Nail dystrophy - an overview (2023)

Median nail dystrophy (dystrophia unguium mediana canaliformis) is a rare transient nail disorder in which a cleft- or canal-like dystrophy develops in one or more nails, usually those of the thumb.

Von:Hurwitz Clinical Pediatric Dermatology (4. Auflage), 2011

Related terms:

  • cyst
  • neoplasm
  • Congenital dyskeratosis
  • psoriasis
  • Alopecia Mucinosa
  • lesion
  • Autosomal dominant inheritance
  • bed of nails
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diseases of the nails

Frederick M. Azar MD, inCampbell's operative orthopedics, 2021

Dystrophic nails (onychogryposis, onychomycosis)

Deformed nails in elderly and diabetic patients can be difficult to manage at best and catastrophic at worst, especially when accompanied by an insensitive foot. It is recommended to have a small double action rongeur and a nail splitter in the office. These nails can be repositioned quickly and safely with these instruments (Abb. 88.3).

Aside from reducing nail mass, onychomycosis, or fungal infection of the nails, can often be treated with benign neglect since its main effect is cosmetic. If treatment to eradicate the fungal infection is desired, referral to a dermatologist for confirmatory testing by appropriate cultures, followed by inexpensive medical treatment, either by topical or oral agents, may be warranted. Most treatment regimens are prolonged, since it is difficult for various drugs to penetrate the nail. Many of the oral medications have serious side effects and patients should be monitored appropriately for these side effects.

The effectiveness of laser therapy for onychomycosis remains controversial. Lasers are approved by the U.S. Food and Drug Administration (FDA) for the "temporary increase in clear nails in patients with onychomycosis," but laser treatment has resulted in lower cure rates than oral and topical therapies. Therefore, laser treatment is not considered a first-line treatment for onychomycosis.

Diseases of the hair and nails

Anna M. Bender, Bernard A. Cohen, inPediatric Dermatology (Fourth Edition), 2013

nail dystrophy

nail dystrophy(Distortion and discoloration of normal nail plate structure) can result from a traumatic or inflammatory process affecting the nail matrix, nail bed, or surrounding tissues. Although onychomycosis, the result of a dermatophyte fungal infection, is the most common cause of nail dystrophy in adults, it is uncommon in prepubertal children (Abb. 8.56). Dystrophic nails often occur as a complication of trauma (Abb. 8.57) or underlying dermatoses such as psoriasis, atopic dermatitis, and lichen planus (Abb. 8.58–8.61).

Nail trauma can cause a subungual hematoma, resulting in a brown-black discoloration. This is especially likely after crush injuries. Diagnosis is usually easy unless the trauma is subtle. Although most hematomas go away without treatment, large, painful collections of blood can be drained by piercing a small hole in the nail plate with a sterile, large-bore needle. This relieves pain and reduces the risk of infection. Dark pigmentation at the base of the big toenail caused by snagging the toe into the end of the shoe during a sudden stop is called "turf toe" and also results from subungual hemorrhage (Abb. 8.62). This must be of melanoma and melanonychia (Abb. 8.63). Hemorrhage can be identified by the presence of purplish-brown pigment in the distal nail and normal proximal nail outgrowth. In melanonychia, gray-brown pigment streaks of variable width extend longitudinally from the proximal nail fold of one or more nails. Although this finding is common in darkly pigmented individuals, it can occur in individuals of any race and age. Irregular or changing streaks of pigment may require a nail biopsy to confirm innocence and rule out melanoma.

Nail biting, grooming, and chronic manipulation of any kind can also lead to nail dystrophy. Repeated trauma to the cuticle can result in leukonychia (transverse white lines) and median nail dystrophy (central longitudinal ridges;Abb. 8.64).

Twenty-nail dystrophy (trachyonychia) is a disorder of otherwise healthy school-age children and is characterized by yellowing, pitting, increased brittleness, and other dystrophic changes that progress over 6 to 18 months and affect most or all nails bearing them to give a roughened texture (Abb. 8.65). Although the course is variable, in many cases the dystrophy heals without scarring over a period of several years. This disorder likely includes a number of conditions that cannot be distinguished unless other skin findings are present.

