This document provides a summary of a seminar presentation on the anatomy and physiology of nails. The summary includes:
1) The presentation covered the embryology, basic structure, microscopic anatomy, blood supply, growth, and signs of systemic disease of nails.
2) Key structures discussed include the nail matrix, which produces the nail plate, and the nail bed, which consists of epidermis and connective tissue closely apposed to the distal phalanx.
3) Environmental and pathological factors can affect nail growth rate, with faster growth seen in conditions like psoriasis and slower growth with issues like finger immobilization.
Anatomy & physiology of sweat glands, sebaceousAhmed Amer
1. The document describes the anatomy and physiology of sweat glands, sebaceous glands, hair, and nails. It discusses the structure, development, innervation, function, and disorders of eccrine and apocrine sweat glands.
2. Sebaceous glands are described in relation to their sites of occurrence, development linked to androgen levels, and role in secreting sebum.
3. The stages of the hair follicle from infundibulum to bulb and the cycle of hair growth and shedding are outlined. The structure and pigmentation of the hair shaft is also covered.
4. Nail anatomy includes the nail plate, proximal nail fold, nail bed, nail
Keratinisation is the process by which keratin, a high sulfur protein, is formed in hair, nails, and skin. There are two types of keratin - soft keratin found in skin containing 1-2% sulfur, and hard keratin found in hair and nails containing 4-8% sulfur and making up 97% of hair. During keratinisation, cells change shape and flatten out as they lose moisture and internal cell structures, leaving amino acids that bond together to form the keratin polypeptide chains.
The document defines and describes the structure and function of nails. It discusses that nails are composed of keratin and line the tips of fingers and toes. The nail has several parts including the nail matrix that produces nail cells, nail bed, and cuticle. Nails grow at a rate of about 0.1 mm per day and various factors can influence growth rate. The document outlines common nail disorders and the importance of proper nail care including trimming nails regularly and using moisturizers.
The document discusses the structure and composition of nails and problems associated with nails. It describes the 11 parts of the nail structure including the nail bed, nail plate, free edge, hyponychium, matrix, and cuticle. It explains that nails are made up of hard keratin and contain protein, water, and fatty materials. Common nail problems discussed include anonychia, onychomadesis, leukonychia, onycholysis, koilonychia, brittleness, onychorrhexis, pitting, paronychia, and discoloration. Causes and characteristics of each problem are described.
The document discusses diseases and abnormalities of the nails. It covers:
1. The anatomy and growth of normal nails.
2. Common nail disorders including trauma, fungal infections, psoriasis, and nail changes associated with systemic diseases.
3. Nail tumors such as warts and melanomas that can appear under the nail.
4. Rare inherited nail disorders with characteristic thickened or malformed nails.
This document discusses hair science and the classification of alopecia. It begins by covering hair anatomy and the hair cycle process. It then classifies different types of alopecia as either noncicatricial (non-scarring) or cicatricial (scarring). One type covered in detail is alopecia areata, which is described as a chronic inflammatory disorder characterized by patchy hair loss without scalp atrophy. The etiology, clinical features, investigations, histopathology and prognosis of alopecia areata are summarized.
This document provides information on various types of palmoplantar keratoderma (PPK). It describes the clinical patterns, genetic causes, histopathological findings, and management options for different syndromic and non-syndromic forms of PPK, including epidermolytic, punctate, striate, and transgradient PPK as well as disorders associated with PPK like pachyonychia congenita and Naxos syndrome. The document discusses the characteristic features, genetic defects, and treatment approaches for these PPK subtypes.
This is a powerpoint presentation on the epidermal keratinization and its associated disorders, presented by Dr. Jerriton, Dermatology resident of SVMCH, Pondicherry.
The hair follicle contains several key structures that work together to produce hair. The papilla at the base is made of connective tissue and contains a blood vessel loop. Surrounding the papilla is the matrix, containing epithelial cells and melanocytes. The matrix is one of the fastest growing cell populations and produces the cells that form the hair fiber and inner root sheath. The root sheath surrounds the hair fiber and is composed of three layers. Other structures associated with hair follicles include arrector pili muscles that cause hairs to stand up, sebaceous glands that secrete oil, and sweat glands of two main types.
Keratinization is the process by which keratinocytes differentiate and move towards the skin surface. Epidermal stem cells through symmetrical and asymmetrical division cause epidermopoiesis regulated by growth factors like EGF and TGFα. Keratinocytes synthesize keratin intermediate filaments which aggregate through filaggrin. They develop a lipid barrier and insoluble cornified envelope through crosslinking of proteins by transglutaminases. Hair and nails are also formed through keratinization to produce hard keratin structures that do not desquamate.
The document discusses the structure of hair. It begins by describing the different types of hair like lanugo, vellus, terminal and intermediate hair. It then discusses the embryology and development of hair follicles. The root, shaft and their various layers like medulla, cortex, cuticle and inner and outer root sheaths are described in detail. The physiology of hair growth and the functions of hair like protection and aesthetics are also summarized.
The hair consists of three layers - the medulla, cortex, and cuticle. The medulla is the inner core and may contain melanin. The cortex is the largest layer and determines hair texture and holds melanin. The cuticle is the outer protective layer.
The hair follicle contains the papilla, germinal matrix, and hair bulb. The papilla supplies nutrients to the germinal matrix where new hair cells are produced. These cells are pushed up through the hair bulb where they harden into the hair shaft before exiting the skin surface.
The dermis is the middle layer of skin located between the epidermis and subcutaneous fat. It varies in thickness from 1mm on eyelids to 5mm on the back and makes up 15-20% of body weight. The dermis provides nutrients to the epidermis and dermal appendages, cushions the body against injury, retains water, aids thermal regulation, and contains receptors for sensory stimuli. It has two layers - a thin papillary dermis that interdigitates with the epidermis, and a thick reticular dermis that merges with subcutaneous fat and contains large collagen and elastic fibers. The dermis develops from mesenchymal cells and contains components like elastin, collagen, ground
This presentation includes structure and functions of sweat glands i.e. eccrine, apocrine and apoeccrine glands. mechanism of sweat secretion and role of sweat in thermoregulation is included.
This document discusses the dermo-epidermal junction (DEJ) and dermis. It describes the four layers of the basement membrane zone (BMZ) of the DEJ - the basal keratinocyte layer containing hemidesmosomes, the lamina lucida, lamina densa containing type IV collagen and laminins, and the lamina fibroreticularis containing anchoring fibrils made of type VII collagen. It also discusses the cells and extracellular matrix components of the dermis, including collagen, elastic fibers, proteoglycans, fibroblasts, macrophages, dendrocytes and mast cells. Disorders of the DEJ like epidermolysis bullosa are also mentioned.
