Parrot beak nails raynauds – nail disorders – mitch medical healthcare f gas regulations ireland

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Early childhood (Figures 2.12-2.13) Idiopathic Congenital LEOPARD syndrome Ectodermal dysplasias (Figure 2.15) Trichothiodystrophy Nail-patella syndrome Acquired Metabolic/endocrine iron deficiency acromegaly haemochromatosis porphyria renal dialysis/transplant thyroid disease Dermatoses alopecia areata Darier’s disease lichen planus psoriasis

Pincer nail is characterized by transverse overcurvature that increased along the longitudinal axis of the nail and reaches its greatest proportion towards the tip (Figure 2.18, 2.19). At this point the lateral borders tighten around the soft tissues, which are pinched without necessarily disrupting the epiderms. Eventually the soft tissue may actually disappear, sometimes accompanied by resorption of the underlying bone. Subungual exostosis may present in this way: the dorsal extension of bone producing the pincer nail (the exostosis) must be excised. The lateral borders of the nail exert a constant pressure, permanently constricting the deformed nail plate (unguis constringens). In extreme cases they may join together, forming a tunnel, or they may become rolled, taking the form of a cone. In certain varieties, the nails are shaped like claws, resembling pachyonychia congenita.

is a developmental abnormality which may be an autosomal dominant trait. gas definition state of matter The pathogenesis of the nail plate deformation has recently been clarified: the great toe nail, which is normally curved transversely, spreads around almost 40% of the dorsal aspect of the base of the terminal phalanx. Radiographs demonstrate that in people with pincer nails the base of the terminal phalanx is widened by lateral osteophytes that are even more pronounced on the medial aspect of the phalanx. By widening the transverse curvature of the nail at its proximal end it becomes more curved distally. This can easily be shown by trying to flatten a curved elastic sheet at one end: the other end will increase its curve. The asymmetry of the lateral osteophytes explains why the lateral deviation of the nail is even more pronounced than that of the distal phalanx.

In brachy onychia (Figures 2.26-2.34) the width of the nail plate (and the nail bed) is greater than the length. electricity lab activities It may occur in isolation or in association with shortening of the terminal phalanx. This ‘racquet thumb’ is usually inherited as an autosomal dominant trait. All the fingers may rarely be involved. The epiphyses of the terminal phalanx of the thumb usually undergo closure between 13 and 14 years of age in girls, slightly later in boys. In individuals with this hereditary defect the epiphyseal line is obliterated on the affected side by 7-10 years of age, only occurring at the usual later age in the normal thumb. electricity usage by state Since periosteal growth continues, the result is a deformed, racquet-like thumb.

Racquet nails have been reported in association with brachydactyly and multiple malignant Spiegler tumours. A syndrome of broad thumbs, broad great toes, facial abnormalities and mental retardation has also been described. Table 2.4 lists many well-recognized causes of short nails, while Table 2.5 gives details of the rarer hereditary and congenital conditions in which it can occur.

? Short stature; spade-like thumbs with thick palmar pads; massive, ‘knobby’ thumbs; short, flexed fingers; limited joint motion with contractures XD or AR Short stature; round face; depressed nasal bridge; short metacarpals; mental retardation; cataracts in 25%; enamel hypoplasia; calcifications in skin ? Osteolysis of peripheral phalanges;

In this symmetrical overcurvature of the free edge, some finger nails mimic the beak of a parrot (Figures 2.35, 2.36); this shape disappears temporarily if the nails are soaked in lukewarm water for about 30 minutes. world j gastrointest surg impact factor This condition is often not seen in clinical practice because such patients usually trim their nails close to the line of separation from the nail bed. Parrot-beak nails are a typical sign of severe acrosclerosis with distal phalangeal resorption. The nail plate bends around the shortened fingertip. ROUND FINGERPAD

One or both little toe nails are often rounded like a claw. This condition predominates in women wearing high heels and narrow shoes and is often associated with the development of hyperkeratosis such as calluses on the feet. Congenital claw-like fingers and toe nails have been reported (Figures 2.38, 2.39) Claw nails may be curved dorsally showing a concave upper surface, resembling onychogryphosis or post-traumatic hook nail. gas vs electric water heater In the nail-patella syndrome when the pointed lunula sign occurs, if the nail is not manicured it will tend to grow with a pointed tip, resembling a claw. Hook nails (Figure 2.40) may be an isolated defect, congenital or acquired (e.g. traumatic).