Nail dystrophy can accompany other skin diseases and help in their diagnosis. For example, alopecia areata is associated with the characteristic Scotch plaid nail pitting (Abb. 8.66). Psoriasis in the nail matrix results in scattered pits that are larger, deeper, and fewer in number than those in alopecia areata (cfAbb. 8.58a). Psoriasis of the nail bed, particularly under the distal nail, causes detachment of the nail plate from the underlying skin (onycholysis) and an oily drop-like discoloration with accumulated scaling (see FigAbb. 8.58b). Onycholysis alone, without pitting or discoloration, can be caused by trauma, infection, nail polish hardener, or phototoxic reactions to drugs like tetracycline (Abb. 8.67).

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diseases of the nails

Robert M. Kliegman MD, inNelson Textbook of Pediatrics, 2020

Trachyonychie (20-Nagel-Dystrophie)

Trachyonychia is characterized by longitudinal ridges, pitting, brittleness, thinning, distal notching, and opalescent discoloration of all nails (Abb. 683.9). Patients must not have associated skin or systemic diseases or other ectodermal defects. Its occasional association with alopecia areata has led some authorities to believe that trachyonychia may reflect an abnormal immunological response to the nail matrix, whereas histopathological studies suggest that it is a manifestation of lichen planus, psoriasis, or spongiotic (eczematous) inflammation of the nail Nagels could act nail matrix. The disorder must be differentiated from fungal infections, psoriasis, nail changes and alopecia areatanail dystrophysecondary to eczema. Eczema and fungal infections rarely cause changes to all nails at the same time. The disease is self-limiting, can be treated with potent topical steroids or topical retinoids, and eventually resolves in adulthood.

(Video) Nails disorders , Nails diseases and differential diagnosis || Mis.Medicine

Diseases of the hair and nails

Saleh Rachidi, ... Bernard A. Cohen, inPediatric Dermatology (Fifth Edition), 2022

nail dystrophy

nail dystrophy(Distortion and discoloration of normal nail plate structure) can result from any traumatic or inflammatory process affecting the nail matrix, nail bed, or surrounding tissues. Although onychomycosis, the result of a dermatophyte fungal infection, is the most common cause of nail dystrophy in adults, it is uncommon in prepubertal children (Abb. 8.56). Dystrophic nails often occur as a complication of trauma (Abb.8.57) or underlying dermatoses such as psoriasis, atopic dermatitis, lichen planus and alopecia areata (figs 8:58-8:61).

Nail trauma can cause a subungual hematoma, resulting in a brown-black discoloration. This is especially likely after crush injuries. Diagnosis is usually easy unless the trauma is subtle. Although most hematomas go away without treatment, large, painful collections of blood can be drained by piercing a small hole in the nail plate with a sterile, large-bore needle. This relieves pain and reduces the risk of infection. Dark pigmentation at the base of the big toenail caused by snagging the toe into the end of the shoe during a sudden stop is called a "turf toe" and also results from subungual hemorrhage (Abb.8.62). This must be of melanoma and melanonychia (Abb. 8.63). Hemorrhage can be identified by the presence of purplish-brown pigment in the distal nail and normal proximal nail outgrowth. In melanonychia, gray-brown pigment streaks of variable width extend longitudinally from the proximal nail fold of one or more nails. Although this finding is common in darkly pigmented individuals, it can occur in individuals of any race and age. Irregular or changing pigment streaks require a nail biopsy to confirm their innocence and rule out melanoma. The extension of a dark longitudinal stripe to the proximal nail fold is called Hutchinson's sign and strongly suggests melanoma.

Nail biting, grooming, and chronic manipulation of any kind can also lead to nail dystrophy. Repeated trauma to the cuticle can produce leukonychia (white transverse lines), and constant plucking of the nail plate leads to median nail dystrophy (median longitudinal ridges;Abb. 8.64).

Twenty-nail dystrophy (trachyonychia) is a disorder of otherwise healthy school-age children and is characterized by yellowing, pitting, increased brittleness, and other dystrophic changes that progress over several months and affect most or all nails, causing them to become rough texture (Abb. 8.65). Although the course is variable, in many cases the dystrophy isdissolves without scarring over a period of several years. This disorder likely includes a number of conditions that cannot be distinguished unless other skin findings are present. The main causes of trachyonychia are lichen planus, alopecia areata and psoriasis.