This document summarizes the anatomy and physiology of the various glands in skin - sweat glands, sebaceous glands and apocrine glands. It describes the two main types of sweat glands - eccrine and apocrine, as well as apoeccrine glands. Details are provided on the structure, development, distribution and functions of each gland type. The hormonal control of sebaceous gland activity is also summarized, noting the effects of androgens, estrogens and other hormones.
This document discusses trichology, the study of hair. It defines key terms and describes the structure and growth cycle of hair. The hair root contains the dermal papilla, hair bulb, arrector pilli muscle, sebaceous gland, and hair follicle. The hair shaft has three layers - the cuticle, cortex, and medulla. Hair grows in a cycle of anagen, catagen, and telogen phases. Common hair and scalp disorders like dandruff, alopecia, split ends, and graying are also explained.
The document discusses the vasculature and innervation of skin. It describes in detail the blood vessels of skin including the superficial and deep plexuses, communicating vessels, and venous drainage. It discusses the histology of arteries, arterioles, capillaries and venules. It also covers lymphatics, vascular development, angiogenesis, factors affecting vascular tone, and various clinical conditions related to the cutaneous vasculature. For innervation, it describes the somatic sensory and autonomic nervous systems that supply the skin and provides details on specialized receptors like Pacini corpuscles, Meissner's corpuscles and mucocutaneous end organs.
This document provides an overview of nail anatomy through a presentation. It discusses the basic structure of the nail including the nail matrix, nail bed, nail plate, cuticle, and lunula. It describes the blood supply and nerve innervation of the nail. It also reviews nail growth and factors that can affect the rate of growth such as age, gender, season, and certain medical conditions. The presentation provides details on nail development during embryology and changes that occur in childhood and old age.
This document provides an overview of the structure and anatomy of the nail unit. It describes the key components of the nail including the nail plate, nail matrix, nail bed, eponychium, hyponychium, nail folds, and nail isthmus. It discusses the development, blood and nerve supply, growth, and functions of the nail. Finally, it outlines common nail signs that can be seen in health and disease such as Beau's lines, onychorrhexis, nail pitting, clubbing, and melanonychia.
• Introduction
• Definitions
• Macroscopic Features
• Microscopic Features
• Blood supply
• Nerve supply
• Lymphatic drainage
• Role of epithelium in defence mechanism
• Oxygen consumption of gingiva
• Correlation of Macroscopic with microscopic features
• Conclusion
a brief review of nail diseases by, Dr. Mohammad Baghaei Mohammad Baghaei
The nail organ is an integral component of the digital tip. It is a highly versatile tool that protects the fingertip, contributes to tactile sensation by acting as a counterforce to the fingertip pad, and aids in peripheral thermoregulation via glomus bodies in the nail bed and matrix. Because of its form and functionality, abnormalities of the nail unit result in functional and cosmetic issues ...
Trans ungual drug transport advancement and challengesGulzar Alam
ABSTRACT
Disorders of the nail unit range from relatively innocuous conditions such as pigmentation in heavy smokers, to painful and debilitating states where the nail
unit can be dystrophied, hypertrophied, inflamed, infected etc. The human nail forms a resistant barrier to the topical penetration of drugs. Thus, treatment
of nail disorders, such as fungal infections, remains a challenge because of the difficulty encountered in achieving therapeutic concentrations of drugs at the
site of infection, which is often under the nail. Ungual and trans-ungual drug delivery continues to receive significant attention due to the need for efficacious
topical therapies for onychomycosis given the potential risk of systemic adverse effects associated with the conventional oral therapy. To successfully treat
nail disorders, applied drugs must permeate through the dense keratinized nail plate and reach the deeper layers of the nail plate, nail bed and the nail matrix.
Physical, chemical and mechanical methods have been used to decrease the nail barrier. This current review include anatomy of human nail, nails disorders,
factors affecting tans-ungual delivery of drugs and methods used for enhancement of drugs penetration into/across the nail.
Key words: Nail-plate, Nail disorders, Onychomycosis, Trans-ungual
Nails develop beginning around 10 weeks of gestation from thickened epidermal tissue. They correspond to claws and hooves in other animals. The nail plate is produced from specialized keratinizing cells in the nail matrix beneath the proximal nail fold. Nails serve to protect the fingertips and enhance delicate finger movements and grip. Abnormal nail development can occur, including incomplete or absent nails, thin nails, or nails associated with genetic syndromes affecting other parts of the body.
The periodontal ligament is a specialized connective tissue that connects the cementum covering the tooth root to the alveolar bone. It is composed of collagen fibers, fibroblasts, and a ground substance. The principal fibers of the periodontal ligament are bundles of collagen fibers that follow a wavy course between the cementum and bone. The periodontal ligament develops as the root forms and continues to remodel throughout life.
1. The document discusses different types of cysts found in the oral cavity, including dentigerous cysts, radicular cysts, and odontogenic keratocysts.
2. Dentigerous cysts originate from fluid accumulation between the reduced enamel epithelium and a tooth crown. Radicular cysts arise from epithelial residues in the periodontal ligament following pulp necrosis. Odontogenic keratocysts arise from dental lamina cell rests.
3. Key diagnostic features, histological characteristics, recurrence risks, and treatment considerations are provided for each cyst type. Differential diagnoses are also mentioned.
This document provides definitions and details about the anatomy and microscopic structure of gingiva. It begins with definitions of gingiva from several sources and discusses the development, macroscopic anatomy including the different types of gingiva, and microscopic anatomy. The microscopic anatomy section describes the layers of the gingival epithelium and cell types present. It also discusses the different types of gingival epithelium including oral, sulcular, and junctional epithelium. In summary, the document provides a comprehensive overview of the definitions, structures, and histology of gingival tissues.
The document discusses the anatomy and histology of the gingiva. It defines gingiva as the part of oral mucosa that surrounds the teeth. Macroscopically, it describes the three types of gingiva: marginal, interdental, and attached gingiva. Microscopically, it explains that gingiva contains stratified squamous epithelium, the epithelium-connective tissue interface, and connective tissue. It details the layers of the epithelium, the cells present, and their roles in keratinization and immune response.
This document provides an overview of the gingiva. It begins with definitions of gingiva from various sources. It then discusses the development, macroscopic anatomy including the different regions of gingiva, and microscopic anatomy. The latter covers the histology of the epithelial layers and cell types present. It also describes the different types of gingival epithelium and concludes with the dentogingival unit.
This document provides an overview of the microscopic anatomy of the gingiva. It describes the different layers of the gingival epithelium including the oral epithelium, sulcular epithelium, and junctional epithelium. It also discusses the cellular components and layers of the connective tissue below the epithelium. Key structures are described like desmosomes, hemidesmosomes, and tonofilaments that provide connections between epithelial cells and attachment to underlying tissues. The functions of the different epithelial layers and their roles in barrier function and wound healing are also summarized.
