Edit concept Question Editor Create issue ticket

Isolated Toenail Dystrophy

Congenital Nonsyndromic Nail Disorder 8


Presentation

  • A 4-year-old boy presents with concern for toenail changes. His toenails were normal at birth. Nine months before presentation his mother noticed three of the nails on his left foot were yellow.[healio.com]
  • It is best considered a reaction or morphologic pattern with a variety of clinical presentations and etiologies.[mdedge.com]
  • If it is dominant type, it presents with less severe form of alopecia and often manifests in later years.[ijtrichology.com]
  • Dermatology Quiz Case presentation An 8-year-old boy presents with a scaly erythematous lesion on his left palm that has been present for six months (Figure 1). His thumbnail of the same hand became dystrophic four months ago (Figure 2).[medicinetoday.com.au]
  • Gene Identification Often, the clinical presentation is not as straight forward as the texts present. Clinical evaluation can present with diffuse as well as punctuate keratodermas and associated nail dystrophy.[faoj.org]
Physician
  • This information is not intended to be patient education, does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment.[diseaseinfosearch.org]
  • *Medscape Business of Medicine Academy Survey, September 2015 Learn from Experienced Professionals Courses were developed especially for physicians by business health experts and experienced physicians.[medscape.org]
  • Am Fam Physician. 2001;63:1113–6. 4. Rodgers P, Bassler M. Treating onychomycosis. Am Fam Physician. 2001;63:663–78.[erratum in Am Fam Physician 2001;63:2129] 5. Samman PD, White WF. The ‘yellow nail’ syndrome. Br J Dermatol. 1964;76:153–7. 6.[aafp.org]
  • Perman, MD, is an attending physician at The Children’s Hospital of Philadelphia. Disclosure: Coughlin and Perman report no relevant financial disclosures.[healio.com]
  • Physicians should be aware of this diagnosis, especially in patients with isolated unilateral or bilateral toenail deformity present from birth. Conflict of interest: none declared. References Richert B, André J.[racgp.org.au]
Enthesopathy
  • DermNet NZ Psoriasis Chronic plaque psoriasis Palmoplantar pustulosis Acrodermatitis continua of Hallopeau Paediatric psoriasis Psychological effects of psoriasis Drug-induced psoriasis Skin signs of rheumatic disease Other websites Psoriasis, nails and enthesopathy[dermnetnz.org]
Self-Mutilation
  • In this disorder, patients pick at and self-mutilate their nails, which can lead to parallel transverse grooves and ridges (washboard deformity or habit-tic nail deformity).[msdmanuals.com]
Self Mutilation
  • In this disorder, patients pick at and self-mutilate their nails, which can lead to parallel transverse grooves and ridges (washboard deformity or habit-tic nail deformity).[msdmanuals.com]
Forgetful
  • Do not forget to exclude onychomycosis when the nail symptoms include onycholysis and subungual hyperkeratosis, and keep in mind that the 2 diseases may occur together ( 12 ).[clinicaldermatology.eu]

Workup

  • The rate of osteolysis is higher in the earlier disease course and more severe in those with nail dystrophy. 17 Pearls On Conducting A Thorough Workup Dermoscopic examination of the nail unit can detect early nail involvement in psoriasis and aid in differentiating[podiatrytoday.com]

Treatment

  • Stay at the forefront of your field with updated treatment methods throughout, as well as an increased focus on patients with skin of color.[books.google.com]
  • CLOSE Medical Disclaimer The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes.[diseaseinfosearch.org]
  • Early diagnosis and treatment of psoriatic arthritis prevents permanent joint damage.[clinicaldermatology.eu]
  • What is the treatment for nail psoriasis? It is difficult to treat nail psoriasis effectively. Topical treatment must be applied to the nail matrix and hyponychium for months or years, and its effects are often disappointing.[dermnetnz.org]

Prognosis

  • Prognosis - Isolated congenital nail dysplasia The ICND is a lifelong condition. Patient documented by Pavone (1982) lost his nails almost completely in his twenties and did not regain them before he died at 77.[checkorphan.org]
  • Prognosis for habit-tic deformity is difficult to determine, as most of the literature on the disorder is in the form of isolated case studies.[clinicaladvisor.com]
  • Prognosis The prognosis is variable and depends on the type of infection as well as host factors such as comorbidities and age.[patient.info]
  • In conclusion, it is an uncommon and probably misdiagnosed condition which may be considered a specific late-onset clinical manifestation of CCC, usually associated with a good prognosis.[journals.lww.com]
  • […] on children of alopecia observed that about 46% of the children had nail abnormalities and about 12% had twenty-nail dystrophy. [8] In fact, it is seen that the nail dystrophy may further speed up the progression of alopecia and is a marker of poor prognosis[ijtrichology.com]