Nail dystrophy can accompany other skin diseases and help in their diagnosis. For example, alopecia areata is associated with the characteristic Scotch plaid nail pitting (Abb. 8.66). Psoriasis in the nail matrix results in scattered pits that are larger, deeper, and less numerous and more randomly located than in alopecia areata (Abb.8.58a). Psoriasis of the nail bed, particularly under the distal nail, causes detachment of the nail plate from the underlying skin (onycholysis) and an oily drop-like discoloration with aggregate scales (Abb. 8.58b). Onycholysis alone, withoutDimples, or discoloration, can be caused by trauma, infection, nail polish hardener, or phototoxic reactions to drugs such as tetracyclines (Abb. 8.67).

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Dermatology

Basil J. Zitelli MD, inZitelli und Davis' Atlas of Pediatric Physical Diagnosis, 2018

Onychomycosis and nail dystrophy

Onychomycosis or fungal infection of the nail plate (Abb. 8.132), is not as common in children as in adults. Hencenail dystrophyshould not automatically be treated as a fungal infection unless demonstrated by microscopic examination and/or fungal culture. Dystrophic nails can be the end result of many different types of inflammation of the nail matrix and often occur after discrete or more minor repetitive trauma or friction (Abb. 8.133) or from an underlying dermatosis such as psoriasis, atopic dermatitis, or lichen planus.

Diseases of hair and nails

Amy S. Paller MD, Anthony J. Mancini MD, inHurwitz Clinical Pediatric Dermatology (Fifth Edition), 2016

Median Nail Dystrophy and Habit-Tic Dystrophy

Mediannail dystrophy(also referred toSolenonychiaormedian canaliform nail dystrophy) and habit-tic dystrophy (also calledOnychotillomaniaorHabitus tic deformity) are rare conditions that usually affect the thumbs. Both disorders have a central channel-like depression or fissure of varying severity with fissures or lines extending from the central longitudinal lesion to the lateral nail edges (Abb. 7-56). In median nail dystrophy, the lines are typically described as feathery cracks resembling a Christmas tree, and in habit tic dystrophy they are described as being more horizontally arranged and irregularly spaced; However, the two disorders can appear identical, leading some experts to group them as one disorder. A transient defect in the matrix interfering with nail formation is believed to be the cause, causing the indentation or split to appear initially at the cuticle and propagate outward as the nail grows. Median nail dystrophy has been reported during isotretinoin administration478.479and with habitual use of smartphones and tablets,480whereas habit tic dystrophy is often associated with continuous picking of the nail cuticle of the affected digit and has been described in association with guitar playing.481The disorder can sometimes resolve spontaneously years later, especially after the causative trauma has subsided. Aside from preventing trauma, there is no effective treatment, although 4 months of tacrolimus 0.1% ointment resulted in significant improvement in a 19-year-old man with moderate nail dystrophy.482

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Nagelerkrankungen

James G. MarksJrMD, Jeffrey J. Miller MD, inThe Principles of Dermatology by Lookingbill and Marks (Fifth Edition), 2013

Definition

nail dystrophycaused by psoriasis is the result of abnormal keratinization of the nail matrix and nail bed as a result of involvement of these structures in psoriasis.

incident

Nail involvement in patients with psoriasis is common. Reported incidences range from 10% to 50%.

Story

Nail psoriasis is usually asymptomatic. However, fingernail involvement can be a significant cosmetic problem, and toenail deformity can cause pain related to pressure from shoes.

Physical examination

Fingernails are more commonly affected in psoriasis than toenails. All or some nails may be affected. It is uncommon for psoriasis to only affect the nails; in less than 5% of patients only the nails are affected without skin disease. The examiner should look to other sites to confirm the diagnosis, particularly other areas commonly affected by psoriasis: the scalp, elbows, knees, and intergluteal folds. In the nails, the most characteristic lesions are small, multiple pits created by punctate psoriatic lesions in the nail matrix. Involvement of the nail bed leads to brown discoloration (oil stain), thickening of the nail plate, detachment of the nail plate from the nail bed (onycholysis), distal crumbling, and splinter hemorrhage (Abb. 21.4A).

Having psoriatic nails:

1.

pits

2.

Ölfleck

3.

