Abnormal Thickness
Nail thickening is a common sign of a large number of different conditions. Acquired thickening may be due to conditions that reduced nail growth or inflammatory disorders of the nail bed, which result in nail bed hyperkeratosis. Nail thickening is also c
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Abnormal Thickness Nail thickening is a common sign of a large number of different conditions. Acquired thickening may be due to conditions that reduce nail growth or inflammatory disorders of the nail bed, which result in nail bed hyperkeratosis. Nail thickening is also commonly seen in patients with foot deformities due to chronic trauma and friction. Table 5.1. Causes of abnormal thickness Congenital
Acquired
Pachyonychia congenita Epidermolysis bullosae Ectodermal dysplasias Chronic muco cutaneous candidiasis
Onychogryphosis Pachyonychia Dystrophic fifth toe Yellow nail syndrome Onichomatricoma Inflammatory nail disorders: −−Psoriasis −−Pytiriasis rubra pilaris −−Lichen planus of the toenails −−Contact dermatitis −−Onychomycosis
5.1 Congenital Abnormal Thickness Pachyonychia Congenita Pachyonychia congenita (PC) are a group of genetic disorders characterized by nail thickness. PC type I is the most common form and it is caused by a mutation in the keratin 16 or 6A gene. Clinical features include nail abnormalities, palmo-plantar keratoderma, and leukokeratosis. Nail thickening may be preceded by nail bed erythema. Severity of the disease may vary in the different families. Table 5.2. Clues for diagnosis Nail thickening of the 20 nails, due to nail bed hyperkeratosis, is more evident on the distal half of the nail. Nails show a yellow-brown discoloration, are hard and difficult to trim Palmoplantar keratoderma is a typical feature of type 1 Pachyonychia congenita
A. Tosti et al., Color Atlas of Nails, DOI: 10.1007/978-3-540-79050-1_5, © Springer-Verlag Berlin Heidelberg 2010
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5 Abnormal Thickness
Epidermolysis Bullosae Nail abnormalities are frequent in all types of epidermolysis bullosae (EB) and, in some patients, may be the only symptom of the disease. This is especially seen in dominant dystrophic EB, which may only produce dystrophic toenails. Trauma favors and worsens nail abnormalities. Pachyonychia and onychogryphosis are often associated with nail bed hemorrhages due to subungual blisters. Anonychia and atrophy can also be common features. Table 5.3. Clues for diagnosis Nail thickening associated with skin and nail blistering Isolated nail thickening may be the first symptom
Fig. 5.1. Pachyonychia congenita – severe fingernail thickening.
Fig. 5.2. Pachyonychia congenita – subtle nail changes.
Fig. 5.3. Pachyonychia congenita – the nails are thick, yellowbrown in color and with a transverse over curvature. Note a palmar keratoderma.
Fig. 5.4. Pachyonychia congenita – the nail plates are so thick that the trimming is very difficult.
Fig. 5.5. Thickening and shortening of the great toenail in a patient with dominant dystrophic epidermolysis bullosa. Also note the presence of a hematoma.
Fig. 5.6. Nail thickening, erosions, and granulomatous tissue in a patient with late onset junctional EB.
5.2 Acquired Abnormal Thickness
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5.2 Acquired Abnormal Thickness Onychogryphosis The nail growth is asymmetrical as the medial part of the nail mat
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