View source for Nail disease

{{Redirect|Onychia|the squid genus|Onykia|the genus of moth|Onychia (moth)}}
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| caption         = Onychia without [[granuloma]] 
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A '''nail disease''' or '''onychosis''' is a disease or deformity of the [[nail (anatomy)|nail]].  Although the nail is a structure produced by the skin and is a [[skin appendage]], nail diseases have a distinct classification as they have their own signs and symptoms which may relate to other medical conditions. Some nail conditions that show signs of [[infection]] or [[inflammation]] may require medical assistance.

==Diseases==
[[File:Human nail anatomy.jpg|thumb|Anatomy of the basic parts of a human [[nail (anatomy)|nail]]. A. Nail plate; B. lunula; C. root; D. sinus; E. matrix; F. [[nail bed (anatomy)|nail bed]]; G. [[eponychium]]; H. free margin.]]

*''Onychia'' is an [[inflammation]] of the nail folds (surrounding tissue of the nail plate) of the nail with formation of [[pus]] and shedding of the nail.  Onychia results from the introduction of microscopic [[pathogen]]s through small wounds.
*''[[Ingrown nail|Onychocryptosis]]'', commonly known as "ingrown nails" (''unguis incarnatus''), can affect either the fingers or the toes.  In this condition, the nail cuts into one or both sides of the [[nail (anatomy)#nail bed|nail bed]], resulting in [[inflammation]] and possibly [[infection]]. The relative rarity of this condition in the fingers suggests that [[pressure]] from the ground or shoe against the toe is a prime factor. The movements involved in [[walking]] or other physical disturbances can contribute to the problem.  Mild [[onychocryptosis]], particularly in the absence of infection, can be treated by trimming and rounding the nail.  More advanced cases, which usually include [[infection]], are treated by [[surgically]] excising the ingrowing portion of the nail down to its bony origin and thermally or chemically [[cauterizing]] the matrix, or 'root', to prevent recurrence.  This surgery is called [[matrixectomy]]. The best results are achieved by cauterizing the matrix with [[phenol]]. The [[Ingrown nail|Vandenbos Procedure]] is a highly effective method that focuses on excision of excessive nail fold tissue without affecting the healthy nail and nail matrix. The Vandenbos Procedure is showing high success rates in eliminating onychocryptosis without altering the normal nail. Another, much less effective, treatment is [[Surgery#excision|excision]] of the matrix, sometimes called a 'cold steel procedure'.
[[File:Ingrown_nail_in_hallux_toe.jpg|thumb|[[Ingrown nail]] in [[hallux]] toe]]
*''[[Onychodystrophy]]'' is a [[deformity|deformation]] of the nails that can result from cancer [[chemotherapy]] which includes [[bleomycin]], [[hydroxyurea]], or [[5-fluorouracil]]. It can include [[discoloration]] of the nail, or [[dyschromia]].
*''[[Onychogryposis]]'', also called "ram's-horn nail", is a thickening and increase in [[curvature]] of the nail.  It is usually the result of injury to the matrix.  It may be partially [[hereditary]] and can also occur as a result of long-term neglect.  It is most commonly seen in the great [[toe]] but may be seen in other toes as well as the fingernails.  An affected nail has many grooves and ridges, is brownish in color, and grows more quickly on one side than on the other.  The thick curved nail is difficult to cut, and often remains untrimmed, exacerbating the problem.
[[File:Onychomycosis.JPG|thumb|200px|[[Onychomycosis]] in every nail of the right foot.]]

