NAIL ABNORMALITIES
NAIL ABNORMALITIES: Excerpt from Algorithmic Diagnosis of Symptoms and Signs
Ask the Following Question:
- Are the abnormalities focal or diffuse? Focal abnormalities include thickening, which is often due to fungus infections; inflammation, which is usually due to a paronychia, onychia, fungal infection, or syphilis; hemorrhages under the nail, which may be due to trauma, subacute bacterial endocarditis, or trichinosis; pitting of the nail, which may be due to psoriasis; and atrophy or dystrophy of the nail, which may be due to peripheral vascular disease, epidermolysis bullosa, nail biting, peripheral neuropathy, and various other dermatoses. Diffuse abnormalities of the nail may include thickening due to syphilis, hyperthyroidism or hypothyroidism, clubbing, cyanotic heart disease, bronchiectasis, carcinoma of the lungs, and other disorders; yellow nails due to lymphedema or chest conditions; and spoon nails due to iron deficiency anemia.
- Diffuse spoon nails may be caused by iron deficiency anemia. Yellow nails may be due to lymphedema or chest conditions. Clubbing may be due to cyanotic heart disease, bronchiectasis, or carcinoma of the lung
. Thickening may result from syphilis, hyperthyroidism, or hypothyroidism. Hemorrhages may be due to trauma, subacute bacterial endocarditis, or trichinosis. Pitting may be due to psoriasis. Focal thickening may be due to fungus infections. Focal inflammation may be due to paronychia, onychia, or syphilis. Focal atrophy or dystrophy may be due to peripheral vascular disease, peripheral neuropathy, epidermolysis bullosa, nail biting, or other dermatoses.
DIAGNOSTIC WORKUP
Focal abnormalities of one nail warrant a culture and sensitivity of any scrapings or exudates from the area, as well as an x-ray of the digit or extremity. A CBC and sedimentation rate will help identify an infectious process. A glucose tolerance test will help identify diabetes mellitus. Careful assessment of the area for vascular insufficiency includes Doppler studies and possibly arteriography. A nerve conduction velocity study and EMG may be necessary if peripheral neuropathy is suspected. A skin or nail biopsy may be helpful.
Routine tests for diffuse nail changes include a CBC, sedimentation rate, chemistry panel, VDRL test, ANA, thyroid profile, chest x-ray, and EKG. Arterial blood gases and pulmonary function studies should be done if clubbing is suspected. Other tests for clubbing will be found on
page 82
. Serial blood cultures should be done if subacute bacterial endocarditis is suspected.
Trichinella
skin test or antibody titer should be done in cases in which there are splintered nails with negative cultures for subacute bacterial endocarditis. Muscle or skin biopsy will be useful not only for trichinosis but also for collagen disease. Nerve conduction velocity studies and EMGs will be helpful in diagnosing peripheral neuropathy.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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