The dental pulp originates from cranial neural crest cells that migrate into the developing tooth germ. During tooth development, these cells form the dental papilla which becomes the dental pulp. The pulp contains odontoblasts, fibroblasts, undifferentiated mesenchymal cells, and macrophages. It has a cell-rich zone containing blood vessels and a cell-free zone near the odontoblasts. The pulp shapes change from development to maturity as the root forms and remodels. It is divided into coronal and radicular portions, connected through the apical foramen.
Root apex and working length determinationAnkit Patel
The root apex is the most complex, challenging, and important part of the root canal system for endodontic treatment. It contains three key anatomical landmarks - the apical constriction, cemento-dentinal junction, and apical foramen. The root apex has lateral and accessory canals that connect the root canal to surrounding tissues. A thorough understanding of root apex anatomy is essential for determining accurate working length and width, performing endodontic surgery, and avoiding procedural errors.
oral mucosa
The term mucous membrane is used to describe the moist lining of the gastrointestinal tract, nasal passages, and other body cavities that communicate with the exterior. In the oral cavity this lining is referred to as the oral mucous membrane, or oral mucosa. At the lips the oral mucosa is continuous with the skin; at the pharynx the oral mucosa is continuous with the mucosa lining the rest of the gut. Thus the oral mucosa is located anatomically between skin and gastrointestinal mucosa and shows some of the properties of each.
CLASSIFICATION
The classification based on these functional criteria, divides the oral mucosa into three major types:
1. Masticatory mucosa 25% (gingiva and hard palate)
2. Lining or reflecting mucosa 60% (lip, cheek, vestibular fornix, alveolar mucosa, floor of mouth and soft palate)
3. Specialized mucosa 10% (dorsum of the tongue and taste buds)
Based on keratinization:
KERATINIZED MUCOSA—
MASTICATORY MUCOSA
VERMILLION BORDER OF LIPS
NON KERATINIZED MUCOSA–
LINING MUCOSA
SPECIALIZED MUCOSA
DEVELOPMENT OF ORAL MUCOSA
The epithelium of the oral cavity is derived from both the ectoderm and the endoderm. The anterior part of the oral cavity is lined by the epithelium derived from the ectoderm.
By 13–20 weeks differences between keratinized and nonkeratinized mucosa becomes apparent. Keratohyaline granules in the keratinized mucosa and region specific cytokeratin appear.
Lingual papillae appear early at about 7th week; the circumvallate and foliate papillae appear earlier than filiform papillae, which can be recognized by 10–12 weeks.
FUNCTIONS OF ORAL MUCOSA
DEFENSE
1.Effective barrier for the entry of the microorganisms.
2.The oral mucosa is impermeable to bacterial toxins. It also secretes antibodies and has an efficient humoral and cell mediated immunity.
LUBRICATION
The secretion of salivary glands keeps the oral cavity moist and thus prevents the mucosa from drying and cracking thereby ensuring an intact oral epithelium.
A moist oral cavity helps in speech, mastication, swallowing and in the perception of taste.
SENSORY
The oral mucosa is sensitive to touch, pressure, pain and temperature.
The sensation of taste is a unique sensation, felt only in the anterior 2/3rd of the dorsum of the tongue.
Swallowing, gagging, retching and salivating reflexes are initiated by receptors in the oral mucosa.
Touch sensations in the soft palate results in gag reflex
PROTECTION
The oral mucosa protects the deeper tissues from mechanical forces resulting from mastication and from abrasive nature of foodstuffs.
DENTIGEROUS CYST- an odontogenic cyst that surrounds the crown of impacted tooth , develops by fluid accumulation between REE(reduced enamel epithelium) and the enamel surface , resulting in a cyst which the crown located within the lumen.
This document describes the ultrastructure of gingiva. It is divided into three parts: marginal gingiva, attached gingiva, and interdental gingiva. Microscopically, gingiva consists of stratified squamous epithelium and connective tissue. The epithelium is classified into oral, sulcular, and junctional epithelium based on location and keratinization. The connective tissue contains fibers, ground substance, and cells. Collagen fibers provide strength while ground substance fills spaces. Gingival fibers attach gingiva firmly to teeth.
The document discusses the anatomy and development of the orbit and its contents. It provides details on:
1) The bones that form the walls of the orbit - the frontal, ethmoid, maxillary, lacrimal, zygomatic, sphenoid and palatine bones.
2) The contents of the orbit which include the eyeball, extraocular muscles, nerves, vessels, lacrimal gland and orbital fat.
3) The development of the orbit which begins as a ring around the eyeball derived from cranial neural crest cells and expands during the third month to form the orbital walls.
The dental pulp is a soft connective tissue located within the tooth. It develops from the dental papilla during tooth formation. The pulp has four zones - the odontoblastic zone containing cells that form dentin, the cell-free zone, cell-rich zone containing many cells, and a central zone with large blood vessels and nerves. The pulp receives blood vessels through the apical foramen and contains many cell types including odontoblasts, fibroblasts, immune cells, and undifferentiated cells. It is highly innervated with sensory fibers that detect pain and sympathetic fibers that control blood flow. The pulp plays key roles in tooth development, defense against infection, and sensitivity.
This document summarizes guidelines for the topical treatment of psoriasis. It discusses several topical treatment options including corticosteroids, vitamin D analogues, tazarotene, tacrolimus, pimecrolimus, salicylic acid, anthralin, coal tar, and combination therapies. It provides details on the efficacy, dosing, safety and guidelines for each treatment. It also discusses when systemic therapies like methotrexate may be appropriate and provides dosing guidelines for methotrexate treatment of psoriasis.
This document summarizes information about Treponema pallidum, the causative agent of syphilis. It describes key details such as:
1. T. pallidum was discovered in 1905 by Schaudinn and Hoffmann in samples from syphilitic patients.
2. It is a thin, helically coiled bacterium that is difficult to view with conventional microscopy but can be seen with specialized staining techniques or darkfield microscopy.
3. Syphilis is diagnosed through direct visualization of T. pallidum, nontreponemal tests that detect antibodies to cardiolipins and treponemal tests that detect antibodies to T. pallidum antigens.
This document summarizes information on chronic urticaria, including its prevalence, causes, impact on quality of life, and treatment options. It notes that chronic urticaria affects approximately 1% of people with acute urticaria and has a significant negative impact on quality of life. First-line treatment includes non-sedating antihistamines, sometimes at higher off-label doses. If patients do not respond sufficiently to antihistamines alone, second-line options include doxepin, leukotriene antagonists, short-term corticosteroids, dapsone, sulfasalazine, and narrowband UVB phototherapy. The document reviews evidence on the efficacy and safety of these second-
Psoriatic arthritis is a chronic inflammatory disease that affects the joints and skin. It is characterized by osteolysis, bony proliferation, and can cause dactylitis, enthesitis, spondylitis, and various forms of arthritis. While it is classified as a type of spondyloarthritis, it is distinct from rheumatoid arthritis in that it is usually seronegative. The presentation and pattern of joint involvement in psoriatic arthritis can vary between patients and change over time, with the most common forms being asymmetrical oligoarthritis or symmetrical polyarthritis. Diagnosis is based on clinical features and classification criteria such as the CASPAR criteria.