Onycholyse

4.

thickening

differential diagnosis

The differential diagnosis of psoriasis of the nails includesOnychomycosis,Trauma,aging, andDystrophy as a result of eczema, or another inflammatory process in the area of ​​​​the nail fold. Fungal infections of the nail can be ruled out by a KOH preparation and culture. Otherwise, psoriatic nails can only be diagnosed with certainty if other typical lesions of psoriasis are found elsewhere. Although nail biting is the most characteristic finding of psoriasis, it is also occasionally associated with itAlopecia areata.

laboratory and biopsy

Nails are rarely examined by biopsy to confirm a diagnosis of psoriasis (Feige. 21.4B).

therapy

Treatment of nail psoriasis is difficult and mostly unsatisfactory. Therefore, therapy is often not recommended. Injecting steroids into the proximal nail fold is painful and the results are often disappointing. Topical preparations are ineffective.

Systemic medications used in psoriasis often help with nail involvement, but nail disease alone does not justify the use of these effective therapies. Trimming and cutting deformed nails reduces discomfort caused by pressure. Fingernails can be cosmetically enhanced through the use of molded plastic nails and the application of fingernail polish.

Therapy of nail psoriasis

Trim

Cosmetics

course and complications

Psoriasis of the nail is a chronic condition and has a waxing and waning course. Arthritis of the distal interphalangeal joint is often associated with nail involvement. The nail is sometimes secondarily infected withCandida albicansorPseudomonas aeruginosa.PseudomonasThe infection is easily recognized by a green discoloration and is treated with 2% thymol in alcohol, one or two drops three times a day.

pathogenesis

Psoriasis is characterized by a marked acceleration of epidermal cell replication, leading to proliferation of keratinocytes. When this occurs in the nail bed, excess keratin becomes trapped under the nail plate and onycholysis occurs. The appearance of an "oil stain" is caused by keratin residue and inflammation in the nail bed. The nail pits result from involvement of the nail matrix, where psoriasis is thought to create small foci of defects in the nail plate. As the nail plate advances, these defective parts fall out, leaving the characteristic pits.

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(Video) NAIL DISEASES AND DISORDERS

Nagelerkrankungen

James G. MarksJrMD, Jeffrey J. Miller MD, inThe Principles of Dermatology by Lookingbill and Marks (Sixth Edition), 2019

psoriasis

Important points

1.

Psoriatic nails can mimic onychomycosis

2.

The treatment is unsatisfactory

Definition

nail dystrophycaused by psoriasis is the result of abnormal keratinization of the nail matrix and nail bed as a result of involvement of these structures in psoriasis.

incident

Nail involvement in patients with psoriasis is common. Reported incidences range from 10% to 50%.

Story

Nail psoriasis is usually asymptomatic. However, fingernail involvement can be a significant cosmetic problem, and toenail deformity can cause pain related to pressure from shoes.

Physical examination

Fingernails are more commonly affected in psoriasis than toenails. All or some nails may be affected. It is uncommon for psoriasis to only affect the nails; in less than 5% of patients only the nails are affected without skin disease. The examiner should look to other sites to confirm the diagnosis, particularly other areas commonly affected by psoriasis: the scalp, elbows, knees, and intergluteal folds. In the nails, the most characteristic lesions are small, multiple pits created by punctate psoriatic lesions in the nail matrix. Involvement of the nail bed leads to brown discoloration (oil stain), thickening of the nail plate, detachment of the nail plate from the nail bed (onycholysis), distal crumbling, and splinter hemorrhage (Abb. 21.4A).

Having psoriatic nails:

1.

pits

2.

Ölfleck

3.

Onycholyse

4.

thickening

differential diagnosis

The differential diagnosis of psoriasis of the nails includes onychomycosis, trauma, aging and dystrophy secondary to eczema or other inflammatory process in the nail fold area. Nail fungal infections can be ruled out by PAS staining of nail sections or KOH preparation and culture. Otherwise, psoriatic nails can only be diagnosed with certainty if other typical lesions of psoriasis are found elsewhere. Although nail galling is the most characteristic finding of psoriasis, it is also occasionally associated with alopecia areata.

Differential diagnosis of nail psoriasis

Onychomycosis

Trauma

aging

eczema

laboratory and biopsy

Nails are rarely examined by biopsy to confirm a diagnosis of psoriasis (Feige. 21.4B).

therapy

Treatment of nail psoriasis is difficult and mostly unsatisfactory. Therefore, therapy is often not recommended. Injecting steroids into the proximal nail fold is painful and the results are often disappointing. Topical preparations are ineffective.

