By Robert Baran, Ivan Bristow, Rodney P. R. Dawber, Ekart Haneke, Antonella Tosti

A useful diagnostic relief for dermatologists and podiatrists. accomplished assurance of pathologies affecting the toe and finger nails is accomplished via complete dialogue, supported by means of large use of colour pictures.

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11 Lupus erythematosus. 12 Unilateral or limited to a few digits: 7 8 9 10 • subluxation of the shoulder (with paralysis of the brachial plexus), medial nerve neuritis • Pancoast-Tobias syndrome • aneurysm of the aorta or the subclavian artery • sarcoidosis • tophaceous gout. 13 Lower extremities: • arterial graft sepsis. 14 Isolated forms: • local injury, whitlow, lymphangitis • subungual epidermoid inclusions. 15 Transitory form: physiological in the newborn child (due to reversal of the circulation at birth).

In principle the term ‘anonychia’ (total or partial) is probably best reserved for conditions in which the nail has failed to develop; ‘onychatrophy’ should be used to describe processes in which the nail has initially formed satisfactorily and then shown total or partial regression. 7 lists the causes of anonychia and onychatrophy. In aplastic anonychia, a rare congenital disorder occasionally associated with other defects such as ectrodactyly, the nail never forms. Loose, horny masses are produced by the metaplastic squamous epithelium of the matrix and the nail bed in anonychia keratodes.

A similar clinical picture can be seen in the great toe with bifurcation of the terminal phalanx and duplication of the nail. Early treatment is important to maximize functional restoration and aesthetic results. 53 Bifid lunula in a child with congenital polydactyly. A bifid lunula can also be a sign of polydactyly WORN-DOWN, SHINY NAILS Patients with atopic dermatitis or chronic erythroderma may be ‘chronic scratchers and rubbers’. 55). This condition, also called usure des ongles, may also occur in many different manual occupations.

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