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rarely can involve all 20 nails (Figure 19.20) Other findings: discoloration, onycholysis, distal subungual debris and oil spotting Periungual psoriasis can lead to marked nail dystrophy with hyperkeratosis and crumbling of the nail plate Figure 19.18 Pincer nail causing pain in this teenager Mallory Chapter 19 366 27/1/05 3:07 pm Page 366 Illustrated Manual of Pediatric Dermatology Racquet nail • Congenital abnormality of the nail, causing the • nail to be broader and shorter Most common on the thumb Red lunulae • Seen in collagen vascular disease, alopecia areata, congestive heart failure Splinter hemorrhages • Associated with subacute bacterial endocarditis, trauma, vasculitis, cirrhosis, trichinosis, scurvy, psoriasis, chronic glomerulonephritis, Darier disease Terry’s nails Figure 19.19 Pseudomonas infection of the nail bed causing yellow–green discoloration of the nail and the nail bed • Distal 1–2 mm pink, proximal nail white • Seen with hypoalbuminemia or hepatic cirrhosis Trachyonychia • Uniform roughness of surface of nail plate • Associated with ichthyosis vulgaris, ectodermal dysplasia, 20-nail dystrophy, others Traumatic nail injury • Injury to the nail, nail matrix, nail plate (Figures • • 19.21 and 19.22) Common in childhood Can cause permanent dystrophy Twenty-nail dystrophy Figure 19.20 Psoriasis – hyperkeratotic plaques under nails with pitting • Acquired dystrophy involving all 20 nails • Characterized by marked roughness of the nail Pterygium • Associated with dyskeratosis congenita, graft- • • • • versus-host disease, Raynaud disease, systemic sclerosis • • Wing-shaped destruction of nail matrix • Overgrowth of cuticle onto nail eventually destroying the nail, causing scarring plates (trachyonychia) with longitudinal grooves, striations, onychorrhexis, distal chipping (Figure 19.23) Nails can be either thin or thick May be associated with lichen planus Cause unknown Course variable with improvement in 6 months to 16 years Treatment: Mallory Chapter 19 27/1/05 3:08 pm Page 367 Nail disorders Figure 19.21 Trauma – residual damage to nail caused by slamming the finger in a car door 367 Figure 19.23 Twenty-nail dystrophy – all nails simultaneously developed trachyonychia • Painful recurrent vesicles around the distal finger or nails Yellow nails • Thickened yellow nails • Associated with chronic lymphedema, pleural effusion, bronchiectasis, chronic bronchitis, rheumatoid arthritis, sinusitis, thyroid disease, psoriasis, pachyonychia congenita, drugs (e.g