Systemic medications used in psoriasis often help with nail involvement, but nail disease alone does not justify the use of these effective therapies. Trimming and cutting deformed nails reduces discomfort caused by pressure. Fingernails can be cosmetically enhanced through the use of molded plastic nails and the application of fingernail polish.

Therapy of nail psoriasis

Trim

Cosmetics

(Video) Nail Abnormalities or Onychodystrophy

course and complications

Psoriasis of the nail is a chronic condition and has a waxing and waning course. Arthritis of the distal interphalangeal joint is often associated with nail involvement. The nail is sometimes secondarily infected withC. albicansorPseudomonas aeruginosa. Pseudomonas infection is easily recognized by the green discoloration and is treated with gentamicin or polymyxin-B, one or two drops three times a day.

pathogenesis

Psoriasis is characterized by a marked acceleration of epidermal cell replication, leading to proliferation of keratinocytes. When this occurs in the nail bed, excess keratin becomes trapped under the nail plate and onycholysis occurs. The appearance of an "oil stain" is created by keratin debris and inflammation in the nail bed. The nail pits result from involvement of the nail matrix, where psoriasis is thought to create small foci of defects in the nail plate. As the nail plate advances, these defective parts fall out, leaving the characteristic pits.

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Nagelerkrankungen

Robert A. Silverman, inNeonatal Dermatology (2nd Edition), 2008

CONGENITAL ONYCHODYSPLASIA OF THE INDEX FINGER

Congenital onychodysplasia of the index fingers (COIF), also known as Iso and Kikuchi syndromes, was first described in 1969.47,48Original cases were congenital, confined mainly to the index fingers, and characterized by anonychia, micronychia, and/or polyonychia (Abb. 29-7). They were non-familial and non-hereditary and had no underlying bone or joint abnormalities. Since then, the clinical criteria have been modified or expanded to include a number of additional observations.49

Although the index fingers are most commonly affected, onychodystrophy has been reported in other fingers and toes.50,51Malformations, rolled micronychia, hemionychogryphosis, onychoheterotopia, and polyonychia with syndactyly have also been detailed. Unlike nail-patella syndrome, abnormalities in the nail unit are more prominent on the radial aspects of the digits. A Y-shaped bifurcation of the terminal phalanx on lateral radiographs is common and characteristic of the disease.52Familial cases are also documented.53

The pathogenesis of congenital onychodysplasia is poorly understood. Abnormal vasculature, anomalies from an abnormal grip, external deformation from pressure on the skull, exposure to teratogens, and genetic influences have been implicated by a number of authors.54It is quite possible that the clinical findings can be explained by one of these theories if the initiating event occurs at some point during the embryological development of the nail unit.

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Various congenital and developmental disorders

B.J. Manaster MD, PhD, FACR, ... David G. Disler MD, FACR, inMusculoskeletal Imaging (Fourth Edition), 2013

Osteo-Onychodysplasia

Osteo-Onychodysplasia(Nail-Patella Syndrome,Fong Syndrome) is a rare autosomal dominant disease with multiple skeletal abnormalities. The most prominent feature is posterior iliac horns, a pathognomonic finding present in most cases (Abb. 47-14A). The knees are dysplastic with absent or hypoplastic kneecaps (Abb. 47-14B), hypoplastic lateral femoral condyles and the associated valgus alignment (genu valgum). The elbows are also dysplastic, with a hypoplastic capitellum and associated radial head dislocation. The fifth metacarpals may be short. Clinical features include dysplastic fingernails, particularly of the thumb and index finger, clinodactyly, and renal disease.

A B C D

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FAQs

How do you describe nail dystrophy? ›

Abnormal changes in the shape, color, texture, and growth of the fingernails or toenails. Nail dystrophy is often caused by infection or injury to the nail. It may also be caused by certain conditions, including psoriasis, eczema, warts, cysts, and some tumors.

What causes dystrophic nails? ›

Dystrophic toenails are commonly caused by a fungal infection of the toenail, called onychomycosis. Other potential causes include psoriasis and trauma - either direct injury or chronic, repetitive microtrauma.

How do you treat nail dystrophy? ›

Treatment includes filing or buffing of the nails, oral biotin supplements, urea nail preparations and triamcinolone injections into the nail matrix. Trachyonychia may also spontaneously resolve with time.