Physiotherapy aims to preserve, enhance or restore movement and physical function impaired by disability, injury or disease. It utilizes techniques like therapeutic exercises, physical modalities, assistive devices and patient education. Physiotherapy can improve function by minimizing contractures, loss of strength and decreased skin compliance, although it may not change underlying pathology or prevent all disability. Major physiotherapy techniques include therapy using mechanical treatment, non-electric thermotherapy, electrotherapy, ozonetherapy, vacuum therapy and balneotherapy. Electrotherapy techniques like electrostimulation, ultrasound and magnetotherapy have anti-inflammatory, analgesic, spasmolytic and trophic clinical effects. Physiotherapy plays an important role in managing various conditions like wounds,
This journal club discusses targeted treatments for pruritus by reviewing recent research on the mediators and pathways involved in itch transmission. It summarizes findings on histamine receptors (especially H4), proteases/PAR-2, opioids, interleukin-31, vanilloids like capsaicin, and cannabinoids. Promising new treatments discussed include H4 antagonists, serine protease inhibitors, opioid agonists/antagonists, IL-31 antibodies, high-potency capsaicin formulations, and topical cannabinoids. These emerging therapies have potential to treat pruritus in diseases like atopic dermatitis by targeting specific components in the itch pathways.
This document discusses scar revision techniques. It begins by explaining the types of scars that can form during the wound healing process and classifications of abnormal scarring. Both non-invasive and invasive scar revision techniques are then outlined. Non-invasive options include medications, massage, silicone sheets, and lasers. Invasive techniques involve excisional procedures, grafting, and dermal augmentation using fillers or fat transfer. The timing of scar revision and factors to consider for specific scar types are also addressed.
This document summarizes methotrexate, an antimetabolite drug used to treat various conditions like psoriasis and rheumatoid arthritis. It discusses methotrexate's structure, mechanism of action, administration, indications, contraindications, dosing, monitoring guidelines, adverse effects and drug interactions. The summary describes methotrexate as a folic acid analogue that inhibits dihydrofolate reductase, interfering with DNA synthesis and having anti-inflammatory effects. It lists approved uses including psoriasis and potential off-label uses, and emphasizes monitoring blood work and liver biopsies when using long-term.
This document provides a detailed tutorial on the procedure for culturing human melanocytes. Key steps include:
1) Isolating epidermis from skin specimens using dispase enzyme solution overnight at 4°C.
2) Dispersing epidermal cells using trypsin and mechanically dissociating into a single cell suspension.
3) Seeding cells in TPA-free growth medium and incubating without disturbance for 48-72 hours.
4) Maintaining cultures by changing medium twice weekly and passaging confluent cultures using trypsin.
Methods for cryopreserving and thawing melanocytes are also described. Morphology and growth characteristics of cultured melanocytes are provided.
This document provides an overview of leprosy in India, including its transmission, diagnosis, treatment, and the national program to eliminate leprosy. Some key points:
- Leprosy primarily affects the skin, nerves, and mucous membranes and can cause deformities. It is spread through droplets and untreated patients are the main reservoir. Multi-drug therapy can cure patients and interrupt transmission.
- India's National Leprosy Elimination Program aims to integrate services, provide MDT, conduct surveillance, increase awareness, and prevent disabilities. Through these strategies, the national prevalence rate has declined and most states have achieved elimination targets.
- However, some areas still have high rates and ongoing efforts include training
Isotretinoin is a highly effective treatment for acne that works by reducing sebum production and modifying the follicular epithelium. It has immunomodulatory effects that help resolve inflammation. The document summarizes guidelines for isotretinoin use and dosing from international experts. It is recommended for severe nodular cystic acne or less severe acne that causes scarring or psychological distress. Low-dose and intermittent dosing regimens can be effective with fewer side effects. Precautions are needed in women of childbearing age due to teratogenicity. Isotretinoin provides long-term remission and is beneficial as early treatment to prevent scarring.
This document summarizes information about gonorrhea (Neisseria gonorrhoeae), including:
1. The history of gonorrhea identification and treatment, from ancient Greek beliefs to the development of antibiotics and culture techniques in the 19th-20th centuries.
2. Details on the pathogenesis, clinical manifestations, diagnosis, and treatment of common and complicated gonorrheal infections affecting the urethra, cervix, rectum, pharynx, and other sites.
3. Descriptions of local complications like epididymitis and pelvic inflammatory disease, and systemic complications including disseminated gonococcal infection.
This document summarizes an approach to diagnosing and treating cases of genital ulcers. It begins with definitions of genital ulcers and their etiologies, which can be sexually transmitted or non-sexually transmitted infections. It then describes three approaches: traditional clinical, laboratory-assisted, and syndromic management. The syndromic management approach diagnoses based on symptoms and signs and treats for the most common causes. Advantages include being fast, effective, inexpensive and allowing single-dose treatment. Limitations include potential over-treatment. Guidelines for taking history, examination, investigations, and treating common causes like herpes, syphilis, chancroid, and donovanosis are provided.
Approach to a case of diffuse hair loss in females
. Anagen effluvium-
(a)Dystrophic
(b)Loose anagen hair
2. Telogen effluvium –
(a)acute telogen effluvium
(b)Chronic telogen effluvium
3. Female pattern hair loss
Primary CTE –represents a primary disorder and is a diagnosis of exclusion.
Secondary CTE- secondary to variety of systemic disorders.
Iron deficiency
Other deficiency –protein calorie malnutrition ,zinc deficiency
Thyroid diseases
Metabolic diseases-chronic liver or renal failure, advanced malignancy, pancreatic disease and upper GI disorder with malabsorption
SLE and other connective tissue disorders.
HIV infection
Drug induced
This seminar presentation discusses the uses of dapsone, colchicine, and thalidomide in dermatology. For dapsone, it provides a detailed history, mechanisms of action, indications, dosing, administration, and adverse effects. It is commonly used to treat dermatitis herpetiformis, leprosy, and other chronic inflammatory dermatoses. For colchicine, it discusses the mechanisms of action, pharmacokinetics, and various dermatological uses including papulosquamous dermatoses, recurrent aphthous stomatitis, Behcet's syndrome, bullous diseases, vasculitis, and others. Adverse effects include gastrointestinal issues and bone marrow
This document discusses various cutaneous manifestations of endocrine diseases. It covers skin symptoms of diabetes mellitus including diabetic microangiopathy, which can cause conditions like erysipelas-like erythema and wet gangrene of the foot. It also discusses diabetic neuropathy and its associated symptoms. Further, it discusses cutaneous features of thyroid diseases including hypothyroidism and thyrotoxicosis, as well as associated autoimmune conditions. Finally, it briefly covers skin conditions related to pituitary disorders like acromegaly and gigantism seen in hyperpituitarism.