In Iso-Kikuchi syndrome (congenital onychodysplasia of index finger nails, COIF) there are two types of micronychia. The most frequent is medially sited; in ‘rolled’ micronychia the nail is centrally located (Figures 2.41-2.45). Figures 2.46-2.48 illustrate other examples of congenital micronychia. Overlapping of the nail surface by an enlarged lateral nail fold may result in apparent micronychia (Turner’s syndrome).

In macronychia the nails of one or more digits are wider than normal, with nail bed and matrix similarly affected (Figure 2.49). This may occur as an isolated defect or in association with megadactyly, as in von Recklinghausen’s disease, epiloia and Proteus syndrome (Figure 2.50). Table 2.6 lists the known associations of micronychia and macronychia.

Duplication of the thumb is a sign of congenital polydactyly, one of the most common anomalies of the hand. electricity production in india The frequency of polydactyly of the hands has been estimated to be 0.37%; it is more common than polydactyly of the feet (Figure 2.51). Seven types of thumb polydactyly can be distinguished according to the level of bone bifurcation. Patients with types 1 and 2 thumb polydactyly have two distinct nails separated by a longitudinal incision or a unique nail with a central indentation of the distal margin (Figures 2.52, 2.53). Symphalangism is commonly observed. Thumb polydactyly may be sporadic, usually transmitted as an autosomal dominant trait with variable expressivity. A similar clinical picture can be seen in the great toe with bifurcation of the terminal phalanx and duplication of the nail. Early treatment is important to maximize functional restoration and aesthetic results.

Patients with atopic dermatitis or chronic erythroderma may be ‘chronic scratchers and rubbers’. The surface of the nail plate becomes glossy and shiny and the free edge is worn away (Figures 2.54, 2.55). This condition, also called usure des ongles, may also occur in many different manual occupations. It has recently been described as a particular hazard of individuals handling heavy plastic bags.

Shiny finger nails usually imply severe scratching or rubbing of the skin with distal base (Figure 2.56). The distal margin shows a V-shaped incisure. ‘Bidet nails’ result from chronic rubbing of the nails against a hard surface and typically affect the middle three fingers of the dominant hand. The following conditions may be responsible:

It is impossible to differentiate completely between anonychia and onychatrophy in the light of current knowledge. In principle the term ‘anonychia’ (total or partial) is probably best reserved for conditions in which the nail has failed to develop; ‘onychatrophy’ should be used to describe processes in which the nail has initially formed satisfactorily and then shown total or partial regression. Table 2.7 lists the causes of anonychia and onychatrophy.

In aplastic anonychia, a rare congenital disorder occasionally associated with other defects such as ectrodactyly, the nail never forms. Loose, horny masses are produced by the metaplastic squamous epithelium of the matrix and the nail bed in anonychia keratodes. chapter 7 electricity Hypoplasia of the nail plates is a hallmark of the nail-patella syndrome; in the least affected cases only the ulnar half of each thumb nail is missing.

Permanent hypo- or anonychia (Figures 2.57-2.60) +/- ectrodactyly +/- dental malformations Nail-patella syndrome (Figure 2.60) Congenital onychodysplasia of index finger Coffin-Siris syndrome with many congenital defects DOOR syndrome (deafness, onychodystrophy, osteodystrophy, mental retardation) (Figure 2.58) Onychatrophy (Figures 2.61-2.78) With pterygium (Figure 2.71) lichen planus (Figures 2.71, 2.72) acrosclerosis (Figure 2.63) onychotillomania (Figures 2.76, 2.77) Lesch-Nyhan syndrome chronic graft-versus-host disease Stevens-Johnson or Lyell’s syndrome (Figure 2.66) cicatricial pemphigoid (Figure 2.64) Without pterygium severe paronychia with nail dystrophy Stevens-Johnson or Lyell’s syndrome (Figure 2.66) epidermolysis bullosa (Figures 2.67-2.69) amyloidosis etretinate nail dystrophy (Figure 2.62)