Lichen planus is a chronic inflammatory and immune mediated disease that affects the skin, nails, hair, and mucous membranes. It is characterized by polygonal, flat-topped, violaceous papules and plaques with overlying, reticulated, fine white scale, commonly affecting dorsal hands, flexural wrists and forearms, trunk, anterior lower legs and oral mucosa. Although there is a broad clinical range of LP manifestations, the skin and oral cavity remain as the major sites of involvement. The cause is unknown, but it is thought to be the result of an autoimmune process with an unknown initial trigger. There is no cure, but many different medications and procedures have been used in efforts to control the symptoms.
Onychogryphosis is a hypertrophy that may produce nails resembling claws or a ram's horn.
Koilonychia, also known as spoon nails, is a nail disease that can be a sign of hypochromic anemia, especially iron-deficiency anemia. It refers to abnormally thin nails which have lost their convexity, becoming flat or even concave in shape. In a sense, koilonychia is the opposite of nail clubbing. In early stages nails may be brittle and chip or break easily.
Monilethrix is a rare autosomal dominant hair disease that results in short, fragile, broken hair that appears beaded. It comes from the Latin word for necklace (monile) and the Greek word for hair (thrix).
Terry's nails is a physical condition in which a person's fingernails or toenails appear white with a characteristic "ground glass" appearance without any lunula. The condition is thought to be due to a decrease in vascularity and an increase in connective tissue within the nail bed. It frequently occurs in the setting of liver failure, cirrhosis, diabetes mellitus, congestive heart failure, hyperthyroidism, or malnutrition. Eighty percent of patients with severe liver disease have Terry's nails, but they are also found in patients with kidney failure, in patients with congestive heart failure and are described as a brown arc near the ends of the nails. The recognition of characteristic nail patterns, such as Terry’s nails, may be a helpful herald for early diagnosis of systemic diseases.
Trachyonychia, is a condition characterized by rough accentuated linear ridges on the nails of the fingers and toes. When the condition occurs on all the twenty nails of the fingers and toes, it is known as twenty-nail dystrophy, most evident in childhood, favoring males.
Onychomadesis is a periodic idiopathic shedding of the nails beginning at the proximal end, possibly caused by the temporary arrest of the function of the nail matrix. One cause in children is hand foot and mouth disease. This generally resolves without complication.
Half and half nails show the proximal portion of the nail white and the distal half red, pink, or brown, with a sharp line of demarcation between the two halves. Seventy percent of hemodialysis patients and 56% of renal transplant patients have at least one type of nail abnormality. Absence of lunula, splinter hemorrhage, and half and half nails were significantly more common in hemodialysis patients, while leukonychia was significantly more common in transplant patients.
Green nail syndrome, also known as chloronychia, is a paronychial infection caused due to Pseudomonas aeruginosa that can develop in individuals whose hands are frequently submerged in water. It may also occur as transverse green stripes that are ascribed to intermittent episodes of infection.
Melanonychia is a black or brown pigmentation of the normal nail plate, and may be present as a normal finding on many digits in Afro-Caribbeans, as a result of trauma, systemic disease, or medications, or as a postinflammatory event from such localized events as lichen planus or fixed drug eruption.
Pincer nails are a toenail disorder in which the lateral edges of the nail slowly approach one another, compressing the nailbed and underlying dermis. It occurs less often in the fingernails than toenails, and there usually are no symptoms.
Pterygium inversum unguis is characterized by the adherence of the distal portion of the nailbed to the ventral surface of the nail plate. The condition may be present at birth or acquired, and may cause pain with manipulation of small objects, typing, and close manicuring of the nail. secondary due to connective tissue disorders
Pterygium unguis forms as a result of scarring between the proximal nailfold and matrix, with the classic example being lichen planus, though it has been reported to occur as a result of sarcoidosis and Hansen's disease.
In racquet nails, the nail plate is flattened, the end of the thumb is widened and flattened, and the distal phalanx is abnormally short. In racquet nails, the width of the nail bed and nail plate is greater than their length. The condition is painless and asymptomatic.
Psoriatic erythroderma represents a generalized form of psoriasis that affects all body sites, including the face, hands, feet, nails, trunk, and extremities. First-line treatments for psoriatic erythroderma include immunosuppressive medications such as methotrexate, acitretin, or ciclosporin.
Clouston's hidrotic ectodermal dysplasia is caused by mutations in a connexin gene, GJB6 or connexin-30, characterized by scalp hair that is wiry, brittle, and pale, often associated with patchy alopecia.
Lichen striatus is a rare skin condition that is seen primarily in children, most frequently appearing ages 5–15. It consists of a self-limiting eruption of small, scaly papules.
Paraneoplastic acrokeratosis, or Bazex syndrome is a cutaneous condition characterized by psoriasiform changes of hands, feet, ears, and nose, with involvement of the nails and periungual tissues being characteristic and indistinguishable from psoriatic nails. The condition is associated with carcinomas of the upper aerodigestive tract.
Trichilemmal carcinoma is a cutaneous condition reported to arise on sun-exposed areas, most commonly the face and ears.