This document discusses cutaneous pseudolymphoma (CPL). It was first described in 1891 and has been called by various names over time. Pseudolymphoma clinically and sometimes histologically mimics lymphoma, but has benign behavior and does not meet criteria for malignant lymphoma. It is characterized by lymphocytic infiltration in the skin in response to stimuli. CPL is classified into types depending on the predominant cell type (B cell vs T cell) and location of infiltration (nodular vs stripe-like). While CPL has no associated mortality, localized variants can cause minor symptoms. Treatment involves excision, corticosteroids, radiation therapy, and immunosuppressants depending on the subtype.
Coronary Circulation and Ischemic Heart Disease_AntiCopy.pdfMedicoseAcademics
In this lecture, we delve into the intricate anatomy and physiology of the coronary blood supply, a crucial aspect of cardiac function. We begin by examining the physiological anatomy of the coronary arteries, which lie on the heart's surface and penetrate the cardiac muscle mass to supply essential nutrients. Notably, only the innermost layer of the endocardial surface receives direct nourishment from the blood within the cardiac chambers.
We then explore the specifics of coronary circulation, including the dynamics of blood flow at rest and during strenuous activity. The impact of cardiac muscle compression on coronary blood flow, particularly during systole and diastole, is discussed, highlighting why this phenomenon is more pronounced in the left ventricle than the right.
Regulation of coronary circulation is a complex process influenced by autonomic and local metabolic factors. We discuss the roles of sympathetic and parasympathetic nerves, emphasizing the dominance of local metabolic factors such as hypoxia and adenosine in coronary vasodilation. Concepts like autoregulation, active hyperemia, and reactive hyperemia are explained to illustrate how the heart adjusts blood flow to meet varying oxygen demands.
Ischemic heart disease is a major focus, with an exploration of acute coronary artery occlusion, myocardial infarction, and subsequent physiological changes. The lecture covers the progression from acute occlusion to infarction, the body's compensatory mechanisms, and the potential complications leading to death, such as cardiac failure, pulmonary edema, fibrillation, and cardiac rupture.
We also examine coronary steal syndrome, a condition where increased cardiac activity diverts blood flow away from ischemic areas, exacerbating the condition. The long-term impact of myocardial infarction on cardiac reserve is discussed, showing how the heart's capacity to handle increased workloads is significantly reduced.
Angina pectoris, a common manifestation of ischemic heart disease, is analyzed in terms of its causes, presentation, and referred pain patterns. We identify factors that exacerbate anginal pain and discuss both medical and surgical treatment options.
Finally, the lecture includes a case study to apply theoretical knowledge to a practical scenario, helping students understand the real-world implications of coronary circulation and ischemic heart disease. The role of biochemical factors in cardiac pain and the interpretation of ECG changes in myocardial infarction are also covered.
Pharmacotherapy of Asthma and Chronic Obstructive Pulmonary Disease (COPD)HRITHIK DEY
This PowerPoint presentation provides an in-depth overview of the pharmacotherapy approaches for managing asthma and Chronic Obstructive Pulmonary Disease (COPD). It covers the pathophysiology of these respiratory conditions, the various classes of medications used, their mechanisms of action, indications, side effects, and the latest treatment guidelines. Designed for students, healthcare professionals, and anyone interested in respiratory pharmacology, this presentation offers a comprehensive understanding of current therapeutic strategies and advancements in the field.
Hemodialysis: Chapter 8, Complications During Hemodialysis, Part 2 - Dr.GawadNephroTube - Dr.Gawad
- Video recording of this lecture in English language: https://youtu.be/FHV_jNJUt3Y
- Video recording of this lecture in Arabic language: https://youtu.be/D5kYfTMFA8E
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Mainstreaming #CleanLanguage in healthcare.pptxJudy Rees
In healthcare, every day, millions of conversations fail. They fail to cover what’s really important, fail to resolve key issues, miss the point and lead to misunderstandings and disagreements.
Clean Language is one approach that can improve things. It’s a set of precise questions – and a way of asking them – which help us all get clear on what matters, what we’d like to have happen, and what’s needed.
Around 1000 people working in healthcare have trained in Clean Language skills over the past 20+ years. People are using what they’ve learnt, in their own spheres, and share anecdotes of significant successes. But the various local initiatives have not scaled, nor connected with each other, and learning has not been widely shared.
This project, which emerged from work done by the NHS England South-West End-Of-Life Network, with help from the Q Community and especially Hesham Abdalla, aims to fix that.
EXPERIMENTAL STUDY DESIGN- RANDOMIZED CONTROLLED TRIALRishank Shahi
Randomized controlled clinical trial is a prospective experimental study.
It essentially involves comparing the outcomes in two groups of patients treated with a test treatment and a control treatment, both groups are followed over the same period of time. Prepare a plan of study or protocol
a. Define clear objectives
b. State the inclusion and exclusion criteria of case
c. Determine the sample size, place and period of study
d. Design of trial (single blind, double blind and triple blind method)
2. Define study population: Most often the patients are chosen from hospital or from the community. For example, for a study for comparison of home and sanatorium treatment, open cases of tuberculosis may be chosen.
3. Selection of participants by defined criteria as per plan:
Selection of participants should be done with precision and should be precisely stated in writing so that it can be replicated by others. For example, out of open cases of tuberculosis those who fulfill criteria for inclusion may be selected (age groups, severity of disease and treatment taken or not, etc.)
Randomization ensures that participants have an equal chance to be assigned to one of two or more groups:
One group gets the most widely accepted treatment (standard treatment/ gold standard)
The other gets the new treatment being tested, which researchers hope and have reason to believe will be better than the standard treatment
Subject variation: First, there may be bias on the part of the participants, who may subjectively feel better or report improvement if they knew they were receiving a new form of treatment.
Observer bias: The investigator measuring the outcome of a therapeutic trial may be influenced if he knows beforehand the particular procedure or therapy to which the patient has been subjected.
Evaluation bias: There may be bias in evaluation - that is, the investigator(Analyzer) may subconsciously give a favorable report of the outcome of the trial.
Co-intervention:
participants use other therapy or change behavior
Study staff, medical providers, family or friends treat participants differently.
Biased outcome ascertainment:
participants may report symptoms or outcomes differently or physicians
Investigators may elicit symptoms or outcomes differently
A technique used to prevent selection bias by concealing the allocation sequence from those assigning participants to intervention groups, until the moment of assignment.
Allocation concealment prevents researchers from influencing which participants are assigned to a given intervention group.
All clinical trials must be approved by Institutional Ethics Committee before initiation
It is mandatory to register clinical trials with Clinical Trials Registry of India
Informed consent from all study participants is mandatory.
A preclinical trial is a stage of research that begins before clinical trials, and during which important feasibility and drug safety data are collected.
Following points high.
