The nail and its disorders

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1 The nail and its disorders The human nail is a hard plate of densely packed keratinized cells which protects the dorsal aspects of the digits and greatly enhances fine digital movements of the hands. Nails are descendants of claws used for digging and fighting, but now only serve as a protection for the digit and to assist in basic behavior such as scratching and picking up small objects.

2 Onychocryptosis (in growing toenail): Onychocryptosis is a condition in which a spike, shoulder or serrated edge of the nail has pierced the epidermis of the sulcus and penetrated the dermal tissues. It occurs most frequently in the hallux of male adolescents and may be unilateral or bilateral (one site or both sites of the nail). Symptoms: The skin becomes red, shiny and tense and the toe appears swollen. There is throbbing pain, acute tenderness to the slightest pressure and a degree of localized hyperhidrosis. The continued penetration of the nail spike prevents normal healing by granulation of the wound in de sulcus, and a prolific increase of granulation tissue is common. Example: one of our patients

3 Treatment onychocryptosis: If the onychocryptosis is uncomplicated by infection, the penetrating splinter may be located by careful probing and then removed with a small scalpel or fine nippers. Extreme care must be taken to avoid further injury to the sulcus and to ensure that a spike of nail is not left deep in the sulcus. PNA: partial nail avulsion PNA from the second toe in our clinic PNA is designed to remove the involuted section of nail which is causing painful symptoms within the sulcus. The remaining nail plate should be flat and must be sufficiently wide to give some cosmetic apparance. Cause of the pain.

4 Onychogryphosis (ram s horn, ostler toe) Onychogryphosis is readily distinguishable from onychauxis because, as well as hypertrophy there is gross deformity of the nail which develops into a curved or ram s horn shape. The nail is usually a dark brown or yellowish colour, with both longitudinal and transverse ridges on its surface. Commonly, only the great toe is affected because, from its size and prominence, it is the one most prone to injury- but the condition may also arise in other toes. Aetiology: Any one of the aetiological factors involved in the development of onychauxis may be the cause, but by far the commonest cause is a single major trauma arising from a heavy blow or a severe stubbing of the toe. It is sometimes the result of neglect and the consequent increasing impaction from footwear against the lengthening nail.

5 Treatment onychogryphosis : Palliative treatment consist of reduction of the hypertrophy, taking care to prevent haemorrhage from any nail bed tissue which has been caught up in the malformed nail. Footwear should be examined to ensure adequate fitting. This treatment, if repeated at regular intervals, is usually sufficient to give the patient freedom and discomfort. In a young person, especially when only one toe is affected and when palliative measures have been tried, avulsion with matrix destruction is the most satisfactory method of providing long-term relief. Onychogryphosis ram s horn deformity

6 Fungal nail infection Fungal nail infection may be caused by dermatophyste yeasts or nondermatophyste moulds. It is accepted that dermatophytes are by far the predominant pathogens and probably account for more than 85% of all cases of fungal nail infection. Laboratory diagnosis of dermatophyte infection: There is no doubt that many cases of fungal foot infection are treated without laboratory confirmation of diagnosis. Many antifungal preperations are now available on an over-the-counter basis and self treatment is common.

7 Preventing fungus : Keep feet clean, cool and dry. Change socks. Wear shoes that "breathe" like leather, rather than plastic. Make sure shoes fit correctly and are not too tight. Apply an anti-fungal cream or spray or a prescription from your podiatrist for antifungal cream to the bottom of the feet, and on the nails. This may help prevent early re-growth of the fungus. In some cases, an oral medication may be prescribed (by the doctor, internist or dermatologist). Avoid walking barefoot, especially in bathrooms, locker rooms, gyms, on carpeting, and in public bathing areas. Wear slippers or stand on a towel or piece of paper. Keep toenails short, cut straight across and avoid ingrown nails. Do not use the same clippers on abnormal nails and normal nails. Family members and close personal contacts should treat any fungus infections they may have to avoid trading back and forth. Discard old shoes, boots, slippers and sneakers. Do not share footwear with others.

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