Onychopathy is the term used to describe diseases of the nails which the most prevalent is onychomycosis that is responsible for more than 50% of all nail disorders. This high prevalence results from an increase in life expectancy within the population, increasing attention to nail conditions, and associations with other diseases. It is important to do differential diagnosis that include onychomycosis and psoriasis. Psoriasis is a chronic inflammatory skin disease that can also affect the nails. The clinical features of nail psoriasis depend largely on the type of nail tissue affected by the condition. Nail lichen planus (NLP) is an autoimmune disease that leads to destruction of basal keratinocytes, causing anonychia and permanent atrophy. The prevalence of lichen planus in the general population ranges from 0.5% to 1% and occurs in 10% of patients with disseminated disease. Permanent nail change occurs in more than 4% of patients. Treatment of NLP involves corticosteroid infiltration or systemic corticosteroids. Nail apparatus melanoma (NAM) is a rare presentation of this neoplasm, considered a variant of acral lentiginous melanoma. Its incidence is estimated to vary from 0.7% to 3.5% of all cases of melanoma. It is frequently diagnosed in patients between the fifth and seventh decades of life, and no predilection for sex has been noted. It is common among black and Asian persons. The most common clinical presentation is a brown or black macule of short duration. Amelanotic forms might be mistaken for pyogenic granuloma. Onychomycosis, subungual hematoma, striated melanonychia, and junctional nevus might simulate NAM and must be included in the differential diagnosis.
KeywordsOnychomycosis Fungal infection of the nail Nail lichen planus Nail atrophy Psoriasis Periungual warts Melanonychia Glomus tumor Myxoid cyst Nail keratoacanthoma Squamous cell carcinoma and Bowen disease Onychomatricoma Nail melanoma Ingrown toenail and paronychia
Abnormalities of color depend on the transparency of the nail, its attachments, and the character of the underlying tissue.
Extension of melanocytic pigment to lateral, proximal, and distal folds, adjacent to the nail plate.
A transverse and longitudinal concave nail dystrophy giving a spoon-shaped appearance.
A black or brown discoloration of the nail, usually localized and often longitudinal.
A fungal infection of the nail apparatus.
Pits are small erosions in the nail surface.
PUVA is a combination treatment used for severe skin diseases consisting of psoralens (P) followed by exposure of the skin to UVA (long-wave ultraviolet radiation).
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