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3. INTRODUCTION
nail apparatus - strong, relatively
inflexible, keratinous
protective covering for fingertip
allows precision and delicacy when picking up
small objects
4. SHORT EMBRYOLOGY
primitive epidermis – 9 - 20th wks.
20 wk
matrix cells show postnatal-type cell division
differentiation and keratinization
nail plate begins to form and move distally
nail bed loses its granular layer at this stage.
36 wk: nail plate reaches the tip of the digit
and is surrounded by prominent lateral nail
folds and a well-formed cuticle.
5. NAIL BASIC STRUCTURE
1/4 nail is covered by the proximal nail fold
Lunula (half-moon, lunule)
Under proximal part of nail
most distal region of the matrix
most prominent on thumb & great toe
may be partly or completely concealed by the
proximal nail fold in other digits
nail plate distal to lunula usually appears
pink, due to its translucency, which allows the
redness of the vascular nail bed to be seen
through it.
6. PROXIMAL NAIL FOLD
two epithelial surfaces, dorsal and ventral, at the junction of
the two, the cuticle projects distally onto the nail surface.
LATERAL NAIL FOLDS
continuity with the skin on the sides of the digit laterally, and
medially they are joined by the nail bed.
THE MATRIX
subdivided into dorsal (ventral aspect of the proximal nail
fold), intermediate (germinal matrix or matrix) and ventral
(nail bed) sections.
two distinct areas may be visible, THE PROXIMAL LUNULA
AND THE LARGER PINK ZONE on seeing nail plate from
above
On close examination, two further distal zones can often
be identified , the distal yellowish-white margin and
immediately proximal to this the onychodermal band
7. MICROSCOPIC ANATOMY
NAIL FOLDS
The proximal nail folds are similar in structure to the
adjacent skin
devoid of dermatoglyphic markings and
pilosebaceous glands.
From the distal area of the proximal nail fold the
cuticle adheres to the upper surface of the nail plate
serves to protect the structures at the base of the
nail, particularly the germinal matrix, from
environmental insults
8. NAIL MATRIX (INTERMEDIATE
MATRIX)
Nail matrix produces the nail plate
The nail matrix contains melanocytes in the
lowest three cell layers and these donate pigment
to the keratinocytes.
there is presence of 6.5 melanocytes per
millimetre of matrix basement membrane
Langerhans cells are detectable in the matrix by
CD1a staining, and the matrix appears to contain
basement membrane components
9. NAIL BED
Nail bed consists of epidermis with underlying
connective tissue closely apposed to the periosteum
of the distal phalanx.
There is no subcutaneous fat in the nail bed
The nail bed epidermis is usually two or three cells
thick
The nail bed dermal collagen is mainly orientated
vertically, being directly attached to the phalangeal
periosteum and the epidermal basal lamina.
Within the connective tissue network lie blood
vessels, lymphatics, a fine network of elastic fibres
and scattered fat cells; at the distal margin, eccrine
sweat glands have been seen
10. NAIL PLATE
The nail plate comprises three horizontal layers: a
thin dorsal lamina, the thicker intermediate lamina
and a ventral layer from the nail bed
The nail plate contains significant amounts of
phospholipid, mainly in the dorsal and
intermediate layers, which contributes to its
flexibility.
The nail plate is rich in calcium, found as the
phosphate in hydroxyapatite crystals
Calcium does not significantly contribute to the
hardness of the nail
11. NAIL KERATIN
Nail keratin analysis shows essentially the same
fractions as in hair
amino acid analysis shows higher cysteine, glutamic
acid and serine, and less tyrosine in nail compared
with hair
normal nail demonstrates that the suprabasal keratin
pair K1/K10 is found on both aspects of the proximal
nail fold and to a lesser degree in the matrix.
However, it is absent from the nail bed.
The nail bed contains keratin synthesized in normal
basal layer epithelium, K5/K14, which is also found in
nail matrix.
keratin pair K6/K16 are present in the nail bed but
not in the germinal matrix
12. BLOOD SUPPLY OF NAIL
rich arterial blood supply to the nail bed and matrix
derived from paired digital arteries, a large palmar and
small dorsal digital artery on either side.
There are two main arterial arches (proximal and distal)
supplying the nail bed and matrix, formed from
anastomoses of the branches of the digital arteries.
Within the matrix, vessels are longitudinal with a
helicoidal twisting..
There are many arteriovenous anastomoses beneath the
nail— glomus bodies—which are concerned with heat
regulation
Glomus bodies are important in maintaining acral
circulation under cold conditions: arterioles constrict with
cold but glomus bodies dilate.
14. NAIL GROWTH AND MORPHOLOGY
Cell kinetics
Measured by
immunohistochemistry, autoradiography and
direct measurement of matrix product (i.e. nail
plate) by ultrasound ,micrometer or histology.
The rate of nail growth is about 3 mm/month for
finger nails and about 1 mm/month for toe nails
15. NAIL MORPHOLOGY
The nail grows flat, rather than as a
heaped-up keratinous mass
factors probably responsible to produce a
relatively flat nail plate are
orientation of the matrix rete pegs and papillae
the direction of cell differentiation and moulding of
the direction of nail growth between the proximal
nail fold and distal phalanx.
Containment laterally within the lateral nail folds
assists this orientation
the adherent nature of the nail bed
16. PHYSIOLOGICAL AND ENVIRONMENTAL
FACTORS AFFECTING THE RATE OF NAIL
GROWTH.
FASTER SLOWER
DAYTIME NIGHT
PREGNANCY FIRST DAY OF LIFE
YOUTH,INCREASING AGE OLD AGE
FINGERS TOES AND THUMBS
MALE GENDER FEMALE
SUMMER WINTER
RIGHT HAND NAILS LEFT HAND NAILS
TRAUMA,NAIL BITING
17. PATHOLOGICAL FACTORS AFFECTING THE RATE
OF NAIL GROWTH
FASTER SLOWER
PSORIASIS FINGER IMMOBILIZATION
PITYRIASIS RUBRA
PILARIS
FEVER
HYPERTHYRODISM HYPOTHYRODISM
LEVODOPA YELLOW NAIL
SYNDROME
ARTERIOVENOUS
SHUNTS
BEAU’S LINES
BULLOUS ICTHYSIFORM
ERYTHRODERMA
RELAPSING
POLYCHONDRITIS
IDIOPATHIC POOR NUTRITION
18. NAILS IN CHILDHOOD
In early childhood, the nail plate is relatively thin
and may show temporary koilonychia
nails are also prone to terminal onychoschizia
(lamellar splitting),most prominent on the
sucked thumb.
Beau’s lines can be seen in up to 92% of
normal infants between 8 and 9 weeks of age
A herringbone pattern is common in children
and gradually diminishes with time, reflecting a
gradual matrix maturation
19. NAILS IN OLD AGE
The whole subungual area in old age may
show thickening of blood vessel walls with
vascular elastic tissue fragmentation.