Does nail dystrophy disappear? ›

Nail dystrophy may resolve with treatment of the cause, but, if not, manicurists may be able to mask nail changes with appropriate trimming and polishes. (See also Overview of Nail Disorders. Nail changes may occur in many systemic conditions... read more .)

What is the most common nail disorder? ›

Brittle nail, simple chronic paronychia, and onycholysis represent three of the most prevalent nail disorders. Brittle nails are characterized by increased fragility of the nail plate due to damage to the nail matrix or changes to nail plate cohesion, caused by internal and/or external factors.

How do you get rid of 20 nail dystrophy? ›

There is no specific treatment for twenty-nail dystrophy. It is a very difficult condition to treat and often results are unsatisfactory.
...
Some treatments that have been tried include:
  1. Griseofulvin and other oral antifungal agents.
  2. Systemic, topical and intralesional corticosteroids.
  3. Topical PUVA.

What vitamin deficiency can cause nail problems? ›

- A deficiency in B-complex vitamins, especially biotin, will produce ridges along the nail bed. - A diet lacking in calcium contributes to dry, brittle nails. - A lack of folic acid and vitamin C can lead to hangnails.

How does vitamin D deficiency affect nails? ›

Vitamin D regulates calcium levels in the body which is an essential contributor to having healthy nails. If you find yourself with brittle and weak nails, it could mean a lack of Vitamin D.

What is 20 nail dystrophy? ›

The term trachyonychia, also known as twenty-nail dystrophy, is used to describe thin, brittle nails with excessive longitudinal ridging. The term twenty-nail dystrophy has been incorrectly applied to other conditions that can affect all twenty nails.

What vitamins should I take for ridges in nails? ›

Summary Adequate magnesium intake is crucial to prevent vertical ridges in your nails. This mineral also helps with protein synthesis and the formation of new nails.

What are 5 nail disorders? ›

Tips to treat the 5 most common nail disorders: brittle nails, onycholysis, paronychia, psoriasis, onychomycosis.

Can ridges of fingernails be reversed? ›

Some dermatologists suggest you can gently buff nails to remove ridges. However, it's recommended to stick with moisturizing your nails, keeping them trimmed, and checking with a dermatologist for further consideration.

What is trimming of dystrophic nails? ›

Example: A physician trims fingernails or toenails, usually with scissors, nail cutters, or another instrument when the nails are dystrophic from nutritional or metabolic abnormalities.

Why are onychomycosis so difficult to treat? ›

Onychomycosis is more difficult to treat than most dermatophytoses because of the inherent slow growth of the nail. Older antifungal agents (ketoconazole and griseofulvin) are unsuitable for onychomycosis because of their relatively poor efficacy and potential adverse effects.

What do malnutrition nails look like? ›

White nails can be the result of anemia and pink or red nails may suggest malnutrition with several nutrient and vitamin deficiencies. Additionally, biotin deficiency can increase the risk of fungal nail infections and subsequent nail plate discoloration.

Is nail dystrophy contagious? ›

Dystrophic nails can be contagious if they're caused by toenail fungus. But if the problem is caused by trauma or psoriasis, you can't spread it to others.

Can you regrow lost nails? ›

After a nail separates from the nail bed for whatever reason, it will not reattach. A new nail will have to grow back in its place. Nails grow back slowly. It takes about 6 months for a fingernail and up to 18 months for a toenail to grow back.

How do you describe diabetes nails? ›

What to Look For in Diabetic Toenails. The first toenail change you'll notice in diabetic patients is likely to be discoloration. Most have some yellowing of the nails, though the shade and involvement can vary. Discoloring may start at the distal edge (tip), and run all the way to the root of the nail bed.

How can you describe onycholysis? ›

Onycholysis is when your nail separates from its nail bed. It often appears after an injury to your nail, but it may have other causes, including fungi. Treatment may only involve cutting away the separated nail as it grows out, or you may need to take antifungal medications or stop using certain nail products.

What is the characteristics of onycholysis? ›

Onycholysis is characterized by a spontaneous separation of the nail plate starting at the distal free margin and progressing proximally. In onycholysis, the nail plate is separated from the underlying and/or lateral supporting structures.

What are the features of the disorder of the nails? ›

Consult a doctor if you are worried about any of the following symptoms of nail abnormalities: changes in nail shape, such as curling or clubbing. discoloration, such as dark or white streaks, or other changes in color. changes in thickness, such as thinning or thickening of nails.

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