ArTicle | AGEING NAILS |
Figure 6 Onycholysis semilunaris and mild chronic paronychia of the index finger of a 58-year-old woman
Figure 7 Isolated nail psoriasis in the left middle and ring fingers in a 62-year-old woman; note that she has onycholysis semilunaris without apparent nail psoriasis of her right ring finger
■ Genetic ■ Acquired as a result of foot deformities ■ Acquired as a result of chronic dermatoses ■ Acquired as a result of degenerative distal osteoarthritis. The most common is the hereditary type that often
are able to produce hydrogen sulfide that reacts with a
number of metals to form metal sulfides that have a grayish-black colour, which is different to human and fungal melanin (8). Antiseptic treatment will slowly improve these unsightly nail stains. Chronic degenerative osteoarthritis of the distal
interphalangeal joint with Heberden nodes is very common in ageing patients. Owing to the altered bone shape, transverse over-curvature of the fingernails may develop. Acute flares of this condition may worsen the problem, but when this is successfully treated the over- curvature may improve. In contrast, over-curvature of the toenails, commonly called pincer nails, is a common condition. There are at least four aetiologically different types of pincer nail:
begins in the fourth decade of life. With time, the over- curvature increases, gaining over 360° so that the nails look like a trumpet. The distal over-curved part of the nail is heaped up from the nail bed, first causing hyperkeratosis and papillomatosis of the nail bed, and later a traction osteophyte of the distal dorsal tuft of the terminal phalanx. The affected big toenails exhibit a lateral deviation of their longitudinal axis, while the smaller toes are deviated medially when involved in this process. The cause of the condition is a widening of the base of the terminal phalangeal bone, which is asymmetric. In the big toe, the medial aspect of the bone is wider, often forming a hook-like exostosis, which pushes the medial aspect of the matrix in a more distal direction, and therefore induces the lateral deviation of the big toenail (9). The condition is often surprisingly asymptomatic, but may cause excruciating pain and make the wearing of fashionable, pointed shoes impossible. When the nail is curved to approximately 180°, its lateral edges are vertical and press on the epidermis of the lateral nail grooves, inducing a reactive hyperkeratosis called onychophosis. This may cause pain similar to a corn. Another reason for nail over-curvature may be foot deformations or some skin diseases. In these cases, the condition is not symmetric and usually confined to the big toes.
Tumour-like lesions Myxoid pseudocysts (Figure 9), also called dorsal finger cysts, are common in those with distal interphalangeal arthritis, many of whom also have Heberden nodes. They represent a degenerative mucinous lesion, not a true tumour and not a real cyst. Many treatments for this condition have been described, ranging from simple puncture, repeated needling, injection of corticosteroids or sclerosants, electrofulguration, cryotherapy, infrared coagulation, laser vaporisation, and
simple excision, to intra-articular injection with methylene blue, careful dissection of the entire degenerated mucinous tissue, and ligation of the stalk connecting the lesion with the joint (10).
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Figure 8 Onychomycosis in an 88-year-old man; note the very dry skin of the tip of the toe
May 2011 |
prime-journal.com
IMAGES HANEKE
IMAGE HANEKE
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