The nail plate becomes pallor, dull and
opaque with advancing years
white nails similar to those seen in
cirrhosis, uraemia and hypoalbuminaemia
may be seen.
20. NAIL SIGNS AND SYSTEMIC DISEASE
ABNORMALITIES OF SHAPE
CLUBBING --
In clubbing there is increased transverse and longitudinal
nail curvature with hypertrophy of the soft-tissue
components of the digit pulp.
Hyperplasia of the fibrovascular tissue at the base of the
nail also occurs.
Pathological associations of clubbing include ---
inflammatory bowel disease, carcinoma of the bronchus
and cirrhosis.
In forms associated with bronchiectasis or
neoplasm, prominent inflammatory joint signs may also be
seen, resulting in hypertrophic pulmonary osteoarthropathy
21. CLINICAL PICTURE OF CLUBBING
Lovibond’s angle is found at the
junction between the nail
plate and the proximal nail
fold, and is normally less than
160°.
This is altered to over 180° in
clubbing
Curth’s angle at
the distal interphalangeal joint is
normally about 180°. This is
diminished to less than 160° in
clubbing
22. Schamroth’s window is seen when the dorsal
aspects of two fingers from opposite hands
are opposed, revealing a window of
light, bordered laterally by the Lovibond
angles. As this angle is obliterated in
clubbing, the window closes.
In some cases of bronchiectasis, a variant of
clubbing, shell nail syndrome is seen.
Distugunished from clubbing by the presence
of atrophy of underlying bone and nail bed
23. KOILONYCHIA
Greek: koilos, hollow; onyx, nail
In koilonchyia there is reverse curvature in
the transverse and longitudinal axes giving a
concave dorsal aspect to the nail
most prominent in the thumb or great toe.
common in infancy in toe nail
Its persistence may be associated with a
deficiency of cysteine-rich keratin
24. a familial pattern which may be autosomal
Dominant may be seen in some families
Most common systemic association is with
iron deficiency and haemochromatosis
25. PINCER NAIL
Also known as trumpet or involuted nail
Pincer nail describes a dystrophy where nail
growth is pitched towards the
midline, combined with increased transverse
curvature.
There are 3 variants of pincer nail
1) In the inherited version there is often a gradient
of involvement, radiating from the thumbs and
big toes outwards, which progresses with time.
26. 2) the most common is in association with
psoriasis, where the thumbs and big toes are the
most likely to be affected, although the pattern is
not as organised and symmetrical as that seen in
the inherited version
3) The third variant is the individual nail which
develops a pincer deformity.
.
27. MACRONYCHIA AND MICRONYCHIA
Macronychia and micronychia are conditions
where a nail is considered too large or too small
in comparison with other nails
The nail disorder is usually associated with an
abnormal digit, arising from underlying bony
abnormalities such as local gigantism causing
macronychia or megadactyly .
Also the basis of racket thumb, the most
common form of benign, dominantly inherited
macronychia
29. ANONYCHIA
Anonychia is absence of all or part of one or several
nails. It may be congenital, acquired or transient.
A mutation in the R-spondin 4 gene, which plays a
part in Wnt signalling within the cell is responsible for
congenital absence of nail
Acquired forms are due to scarring of the nail matrix.
This can arise as a result of burns, surgery or
trauma, or be due to inflammatory dermatoses such
as lichen planus where the entire nail matrix is
scarred and lost
The transient variant is due to nail shedding. This can
occur due to an intense physiological or local
inflammatory process,
30. ABNORMALITIES OF NAIL ATTACHMENT
Nail shedding
Nails may be lost through different
mechanisms
1) Complete loss of the nail plate due
to proximal nail separation extending
distally is called onychomadesis and is a
progression of profound Beau’s lines
31. 2) Local dermatoses, such as the
bullous disorders and paronychia, cause
nail loss e.g. toxic epidermal
necrolysis, lichen planus etc.
3) Trauma is a common cause of
recurrent loss
It is often associated with subungual
haemorrhage
32. 4) Temporary loss has also been described due to drugs
such as retinoids,cloxacillin and cephaloridine
5) Onychoptosis defluvium or alopecia unguium
describes atraumatic,familial, non-inflammatory nail loss
6) Nail shedding can be part of an inherited structural
defect, most obviously in epidermolysis bullosa
7) Nail degloving this refers to partial or total avulsion
of the nail and surrounding tissue (perionychium).Typically,it
appears as thimble-shaped nail shedding or total loss of the
nail organ with soft tissue
33. DIFFERENT EXAMPLES OF SEPERATION
OF NAIL ATTACHMENT
ONYCHOLYSIS
Onycholysis is the distal or lateral separation of the
nail from the nail bed
Psoriatic onycholysis can be considered the
reference point for other forms of onycholysis where it
is typically distal, with variable lateral involvement.
Areas of separation appear white or yellow due to air
beneath the nail and sequestered debris, shed
squames and glycoprotein exudate.
Isolated islands of onycholysis present as ‘oily spots’
or ‘salmon patches’ in the nail bed.
34. Idiopathic onycholysis
This is a painless separation of the nail from its
bed, which occurs without apparent cause.
Overzealous manicure, frequent wetting and
cosmetic ‘solvents’ may be the cause.
The condition usually starts at the tip of one or
more nails and extends to involve the distal third of
the nail bed.
36. Secondary onycholysis
Onycholysis due to other causes is secondary
onycholysis. It may be localised or systemic
Psoriasis, fungal infections, dermatitis and trauma are
among the most common. Onycholysis occurs in
general medical conditions, including impaired
peripheral circulation, hypothyroidism
,hyperthyroidism , hyperhidrosis, yellow nail syndrome
and shell nail syndrome
Photo-onycholysis may occur during treatment with
psoralens, demethylchlortetracycline and doxycycline
37. PTERYGIUM
The term ‘pterygium’ describes the winged appearance
achieved when a central fibrotic band divides a nail
proximally in two.
inflammatory destructive process precedes pterygium
formation.
There is fusion between the nail fold and underlying nail bed
and matrix.
The fibrotic band then obstructs normal nail growth.
It most typically develops in trauma or lichen planus and its
variants, including idiopathic atrophy of the nail and graft-
versus-host disease
It can also occur in leprosy and secondary purulent infection.
38. Ventral Pterygium
Ventral pterygium or pterygium inversum unguis
occurs on the distal undersurface of the nail
Causes include trauma, systemic sclerosis,Raynaud’s
phenomenon, lupus erythematosus, familial and
infective .
39. Subungual hyperkeratosis
entails hyperkeratosis of the nail bed and hyponychium
Nail plate thickening is common. Dry, white or yellow
hyperkeratosis may crumble away from the overhanging nail
Hyperkeratosis may extend onto the digit pulp.
Features of onychomycosis and wart virus infection (mainly
toes) or psoriasis, pityriasis rubra pilaris and eczema
(mainly fingers) are found
The nail bed is an epithelium of low proliferative turnover.
