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1. Clinical fingernail abnormalities

1.1. Name, description, cause

1.1.1. Name Longitudinal lines

1.1.2. Description Vertical hyperpigmented bands that extend across entire nail plate, but should not extend to cuticle or other skin.

1.1.3. Cause 1. Melanoma. 2. Occasionally, normal, benign finding in African population.

1.2. Name, description, cause

1.2.1. Name Beau's line

1.2.2. Description Transvers depression of the nail plate that grows out

1.2.3. Cause Anything that can affect the rate of nail growth from severe systemic illness, meds

1.3. Name, description, cause

1.3.1. Name Onycholysis

1.3.2. Description Separation of the nail plate from bed

1.3.3. Cause Multiple causes from psoriasis, to fungal infection.

1.4. Name, description, cause

1.4.1. Name Leukonychia

1.4.2. Description Abnormal keratinization of nail matrix leading to white/depigmentation of nail plate

1.4.3. Cause Physiologic, common finding. Idiopathic and benign

1.5. Name, description, cause

1.5.1. Name Median nail dystrophy

1.5.2. Description Abnormal nail plate line along length of nail

1.5.3. Cause Caused by trauma

1.6. Name, description, cause

1.6.1. Name Schamroth's sign (clubbing)

1.6.2. Description This may fit both nail plate and nail bed abnormalities because the plate is abnormal but in varying degrees of clubbing the surround soft tissue is affected. Considered a results of vascular abnormalities in nail

1.6.3. Cause Indication of systemic disease. Causes cardiovascular, pulmonary, GI disease, Hyperthyroidism, HIV.

1.7. Name, description, cause

1.7.1. Name Pitting

1.7.2. Description Many small divets on most if not all nails

1.7.3. Cause Psoriasis

1.8. Name, description, cause

1.8.1. Name Koilonychia

1.8.2. Description Spoon shape abnormality of nail. iron def. The lateral edges of the nail extend upward

1.8.3. Cause physiologic in childrenor diabetes mellitus in adults.

1.9. Name, description, cause

1.9.1. Name Splinter hemmorhage

1.9.2. Description Longitudinal pigmented abnormality in nail bed.

1.9.3. Cause May be from trauma, psoriasis and most notably endocarditis

1.10. Name, description, cause

1.10.1. Name Paronychia

1.10.2. Description Inflammed, white or red skin around lesion. Likely only on a single or adjacent fingers

1.10.3. Cause Infection (inflammatory response).

2. Skin pathology

2.1. 1. Psoriasis

2.1.1. Description 1. A common, chronic immune-mediated skin disease which may also affect the joints 2. Affects approx. 2% of US population. 3. All ages can be affected; bimodal peak age at onset (adolescence & 60 yrs). 4. Sometimes associated with arthritis, myopathy, enteropathy, spondylitic joint disease.

2.1.2. Cause Autoimmune. Strong HLA-C association

2.1.3. Clinical finding 1. Well-demarcated, pink to salmon-colored plaques covered by characteristic silver-white scale. 2. Frequently affects elbows, knees, scalp, lumbrosacral area, intergluteal clefts, & glans penis 3. Koebner phenomenon (Lesions can be induced by local trauma). 4. Auspitz sign (Pinpoint bleeding when scales are scraped off). 5. Nail pitting

2.1.4. Treatment Self limiting. Steroids as needed.

2.2. 2. Tumors of cellular migrants to the skin

2.2.1. Overview Proliferations of cells that develop in other locations in the body & migrate to the skin.

2.2.2. Types Mycosis fungoides Description Clinical findings Stages Sezary syndrome (Cutaneous T-cell lymphoma) Description Clinical findings Histology Mastocytosis (group of disorders) Overview Examples

2.3. 3. Seborrheic Dermatitis

2.3.1. Description 1. A common inflammatory skin condition that causes flaky, white to yellowish scales to form on oily areas such as the scalp or inside the ear. It can occur with or without reddened skin. Cradle cap is the term used when seborrheic dermatitis affects the scalp of infants. 2. Affects 3-5% of population.

2.3.2. Clinical finding 1. Involves areas w/high density of sebaceous glands (scalp, forehead, external auditory canal). 2. Causes dandruff (cradle cap in infants) 3. Macules & papules on an erythematous-yellow, greasy base with extensive scaling & crusting. Top picture: "cradle cap"

2.3.3. Cause Most often the fungus Malassezia furfur

2.3.4. Treatment Selenium sulfite (OTC shampoo called Selson Blue)

2.4. 4. Lichen planus

2.4.1. Description 1. Recurrent, pruritic, inflammatory disorder that affects the skin & oral mucosa. 2. Slight female predominance. 3. 30-60 yrs of age. 4. Associated with Hepatitis C, and may be found with autoimmune diseases.

2.4.2. Clinical finding 1. The 6 P's 6P's: 1. Pruritic 2. Purple 3. Polygonal 4. Planar 5. Papules 6. Plaques 2. Oral lesions 1. Seen in about 70% of cases. 2. Present as white reticulated lesions.

2.4.3. Cause Unknown

2.4.4. Histology 1. Acanthosis (Epidermal thickening) 2. Saw-toothed rete ridge (zigzag contour of dermoepidermal junction). 3. Lymphocytic infiltrate along dermoepidermal junction

3. Hair

3.1. More content coming soon!