Diseases of the generative nail apparatus. Part II: Nail bed

Abstract

Nail bed insults may affect the resultant nail product in a number of ways. If focal in nature, the severity and duration of the insult will determine the appearance of the nail product. Widespread insults may alter the size, shape or colour of the nail plate. Nail bed insults tend to present with more immediacy than nail matrical insults, as there is no need to wait until the nail grows out until the sign is obvious. We are less interested in the history of the event, than we are with the clinical sign being presented to us. Should treatment be required for focal nail bed insults, treatment is likely to be local and curative. Widespread nail bed insults may be associated with systemic diseases and if a result of local problems these may be difficult to treat.

Nail dyschromias

“…[22] Topical and oral vitamin E 800 U for 12-18 months is thought to be effective due to its antioxidant role thereby reducing lipofuscin deposition and by increasing the nail growth rate. [15,23] Oral zinc 300 mg has shown result in one case report. [24] Blue chromonychia Blue discoloration of nails is most commonly drug induced.…”

“…[15] [ Figure 4] Few dermatological conditions which may give rise to yellow discoloration of nails include onychomycosis, psoriasis, and alopecia areata.…”

“…Other reported associations of YNS include rheumatoid arthritis, immunodeficiency states including AIDS, mycosis fungoides, carcinoma breast and gall bladder, nephrotic syndrome, and thyroid disease. [15] Spontaneous recovery in nail changes have been reported to vary between 5% to 30% in various studies, though this is often incomplete and relapse are common. [20,21] Various treatments have been described for nail changes in YNS with varying efficacy.…”

“…Similar discoloration is also reported with the use of azidothymidine for AIDS. [15] Beside drugs, other causes of blue nails include exposure to silver salts either occupationally or as medications, Wilsons disease (causing Azure lunula), glomus tumor of nail, digital arterio-venous malformation, hereditary acrolabial telangiectasia, and advanced AIDS infection [15] [ Figure 5]. …”

Acral lesions in tuberous sclerosis complex: Insights into pathogenesis

“…They are also associated with skin diseases such as psoriasis or onychomycosis, systemic diseases such as subacute bacterial endocarditis or antiphospholipid antibody syndrome , and treatment with kinase inhibitors such as sorafenib 29–32. It is important to recognize the association of splinter hemorrhages with TSC since this may avoid needless evaluation for other conditions.…”