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SUMMARY

SUMMARY

  • Careful observation of the nail and knowledge of its physiology allows one to see which components of the nail apparatus are affected by the pathological process.

  • The objective examination of the nails begins with observation of the periungual tissues, then of the nail plate, observing its size, proportions, shape, color, transparency, surface, adhesion to the free margin.

TIPS FOR DIAGNOSIS

  • In the problem is localized to only one digit, a tumor should be ruled out.

  • Toenail onycholysis is suggestive for trauma or onychomycosis

  • Fingernail onycholysis can be idiopathic or due to psoriasis or trauma

  • Onychoscopy refers to the examination of the nail unit using a dermatoscope.

TIPS FOR TREATMENT

  • Don’t forget that treatment results require months due the slow nail growth

  • Topical drugs do not reach the nail matrix

DON’T FORGET

  • Patients with nail problems should be examined carefully, with proper observation of all twenty nails, under a good source of light, from the different sides.

  • The most important data to collect are as follows: onset, duration, mode of onset, course of nail dystrophy, hobbies, work, hygiene habits, systemic and cutaneous diseases, and family and pharmacological history.

PITFALLS AND CAUTIONS

  • Always use a dermatoscope in case of pigmented nail lesion or possible tumors

  • Nail clippers should always be on hand when visiting a patient with nail dystrophy, since the nail bed is not visible if the onycholytic lamina covers it.

EXPERT PEARLS

  • Photographs should be taken in a standardized and repeatable manner.

  • Instrumental examinations, such as ultrasound, radiography, magnetic resonance nuclear imaging (MRI), or biopsy with histological examination are necessary in some cases.

PATIENT EDUCATION POINTS

  • The approach of nail diseases is complex and requires different steps.

  • The first approach is with non-invasive techniques, such as onychoscopy.

  • In a second step, the clinician could require an invasive technique, such a nail biopsy, especially in case of a suspected nail tumor.

INTRODUCTION

Nail alterations are often associated with dermatological diseases or are consequent to pharmacological treatments. Toenails are frequently subject to footwear-induced trauma. Bacterial, viral, and especially fungal infections can affect the nails, often without other skin symptoms. There are benign and malignant tumors specific to the nails and skin tumors with possible nail localization.

For this reason, patients with nail problems should be examined carefully, with proper observation of all twenty nails, under a good source of light, from the different sides.

HISTORY

The objective examination of the nails begins with observation of the periungual tissues (lateral and proximal folds, cuticle, hyponychium), then of the nail plate, observing its size, proportions, shape, color, transparency, surface, and adhesion to the free margin. The alignment of the nails with the phalanx must always be evaluated; in fact, lateral nail ingrowth and traumatic alterations of the ...

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