Skip to main content
SpringerLink
Log in

Nail Diseases

  • Chapter
  • First Online:
Dermatology in Public Health Environments

  • 791 Accesses

Abstract

Onychopathy is the term used to describe diseases of the nails of 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 includes 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.

This chapter is an approach of clinical interest onychopathies. All photos are of Dr. Renan Minotto’s collection.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 229.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Free shipping worldwide - see info
Hardcover Book
USD 299.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

Abbreviations

ABCDEF:

Age, band, change, digit involved, extension, family and personal history

HPV:

Human papilloma virus

MRI:

Magnetic resonance imaging

NAM:

Nail apparatus melanoma

NLP:

Nail lichen planus

PAS:

Periodic acid-schiff

SCC:

Squamous cell carcinoma

References

  1. Gupta AK, Cernea M, Foley KA. Improving cure rates in onychomycosis. J Cutan Med Surg. 2016;20:517–31.

    Article  PubMed  Google Scholar 

  2. Vlahovic TC. Onychomycosis: evaluation, treatment options, managing recurrence, and patient outcomes. Clin Podiatr Med Surg. 2016;33(3):305–18.

    Article  PubMed  Google Scholar 

  3. Gupta AK, Daigle D, Foley KA. Network meta-analysis of onychomycosis treatments. Skin Appendage Disord. 2015;1(2):74–81.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bolognia J, Jorizzo J, Rapini R. Nail disorders. In: Dermatology. 2nd ed. Louis: Mosby Elsevier; 2008. p. 1019–142.

    Google Scholar 

  5. Natarajan V, Nath AK, Thappa DM, Singh R, Verma SK. Coexistence of onychomycosis in psoriatic nails: a descriptive study. Indian J Dermatol Venereol Leprol. 2010;76(6):723.

    Article  PubMed  Google Scholar 

  6. Iorizzo M. Tips to treat the 5 most common nail disorders: brittle nails, onycholysis, paronychia, psoriasis, onychomycosis. Dermatol Clin. 2015;33:175–83.

    Article  CAS  PubMed  Google Scholar 

  7. Baran R, Nakamura R. Doença das Unhas: do diagnóstico ao tratamento. Rio de Janeiro: Elsevier; 2011.

    Google Scholar 

  8. Leung AKC, Lam JM, Leong KF, Hon KL, Barankin B, Leung AAM, Wong AHC. Onychomycosis: an updated review. Inflamm Allergy Drug Targets. 2020;14(1):32–45.

    Article  CAS  PubMed Central  Google Scholar 

  9. Belda W Jr, Di Chiacchio N, Criado PR. Tratado de Dermatologia. Athenaeum. 2014;50:1079–118.

    Google Scholar 

  10. Baran R. How to diagnose and treat psoriasis of the nails. Presse Med. 2014;43(11):1251–9.

    Article  PubMed  Google Scholar 

  11. Crowley JJ, Weinberg JM, Wu JJ, Robertson AD, Van Voorhees AS, National Psoriasis Foundation. Treatment of nail psoriasis: best practice recommendations from the Medical Board of the National Psoriasis Foundation. JAMA Dermatol. 2015;151(1):87–94.

    Article  PubMed  Google Scholar 

  12. Grover C, Reddy BS, Uma CK. Diagnosis of nail psoriasis: importance of biopsy and histopathology. Br J Dermatol. 2005;153(6):1153–8.

    Article  CAS  PubMed  Google Scholar 

  13. Pasch MC. Nail psoriasis: a review of treatment options. Drugs. 2016;76:675–705.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Haneke E. Nail psoriasis: clinical features, pathogenesis, differential diagnoses, and management. Psoriasis (Auckl). 2017;7:51–63.

    PubMed  Google Scholar 

  15. Tosti A, Piraccini BM. Warts of the nail unit: surgical and nonsurgical approaches. Dermatol Surg. 2011;27(3):235–9.

    Google Scholar 

  16. Herschthal J, McLeod MP, Zaiac M. Management of ungual warts. Dermatol Ther. 2012;25(6):545–50.

    Article  PubMed  Google Scholar 

  17. Baran R, Kechijian P. Longitudinal melanonychia (melanonychia striata): diagnosis and management. J Am Acad Dermatol. 1989;21:1165–78.

    Article  CAS  PubMed  Google Scholar 

  18. Haneke E, Baran R. Longitudinal melanonychia. Dermatol Surg. 2001;27:580–4.

    Article  CAS  PubMed  Google Scholar 

  19. Azulay RD, Azulay DR. Dermatologia. 4th ed. Rio de Janeiro: Guanabara Koogan; 2006. p. 532–48. 653

    Google Scholar 

  20. Baran R, Dawber RPR, de Becker D, Haneke E, editors. Baran and Dawber’s diseases of the nail and their management. 3rd ed. New York: Blackwell Science; 2001. p. 607–30.

    Google Scholar 

  21. Bilemjian APJ, Maceira JP, Barcaui CB, Pereira FB. Melanoníquia: importância da avaliação dermatoscópica e da observação da matriz/leito ungueal. An Bras Dermatol. 2009;84(2):185–9.