Any disease process that affects it is likely to result in an
excess of squamous debris. The overlying nail prevents
simple loss. The initial outcome is compaction of debris into
layers of subungual hyperkeratosis.
Focal subungual keratoses seen with Darier’s disease, and
keratotic debris beneath the nail in Norwegian (crusted).
40. CHANGES IN NAIL SURFACE
Longitudinal grooves
Longitudinal grooves may run all or part of the
length of the nail in the longitudinal axis
The median canaliform dystrophy of Heller is
the most distinctive form in this
The nail is split, usually in the midline, with a fir-
tree-like appearance of ridges angled
backwards.
The thumbs are most commonly affected and
the involvement may be symmetrical.
41. TRANSVERSE GROOVES AND BEAU’S LINES
Transverse grooves may be full or partial
thickness through the nail.
When they are endogenous they have an
arcuate margin matching the lunula.
If exogenous, such as those due to manicure
the margin may match the proximal nail fold
and the grooves may be multiple as in
washboard nails.
42. BEAU’S LINES
When the transverse groove’s are due to
endogenous cause, the groove is better
known as beau’s lines
43. PITTING
Pitting presents as punctate erosions in the
nail surface
The individual pits of psoriasis are said to be
less regular
An isolated large pit may produce a localized
full thickness defect in the nail plate termed
elkonyxis, which is found in Reiter’s
disease, psoriasis and following trauma
44. TRACHYONYCHIA
Trachyonychia presents
as a rough surface
affecting all of the nail
plate and up to 20 nails
The original French
term was ‘sand-blasted
nails’, which evokes the
main clinical feature of a
grey, roughened surface
mainly associated with
alopecia
areata, psoriasis and
lichen planus
45. ONYCHOSCHIZIA
Onychoschizia is also
known as lamellar
dystrophy and is
characterized by
transverse splitting into
layers at or near the free
edge
It is seldom associated
with any systemic disorder,
although it has been
reported with
polycythaemia, human
immuno-deficiency virus
(HIV) infection and
glucagonoma
46. CHANGES IN COLOUR
Alteration in nail colour may occur because of changes
affecting the dorsal nail surface, the substance of the nail
plate, the undersurface of the nail or the nail bed.
Exogenous pigment
Exogenous pigment on the upper surface is easy
to demonstrate by scraping the nail. If the
proximal margin of the pigment is an arc
matching the proximal nail fold, this is a further
clue confirming an exogenous source.
47. NAIL PLATE CHANGES
The nail plate can be changed by the addition of pigment or the
alteration of the normal cellular and intercellular organization such
that there is loss of normal lucency.
Normal Pigment is typically added in the form of melanin
produced by matrix melanocytes during nail formation. This
produces a brown longitudinal streak the entire length of the nail.
The incorporation of heavy metals and some drugs into the nail
via the matrix can also produce altered nail plate colour, such as
the grey colour associated with silver.
The disruption of normal nail plate formation by disease,
chemotherapy, poisons or trauma can result in waves of
parakeratotic nail cells or small splits between cells within the nail.
In fungal infection discoloration may start distolaterally rather than
via the matrix.
48. NAIL BED CHANGES
Normally there is generalized vascular changes in the
nail bed, but localized changes, as seen with nail bed
tumours.
Subungual hyperkeratosis or the incorporation of drugs
(antimalarials, phenothiazines) may also change the
apparent colour of the nail.
Splinter haemorrhages, representing ruptured nail bed
vessels, deposit haemoglobin on the undersurface of
the nail, which grows out.
Cyanosis makes the nail bed blue and carbon
monoxide poisoning makes it bright red.
49. LEUKONYCHIA
White discoloration of the nail attributable to
matrix dysfunction is known as leukonychia.
In an inherited form called total leukonychia,
all nails are milky porcelain white.
In subtotal leukonychia,
the proximal two-thirds are white, becoming pink
distally.
This is attributed to a delay in keratin maturation
Transverse leukonychia (Mees’ line) reflects a
systemic disorder , such as chemotherapy or
poisoning
50. APPARENT LEUKONYCHIA
In apparent leukonychia,
changes in the nail bed are responsible for the
white appearance.
Nail bed pallor may be a non-specific sign of
anaemia, oedema or vascular impairment.
51. TERRY’S NAIL
This is white proximally and normal distally
Seen in cirrhosis, congestive cardiac failure and
adult-onset diabetes mellitus.
Nail bed biopsy reveals only mild changes of
increased
vascularity.
Terry’s nail is similar to half-and-half nails where,
there is a proximal white zone and distal (20–60%)
brownish sharp demarcation,
the histology of half and half nail suggests an increase of
vessel wall thickness and melanin deposition.
seen in 9–50% of patients with chronic renal failure and
after chemotherapy
52. MUEHRCKE’S PAIRED WHITE BANDS
These bands are parallel to the lunula in the
nail bed, with pink between two white lines.
They are commonly associated with
hypoalbuminaemia
the correction of hypoalbuminaemia by
albumin infusion can reverse the sign.
53. COLOUR CHANGES DUE TO DRUGS
Yellowing of the nail is a
rare occurrence in
prolonged tetracycline
therapy, which can also
produce a pattern of dark
distal photo-onycholysis
associated with
photosensitivity
BLUE MEPACRINE
BLUE-
BLACK
CHLOROQUI
NE
DARK
BLUE
DRUG
ERUPTION
HYPERPIG
MENTATIO
N
DOXORUBICI
N IN
CHILDREN
54. YELLOW NAIL SYNDROME
•The nails in yellow nail
syndrome are yellow due to
thickening,
•a tinge of green suggets
secondary infection.
•The lunula is obscured
•increased transverse and
longitudinal curvature
•loss of cuticle
•chronic paronychia with
onycholysis and transverse
ridging may occur
• The condition usually
presents in adults
55. YELLOW NAIL SYNDROME
An autosomal dominnant inheritance is
suspected
lymphoedema at one or more sites may
accomapany
respiratory or nasal sinus disease may present
Also occur in d-penicillamine therapy and
nephrotic syndrome ,hypothyroidism & AIDS
Attempted treatments include oral and topical
vitamin E, oral zinc
56. LONGITUDINAL ERYTHRONYCHIA
•It is a longitudinal red
streak in the nail
•Forms a strip where the
nail bed is less compressed
by the overlying nail so that
blood pools
• color is more easily seen
because the nail is thinner
in this line.
•Splinter hemorrhages may
lie longitudinally
•Seen with lichen planus &
darrier’s disease ,
acrokeratosis verruciformis
57. ONYCHOPAPILLOMA
Describe the isolated, benign warty distal nail
bed lesions
term coined by baran
Can be associated with longitudinal
erythronychia
The papilloma is a secondary element, given
that it is found distally in the nail bed while
the cause lies proximally within the matrix.
.