M.D. Tosti - Color Atlas of Nails

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Antonella Tosti , Ralph Daniel , B.M. Piraccini and Matilde Iorizzo Color Atlas of Nails 10.1007/978-3-540-79050-1_1 Springer-Verlag Berlin Heidelberg 2010

1. Nail Evaluation

Antonella Tosti 1

(1)

Department of Dermatology, University of Bologna, Via Massarenti, 1, 40138 Bologna, Italy

(2)

971 Lakeland Drive, Jackson, MS 39216, USA

(3)

Via Canonica 8, 6900 Lugano, Switzerland

Antonella Tosti (Corresponding author)

Email:

Ralph Daniel

Email:

Bianca Maria Piraccini

Email:

Matilde Iorizzo

Email:

Abstract

Examination of the nails under suffi cient lighting should be an integral part of diagnosis. Before the doctor examines the patient, his or her assistants should help the patients to do the following:

1. Remove shoes, socks, stockings

2. Remove all nail cosmetics

3. Have an informative nail questionnaire fi lled out

This will save time for the physician.

Examination of the nails under sufficient lighting should be an integral part of diagnosis. Before the doctor examines the patient, his or her assistants should help the patients to do the following:

Remove shoes, socks, stockings

Remove all nail cosmetics

Have an informative nail questionnaire filled out

This will save time for the physician.

Antonella Tosti , Ralph Daniel , B.M. Piraccini and Matilde Iorizzo Color Atlas of Nails 10.1007/978-3-540-79050-1_2 Springer-Verlag Berlin Heidelberg 2010

2. Anonychia/Micronychia

Antonella Tosti 1

(1)

Department of Dermatology, University of Bologna, Via Massarenti, 1, 40138 Bologna, Italy

(2)

971 Lakeland Drive, Jackson, MS 39216, USA

(3)

Via Canonica 8, 6900 Lugano, Switzerland

Antonella Tosti (Corresponding author)

Email:

Ralph Daniel

Email:

Bianca Maria Piraccini

Email:

Matilde Iorizzo

Email:

Abstract

Total or partial absence of the nail.

May be congenital or acquired.

• Total or partial absence of the nail
• May be congenital or acquired

Table 2.1.

Causes of anonychia/micronychia

Congenital	Acquired
Amniotic bands	Trauma
Teratogens (drugs, alcohol)	Bullous diseases
Nail patella syndrome	Idiopathic atrophy of the nails
Epidermolysis bullosa	Psoriasiform acral dermatitis
Ischemia	Ectodermal dysplasias
DOOR syndrome
Iso-Kikuchy syndrome

2.1 Congenital Anonychia/Micronychia

2.1.1 Teratogens

Nail hypoplasia is more common when drugs are taken during the first months of pregnancy.

Table 2.2.

Causes of anonychia due to teratogens

Alcohol

Carbamazepine

Hidantoine

Morphine

Trimethadione

Warfarin

2.1.2 Nail patella syndrome

Nail hypoplasia is more marked on the ulnar side of the digit. It may be limited to the thumb or involve several nails; in this last case severity decreases usually from the first to the other nails.

Table 2.3.

Clues for diagnosis

Congenital nail hypoplasia more marked on one side of the nail

Other family member affected (AD, mutation of the LMX1B gene)

Exostosis of the iliac crests

Absence or hypoplasia with luxation of the patellae

Nephropathy in up to 60% of cases

Fig. 2.1.

Congenital anonychia due to unknown cause.

Fig. 2.2.

Congenital micronychia due to due to anticonvulsants taken by the mother during pregnancy (courtesy of Prof. A. Oranje, Rotterdam, NL).

Fig. 2.3.

Nail patella syndrome nail hypoplasia and triangular lunula.

Fig. 2.4.

Nail patella syndrome nail hypoplasia is more marked on the ulnar side of the digit.

Fig. 2.5.

Nail patella syndrome the condition is bilateral and symmetric.

Fig. 2.6.

Nail patella syndrome X-ray showing hypoplasia of the patella.

2.1.3 Epidermolysis bullosae

Anonychia is a feature of junctional and dermolytic epidermolysis bullosa, where it is a sequela of bullae formation. It is usually associated with cutaneous blisters or erosions and periungual and subungual granulomatous tissue. Other possible signs are:

• Nail atrophy
• Nail thinning
• Onychogriphosis
• Onychomadesis
• Pachyonychia
• Pincer nails

2.1.4 Ectodermal Dysplasias

Nail hypoplasia is a common feature of ectodermal dysplasias; it may be associated with nail thickening, thinning or fragility.

Table 2.4.

Ectodermal dysplasias

Types	Nails	Associated dermatological features
Hydrotic ectodermal dysplasia (Clouston syndrome) AD	thick, hypoplastic	palmo-plantar keratosis, alopecia
Hypohidrotic ectodermal dysplasia (Christ-Siemens-Touraine) XR	thin, fragile	alopecia
Ankyloblepharon-Ectodermal defects-Cleft lip and palate (AEC, Hay-Wells syndrome) (Rapp-Hodgkin syndrome) AD	thin, fragile, hypoplastic	cicatricial alopecia

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