Adam Rubin

Are You Confident of the Diagnosis? What you should be alert for in the history Clinical history would most likely indicate an acquired nail plate dystrophy on a thumb or the bilateral thumbs. Some reports have described an association of development of median canaliform dystrophy with trauma to the nail unit, but this is not…

Are You Confident of the Diagnosis? What you should be alert for in the history A variety of causes including systemic illnesses and medications can cause this phenomenon. Characteristic findings on physical examination Beau’s lines are a nonspecific physical finding on the nail plate (Figure 1). They represent a transient arrest of nail matrix production…

Are You Confident of the Diagnosis? Retronychia is caused by an ingrown nail plate at the proximal nail fold. Characteristic findings on physical examination Characteristic features include a yellow discoloration of the nail plate, detachment of the nail plate from the nail bed (onycholysis), inflammation of the proximal nail fold. An inflammatory exudate and granulation…

Are You Confident of the Diagnosis? What you should be alert for in the history Since trachyonychia can be associated with a variety of dermatologic disorders, clinical history should include questions about prior dermatoses, including lichen planus, psoriasis, and alopecia areata. The patient may have been treated with antifungal medications in the past without successful…

Are You Confident of the Diagnosis? What you should be alert for in the history Onycholysis refers to the physical sign of separation of the nail plate from the nail bed (Figure 1). Because of this separation, the portion of the nail plate that is not attached appears white. A greenish discoloration can sometimes be…

Are You Confident of the Diagnosis? What you should be alert for in the history Nail patella syndrome is transmitted in an autosomal dominant fashion, so a careful family history may identify other affected individuals. Nail patella syndrome classically will involve the nails, knees, elbows, and patients will demonstrate the presence of iliac horns. The…

Are You Confident of the Diagnosis? Characteristic findings on physical examination Characteristic findings of nail unit psoriasis include pitting, leukonychia, red spots in the lunula, onycholysis, nail plate crumbling, onycholysis, subungual hyperkeratosis, splinter hemorrhages, and “oil drop” discoloration (Figure 1). The diagnosis is straightforward if the patient has obvious signs of psoriasis on other areas…

Are You Confident of the Diagnosis? Characteristic findings on physical examination Diagnosis of ingrown nails (onychocryptosis) is based on the clinical appearance. Most often, the toenails are affected as compared to the fingernails. Overall, the great toenails are most commonly affected. Characteristic clinical history includes pain with pressure on the affected side of the digit,…