*''[[Onycholysis]]'' is a loosening of the exposed portion of the nail from the nail bed, usually beginning at the free edge and continuing to the [[lunula (anatomy)|lunula]].  It is frequently associated with an [[internal disorder]], [[Physical trauma|trauma]], [[infection]], [[nail fungi]], [[allergy]] to [[nail enhancement product]]s, or side effects of [[drug]]s.
*''[[Onychomadesis]]'' is the separation and falling off of a nail from the [[nail (anatomy)#nail bed|nail bed]]. Common causes include localized [[infection]], minor injury to the [[matrix bed]], or severe [[systemic illness]]. It is sometimes a side effect of [[chemotherapy]] or [[x-ray]] treatments for [[cancer]]. A new nail plate will form once the cause of the disease is removed.
*''[[Onychomycosis]]'', also known as [[tinea|''tinea unguium'']], is a contagious [[infection]] of the nail caused by the same [[fungal organism]]s which cause [[ringworm]] of the [[skin]] (''Trichophyton rubrum'' or ''T. mentagrophytes'', rarely other [[trichophyton]] species or ''Epidermophyton floccosum'' <ref name="mycology">{{cite book |last= Hall |first= John C. |editor= John C. Hall |title= Sauer's Manual of Skin Diseases |url= https://archive.org/details/sauersmanualofsk0009hall |url-access= registration |edition= 9th |year= 2006 |publisher= Lippincott Williams & Wilkins |location= Philadelphia |isbn= 0-7817-2947-5|pages= 244–266 |chapter= 25. Dermatologic mycology.}}</ref>). It can result in [[discoloration]], [[thickening]], [[chalkiness]], or crumbling of the nails and is often treated by powerful oral medications which, rarely, can cause severe side effects including [[liver failure]]. Mild [[onychomycosis]] sometimes responds to a combination of [[topical]] [[antifungal medication]], sometimes applied as special [[medicinal]] nail [[lacquer]], and [[periodic filing]] of the nail surface. For advanced onychomycosis, especially if more than one nail is [[infection|infected]], systemic medication (pills) is preferred. Home remedies are often used, although their effectiveness is disputed.
[[Image:HEMORRHAGESUBUNG1.JPG|thumb|right|[[Subungual hematoma]] (mild)]]
*''[[Onychophosis]]'' is a growth of [[horn (anatomy)|horny]] [[epithelium]] in the nail.
*''[[Onychoptosis]]'' is the periodic shedding of one or more nails, in whole or part. This condition may follow certain diseases such as [[syphilis]], or can result from [[fever]], trauma, [[systemic upset]]s or [[adverse reaction]] to drugs.
*''[[Onychorrhexis]]'' also known as brittle nails, is brittleness with breakage of fingernails or toenails.
*''[[Paronychia]]'' is a [[bacterial]] or [[fungal]] [[infection]] where the nail and [[skin]] meet.
*''[[Koilonychia]]'' is when the nail curves upwards (becomes spoon-shaped) due to an [[Iron deficiency (medicine)|iron deficiency]].  The normal process of change is: brittle nails, straight nails, spoon-shaped nails.
*''[[Subungual hematoma]]'' occurs when trauma to the nail results in a collection of [[blood]], or [[hematoma]], under the nail.  It may result from an acute injury or from repeated minor [[Physical trauma|trauma]] such as running in undersized shoes.  Acute [[subungual hematoma]]s are quite painful, and are usually treated by releasing the [[blood]] by creating a small hole in the nail.  [[Drilling]] and [[cauterization|thermal cautery]]  are common methods for creating the hole.  Thermal cautery is not used on [[acrylic nails]] because they are [[flammable]].
*''[[Onychomatricoma]]'', a tumor of the nail matrix.
*''Nail [[pemphigus]]'', an auto-immune disease.
*''[[Longitudinal erythronychia|Erythronychia]]'', red bands in the nail from some inflammatory conditions.
*''[[Melanonychia]]'', a black, brown or grey  discoloration of the nail, with numerous causes.

==Nail changes and conditions associated with them==
Nail inspection can give hints to the internal condition of the body as well. 
Nail disease can be very subtle and should be evaluated by a dermatologist with a focus in this particular area of medicine.  A nail technician may be the first to note a subtle change in nail health.<ref>Common nail tumors.
Baran R, Richert B., Dermatol Clin. 2006 Jul;24(3):297-311. Review.</ref><ref>Dealing with melanonychia. Tosti A, Piraccini BM, de Farias DC. Semin Cutan Med Surg. 2009 Mar;28(1):49-54. Review.</ref><ref>The nail in systemic diseases. Tosti A, Iorizzo M, Piraccini BM, Starace M. Dermatol Clin. 2006 Jul;24(3):341-7. Review.</ref>

===Pliability===
*Brittleness is associated with iron deficiency, thyroid problems,<ref>{{Cite web |url=http://www.bhcs.com/healthinformation/baylorhealthmagazine/2005/nov/AS_thyroid.htm |title=Baylor All Saints Medical Centers: Thyroid Disease<!-- Bot generated title --> |access-date=2007-10-05 |archive-date=2008-02-13 |archive-url=https://web.archive.org/web/20080213021207/http://www.bhcs.com/healthinformation/baylorhealthmagazine/2005/nov/AS_thyroid.htm |url-status=dead }}</ref> and impaired kidney function.
*Splitting and fraying are associated with [[psoriatic nails|psoriasis]] and deficiencies of [[folic acid]], protein, and [[Vitamin C|Vitamin&nbsp;C]].
*Unusual thickness is associated with circulation problems.

===Shape and texture===
*[[Nail clubbing]] - nails that curve down around the fingertips with nailbeds that bulge is associated with oxygen deprivation and lung, heart, or liver disease.
*[[Koilonychia]] - spooning, or nails that grow upwards. Associated with [[iron-deficiency anaemia]] or [[Vitamin B12 deficiency|vitamin B<sub>12</sub> deficiency]].{{Citation needed|date=April 2018}}
*Pitting of the nails is associated with [[psoriatic nails|psoriasis]].
*[[Beau's lines]] are horizontal ridges in the nail.
*[[Habit-tic deformity]] is a condition similar to Beau's Lines caused by long-term skin picking.