Etiology

  • It is best considered a reaction or morphologic pattern with a variety of clinical presentations and etiologies.[mdedge.com]
  • Lymphocytic infiltrate is seen in the entire dermis, mainly around the blood vessels and appendages Click here to view LS, first identified as a distinct clinical entity by Senear and Caro in 1941, is an acquired, self-limiting linear dermatitis of unknown etiology[idoj.in]
  • The purpose of this paper is to demonstrate that common etiologies may be responsible for diseases at first glance far from being close such as YNS and NLP.[journal.frontiersin.org]
  • (eg, lichen planus) from an infectious etiology involving the nail unit To obtain diagnostic and prognostic information in presentations of isolated nail pathology when routine diagnostic procedures are unsuccessful [42] To obtain an acceptable tissue[emedicine.medscape.com]
  • Etiology Most cases of trachyonychia that have been biopsied demonstrate a spongiotic dermatitis. Trachyonychia related to alopecia areata will show a spongiotic dermatitis within the nail matrix histologically.[dermatologyadvisor.com]

Epidemiology

  • About 10% of all children and adolescents have HPV-induced ungual warts; precise data on the their epidemiology are unavailable.[aerzteblatt.de]
  • Articles that reported the epidemiology, disease associations, clinical presentation, histopathology, and treatment options for trachyonychia were included.[karger.com]
  • Severe clubbing Front view Side views Cyanotic nail beds Epidemiology [ edit ] The exact frequency of clubbing in the population is not known.[en.wikipedia.org]
  • Accordingly, this author examines the pathogenesis and epidemiology of psoriatic nails, provides keys to the clinical diagnosis and reviews potential treatment options.[podiatrytoday.com]
  • Onychomycosis- epidemiology, diagnosis, and management. Indian J Med Microbiol 2008;26:108-116. Thomas J, Jacobson GA, Narkowics CK, Perterson GM, Burnet H, Sharpe C. Toenail onychomycosis: an important global disease burden.[dermquest.com]
Sex distribution
Age distribution

Pathophysiology

  • […] condition has been linked to mutations in the gene on the fourth chromosome (4q33-q34) coding for the enzyme 15-hydroxyprostaglandin dehydrogenase (HPGD); this leads to decreased breakdown of prostaglandin E2 and elevated levels of this substance. [12] Pathophysiology[en.wikipedia.org]
  • Pathophysiology The nail changes seen in opaque trachyonychia are caused by inflammation that affects the entire nail matrix and moderates in intensity, but is continuous.[dermatologyadvisor.com]
  • The concurrence of these events suggests that each shares a common pathophysiologic mechanism, possibly an autoimmune process. 36 37 Jerasutus S - - 1990 Twenty-nail dystrophy is a distinctive pattern of nail changes, in which all 20 nails are uniformly[biomedsearch.com]
  • Pathophysiology of psoriasis. UptoDate . Available at . Published July 8, 2015. Valladeau J, Saeland S. Cutaneous dendritic cells. Semin Immunol. 2005;17(4):273-83. Nestle FO, Kaplan DH, Banker J. Psoriasis. N Eng J Med. 2009;361(5):496.[podiatrytoday.com]

Prevention

  • However, even the best over-the-counter treatments may not prevent a fungal infection from coming back.[naildoctors.com]
  • Prevention - Isolated congenital nail dysplasia Not available. Genetic counselling may help in families where the disease occurred previously.[checkorphan.org]
  • How can nail psoriasis be prevented? At this time, we do not know how to prevent nail psoriasis. Avoidance of trauma is essential. What is the outlook for nail psoriasis? Nail psoriasis varies in severity over time.[dermnetnz.org]
  • Prevention Primary prevention is not practised, except where there is a cause of immunocompromise, such as AIDS, where prophylactic therapy may be considered.[patient.info]
  • It also helps to moisturize the nails and skin to prevent cells from peeling and flaking as well.[naildystrophy.com]

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!