Understanding The Abnormalities Of Nails

The nails are the part of the body that covers the dorsal aspect of the terminal phalanges of fingers and toes in humans and enhances the appearance of a person. Nails are the part of the outer layer of the skin are composed of very small cells. The nails are consists:

  • Matrix - A tissue on which a nail rest and is responsible for the production of cells that becomes the nail plate.
  • Nail Plate- It is the actual nail or the hardcover of the nail and it is known as keratin.
  • Nail Bed - It is the skin that is beneath the nail plate.
  • Nail fold - It is the epidermis which overlies the sides of the nail plate.
  • Hyponychium - It is the soft tissue under the nail.

There are various disorders of the nail and some of them include:

1. Onychocryptosis

Onychocryptosis is also known as an ingrown toenail and it mostly affects the great toenail. It is a common problem in which the lateral edge of the nail grows into the lateral nail fold and leads to an inflammation of the tissues. It occurs when the periungual skin gets punctured by the corresponding nail plate and this leads to an inflammation and infections. It is often accompanied by painful, draining and foul-smelling lesion of the involved toe and it is believed that it can be caused due by improper nail trimming. Ingrown toenails are divided into three categories:

  • Mild cases - It is characterized by the swelling of the nail fold, erythema, edema and pain along with pressure.
  • Moderate case - It is characterized by increased inflammation, seropurulent drainage, infection and ulceration of the nail fold.
  • Severe case - It is characterized by chronic inflammation and granulation.

2. Paronychia

Paronychia is a condition in which the nail folds of the hands and toes are affected.  Paronychial infection is the result of any disturbance between the seal of the proximal nail fold and the nail plate. It allows the portal entry for invading organisms. People with the occupation such as baker, bartender, and dishwasher are more likely to develop paronychial infection. Paronychia is of two types:

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  • Acute Paronychia - This type of paronychia often results from finger sucking, nail biting, aggressive manicuring and penetrating trauma. People suffering from acute paronychia experiences pain and tenderness of the perionychium. It is characterized as an inflamed, discolored and distorted nail and if left untreated, pus can develop around the perionychium.
  • Chronic Paronychia - This type of paronychia is usually non-suppurative and the treatment of chronic paronychia is difficult. People who are at a repetitive exposure to water containing irritants and those who are repeatedly exposed to moist environments are at high risk of developing chronic paronychia.

3. Leukonychia

Leukonychia is a nail disorder which is characterized by the white discoloration of the nail plate and it can be caused by the wide range of diseases. Leukonychia can be of four types:

  • Punctate - It is the most common type of leukonychia and it is characterized by the small white spots that appear on the nails as a result of picking and biting of the nails.

  • Striate - It is characterized by the whitening of the nails in bands that run parallel to the lunula. The cause of this type of leukonychia can be hereditary or it can also be associated with diseases like cirrhosis of the liver.

  • Total - It is characterized by the whitening of the entire nail and it can be considered as an early warning sign of underlying diseases such as hypoalbuminemia in renal failure, liver failure,  trichinosis, and typhoid fever.

  • Partial - It is characterized by the partial whitening of the nail and can be due to diseases like tuberculosis, metastatic carcinoma, and leprosy.

4. Onychomycosis

Onychomycosis is one of the most common nail infective disorder and in most of the cases, it is caused by anthropophilic dermatophytes. Through the hyponychium, fungi reach the nail and invade the undersurface of the nail unit place. It is the fungal infection of the nail and is also known as tinea unguium. It is characterized by the white or yellow discoloration of the nail, thickening of the nail and sometimes separation of the nail from the bed. Thickening of nail and discoloration of the nail is the most common symptom of this nail disorder.


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