===Discoloration of entire nail bed===
*Yellowing of the nail bed is associated with chronic bronchitis, lymphatic problems, diabetes, and liver disorders.
*Brown or copper nail beds are associated with [[arsenic poisoning|arsenic]] or [[copper poisoning]], and [[Onychomycosis|local fungal infection]].
*Redness is associated with heart conditions.

===Other color changes and markings===
*[[Melanonychia]] (longitudinal streaking that darkens or does not grow out), especially on the thumb or big toe, may indicate subungual melanoma.
*White lines across the nail ([[leukonychia]] striata, or transverse leukonychia) may be [[Mees' lines]] or [[Muehrcke's lines]].
*Small white patches  are known as [[leukonychia]] punctata.
*Dark nails are associated with B<sub>12</sub> deficiency.
*Stains of the nail plate (not the nail bed) are associated with  smoking and henna use.
*[[Splinter hemorrhages]] (or haemorrhages) are tiny blood clots that tend to run vertically under the nails.
*Drug-induced nail changes are caused by drug usage which may result in various abnormalities.<ref name="Fitz2">Freedberg, et al. (2003). ''Fitzpatrick's Dermatology in General Medicine''. (6th ed.). McGraw-Hill. {{ISBN|0-07-138076-0}}.</ref>{{rp|665–6}}

==Treatment==
In approximately half of suspected nail fungus cases there is actually no fungal infection, but only some nail dystrophy.<ref name="AADfive">{{Citation |author1 = American Academy of Dermatology |author1-link = American Academy of Dermatology |date = February 2013 |title = Five Things Physicians and Patients Should Question |publisher = [[American Academy of Dermatology]] |work = [[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |url = http://www.choosingwisely.org/doctor-patient-lists/american-academy-of-dermatology/ |access-date = 5 December 2013}}, which cites
*{{Cite journal | doi = 10.1046/j.1365-2133.2003.05242.x | last1 = Roberts | first1 = D. T. | last2 = Taylor | first2 = W. D. | last3 = Boyle | first3 = J. | author4 = British Association of Dermatologists | title = Guidelines for treatment of onychomycosis | journal = The British Journal of Dermatology | volume = 148 | issue = 3 | pages = 402–410 | year = 2003 | pmid = 12653730| s2cid = 33750748 }}
*{{Cite journal | last1 = Mehregan | first1 = D. R. | last2 = Gee | first2 = S. L. | title = The cost effectiveness of testing for onychomycosis versus empiric treatment of onychodystrophies with oral antifungal agents | journal = Cutis | volume = 64 | issue = 6 | pages = 407–410 | year = 1999 | pmid = 10626104}}</ref> Before beginning oral antifungal therapy the health care provider should confirm a fungal infection.<ref name="AADfive"/> Administration of treatment to persons without an infection is [[unnecessary health care]] and causes needless exposure to side effects.<ref name="AADfive"/>

==See also==
* [[Hangnail]]
* [[List of cutaneous conditions]]
* [[Occupational hazards associated with exposure to human nail dust]]
* [[Yellow nail syndrome]]

== References ==
{{reflist}}

==External links==
{{subject bar|auto=y|d=y|Medicine}}
{{Medical resources
|   ICD10          = {{ICD10|L|60||l|60}}, {{ICD10|Q|84|3|q|80}}-{{ICD10|Q|84|6|q|80}} 
|   ICD9           = {{ICD9|703}}, {{ICD9|757.5}} 
|   ICDO           = 
|   OMIM           = 
|   MedlinePlus    = 003247 
|   eMedicineSubj  = orthoped 
|   eMedicineTopic = 421 
|   DiseasesDB     = 23092 
|   MeshID         = D009260 
}}
*[https://www.cdc.gov/fungal/nail-infections.html Fungal Nail Infections] - explanation covering causes, treatment, and prevention
*[http://hardinmd.lib.uiowa.edu/nailspictures.html Links to pictures of Nail Diseases (Hardin MD/Univ of Iowa)]
*[http://www.aafp.org/afp/20040315/1417.html Nail Abnormalities: Clues to Systemic Disease] {{Webarchive|url=https://web.archive.org/web/20080512042919/http://www.aafp.org/afp/20040315/1417.html |date=2008-05-12 }}
*[https://web.archive.org/web/20150115061840/http://vikingrx.com/toenail-fungus-onychomycosis-treatment Links to pictures of Toenail Diseases (Wiggins MD)]

{{Disorders of skin appendages}}
{{Congenital malformations and deformations of skin appendages}}
{{Authority control}}

{{DEFAULTSORT:Nail Disease}}
[[Category:Nails (anatomy)]]
[[Category:Conditions of the skin appendages]]