    Article  PubMed  Google Scholar 

  22. Di Chiacchio N, Loureiro WR, Di Chiacchio NG, Bet DL. Tumores Glômicos subungueais sincrônicos no mesmo dedo. An Bras Dermatol. 2012;87(3):477–8.

    Google Scholar 

  23. Maehara LSN, Ohe EMD, Enokihara MY, Michalany NS, Yamada S, Hirata SH. Diagnóstico do tumor glômico pela dermatoscopia do leito e da matriz ungueal. An Bras Dermatol. 2010;85(2):236–8.

    Article  PubMed  Google Scholar 

  24. Minotto R, Corte LD, Boff AL, Silva MVS, Morais MR. Subungual keratoacanthoma: a case report. Surg Cosmet Dermatol. 2014;6(4):377–9.

    Google Scholar 

  25. Santos MF, Souza MEV, Luzzatto L, Albarello L, Minotto R. Giant Onychomatricoma: a case report. Surg Cosmet Dermatol. 2020;12(3):286–9.

    Google Scholar 

  26. Baran R, Kint A. Onychomatrixoma: filamentous tufted tumor in the matrix of a funnel-shaped nail: a new entity (report of three cases). Br J Dermatol. 1992;126(5):510–5.

    Article  CAS  PubMed  Google Scholar 

  27. Carreno AM, Nakajima SR, Pennini SN, Candido Junior R, Schettini APMS. Nail apparatus melanoma: a diagnostic opportunity. An Bras Dermatol. 2013;88(2):268–71.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Haneke E. Nail surgery. Clin Dermatol. 2013;31:516–25.

    Article  PubMed  Google Scholar 

  29. Di Chiacchio N, Di Chiacchio NG. Best way to treat an ingrown toenail. Dermatol Clin. 2015;33:277–82.

    Article  PubMed  Google Scholar 

  30. Baran R, Rigopoulos D. Cirurgia ungueal. In: Tratamento das doenças da unha. Rio de Janeiro: Di Livros; 2014. p. 147–58.

    Google Scholar 

  31. Richert B, Di Chiacchio N, Haneke E. Cirurgia da matriz. In: Cirurgia da unha. Rio de Janeiro: Di Livros; 2012.

    Google Scholar 

  32. Richert B. Surgical management of ingrown toenails: an update overdue. Dermatol Ther. 2012;25:498–509.

    Article  PubMed  Google Scholar 

  33. Mayeaux EJ Jr, Charles C, Murphy TE. Ingrown toenail management. Am Fam Physician. 2019;100(3):158–64.

    PubMed  Google Scholar 

  34. Stacey SK. A practical guide to care of ingrown toenails. J Family Pract. 2019;68(4):199–203.

    Google Scholar 

  35. Richert B, Di Chiacchio N, Haneke E. Cirurgia das dobras laterais. In: Cirurgia da unha. Rio de Janeiro: Di Livros; 2012. p. 85–96.

    Google Scholar 

  36. Rigopoulos D, Larios G, Gregoriou S, Alevizos A. Acute and chronic paronychia. Am Fam Physician. 2008;77:339–43.

    PubMed  Google Scholar 

  37. Baran R, Rigopoulos D. Paroníquia aguda. In: Tratamento das doenças da unha. Rio de Janeiro: Di Livros; 2014. p. 69–71.

    Google Scholar 

  38. Ferreira Vieira d’Almeida L, Papaiordanou F, Araújo Machado E, Loda G, Baran R, Nakamura R. Chronic paronychia treatment: square flap technique. J Am Acad Dermatol. 2016;75(2):398–403.

    Article  PubMed  Google Scholar 

  39. Leggit JC. Acute and chronic paronychia. Am Fam Physician. 2017;96(1):44–51.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Head of the Nail and Hair Department, Dermatology Service, Santa Casa Hospital, Federal University of Health Sciences, Porto Alegre, RS, Brazil

    Renan Minotto

  2. Dermatology Service, Santa Casa Hospital, Federal University of Health Sciences, Porto Alegre, RS, Brazil

    Liliam Dalla Corte, Thaís Millán & Bianca Coelho Furtado

Authors
  1. Renan Minotto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Liliam Dalla Corte
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thaís Millán
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bianca Coelho Furtado
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Dermatology Service, Federal University of Rio Grande do Sul/HCPA, Porto Alegre, Rio Grande do Sul, Brazil

    Renan Rangel Bonamigo

Glossary

Chromonychia

Abnormalities of color depend on the transparency of the nail, its attachments, and the character of the underlying tissue.

Hutchinson’s sign

Extension of melanocytic pigment to lateral, proximal, and distal folds, adjacent to the nail plate.

Koilonychia

A transverse and longitudinal concave nail dystrophy giving a spoon-shaped appearance.

Melanonychia

A black or brown discoloration of the nail, usually localized and often longitudinal.

Onychomycosis

A fungal infection of the nail apparatus.

Pitting

Pits are small erosions in the nail surface.

PUVA therapy

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).

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Minotto, R., Corte, L.D., Millán, T., Furtado, B.C. (2023). Nail Diseases. In: Rangel Bonamigo, R. (eds) Dermatology in Public Health Environments. Springer, Cham. https://doi.org/10.1007/978-3-031-13505-7_77

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-13505-7_77

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-13504-0

  • Online ISBN: 978-3-031-13505-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation