often linked to familial traits or specific syndromes.

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Bart Pumphrey Syndrome

A condition that can manifest as leukonychia totalis, often associated with sebaceous cysts and renal calculi.

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Acquired Leukonychia Totalis

Leukonychia totalis can be acquired from systemic pathologies, including cholelithiasis, cirrhosis, congestive heart failure, and more.

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Causes of Leukonychia Partialis

Leukonychia partialis is often idiopathic, but it can occur with conditions like chilblains, Hansen disease, Hodgkin lymphoma, and others.

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Leukonychia Partialis: A Sign of Systemic Issues

Leukonychia partialis can be a sign of underlying conditions, such as nephritis and tuberculosis.

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Nail Discoloration: Systemic Disease Marker

The discoloration of nails can be associated with various systemic diseases, highlighting the importance of careful observation of nail health.

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Study Notes

Nail Abnormalities Associated with Systemic Pathologies

  • Nail abnormalities can be indicative of underlying systemic conditions, including single-organ diseases, multisystemic diseases, and drug-induced ailments.
  • Associated symptoms include dyschromias (color changes), vascular alterations, periungual tissue changes, textural dystrophies, contour alterations, and growth-rate alterations.
  • Systemic pathologies can affect any part of the nail apparatus—matrix, plate, bed, underlying vasculature, and periungual tissues.
  • The location and extent of the damage dictate the resulting nail abnormality.

Dyschromias

  • Dyschromia refers to any color alteration of the normally transparent nail.
  • External exposure causes discoloration following the shape of the proximal nail fold.
  • Systemic diseases or drugs cause discoloration corresponding to the lunula shape.
  • Localized pathology (e.g., injury, infection, tumor) usually affects a single or limited number of nails.

Leukonychia

  • Leukonychia (white nails) has two main subtypes based on the location of the inciting pathology.
  • True leukonychia originates in the matrix, causing a disturbance in distal nail matrix keratinization resulting in opaque white nails.
  • Apparent leukonychia originates from the nail bed, due to factors like impaired vasculature or substance deposition, leading to translucent white nails.
  • Different subtypes exist, including punctata (spots), striata (bands), totalis (entirely white), and partialis (partially white).
  • Mee lines, a variant of leukonychia striata, are marked by transverse white lines, often linked to acute arsenic or thallium toxicity. Multiple systemic diseases are also associated.
  • Leukonychia totalis is often congenital but can also be acquired from systemic ailments like cholelithiasis, cirrhosis, or heart failure.

Apparent Leukonychia Subtypes

  • Terry nails show a thin pink/brownish band at the distal edge of the nail, often linked to conditions like heart failure or hepatic cirrhosis.
  • Muehrcke nails feature paired transverse white bands paralleling the lunula, frequently associated with low albumin levels, such as in nephrotic syndrome or HIV/AIDS.
  • Half-and-half nails exhibit a pink/brownish distal segment contrasted with proximal leukonychia, commonly observed in chronic kidney disease.

Yellow Chromonychia

  • Yellow chromonychia, or yellow nails, can occur normally in the elderly or with systemic diseases like carotenemia, inflammatory dermatoses, jaundice, or sinopulmonary conditions.
  • Yellow nail syndrome is characterized by yellowing of the nails, respiratory issues like sinusitis, and lymphedema.

Erythronychia

  • Erythronychia (red nails) can be categorized by the location of redness:
  • Red lunulae—redness in the lunula, often associated with cardiovascular problems, cutaneous disorders, and other ailments.
  • Longitudinal erythronychia—red band or streak on the nail plate, linked to localized cutaneous neoplasms or inflammatory diseases.

Blue Chromonychia

  • Blue chromonychia involves blue discoloration in the nails, often drug-induced (antimalarials, azidothymidine, chemotherapeutics, minocycline).
  • This is less common for systemic conditions like Wilson disease (copper accumulation), or hemoglobin M disease.

Melanonychia

  • Melanonychia (darkening of the nails) is related to melanin deposition in the nail matrix.
  • It can be a benign nevus or malignant melanocytic tumor, or be linked to trauma, infection or other systemic disorders.

Textural Dystrophies

  • Textural dystrophies can result from damage to the nail matrix or nail bed, causing structural abnormalities in the nail plate (eg., Beau lines).
  • Beau lines are transverse depressions in the nail plate, frequently linked to stressors like trauma, temperature extremes, or systemic disorders, also possible in conjunction with other disorders as indicated in a table.

Onycholysis and Photoonycholysis

  • Onycholysis is the separation of the nail plate from the nail bed.
  • It has primary and secondary varieties with the latter linked to systemic conditions such as hyperthyroidism or other drugs or toxins.
  • Photoonycholysis happens after photosensitizing drug use/porphyrias.

Brittle Nails

  • Brittle nails are characterized by increased nail-plate fragility, leading to cracking or splitting (onychorrhexis or onychoschizia).
  • Causes include trauma, chemical exposure, or metabolic or systemic diseases—as indicated in tables within the text.

Contour Alterations

  • Contour alterations include clubbing (soft-tissue hypertrophy, widening of the angle between proximal nail fold and nail plate), shell nails, koilonychia (concave nail plate), and pincer nails (increased transverse curvature).
  • Clubbing is associated with several systemic issues—indicated in tables within the text.

Periungual Tissue Changes

  • Pyogenic granulomas are vascular tumors appearing as painful, bleeding nodules near the nail folds; they can arise from trauma, inflammation or drug use.

  • Other periungual changes occur in association with systemic disorders like psoriasis, sarcoidosis or drug-induced inflammation.

  • Drug toxicities are detailed in a table.

  • Relevant pathologies for each nail abnormality are indicated in tables within the text.

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Description

Explore the relationship between nail abnormalities and systemic pathologies. This quiz covers aspects like dyschromias, vascular changes, and the impact of various conditions on the nail apparatus. Learn how these abnormalities can indicate underlying health issues.

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