java barcode generator tutorial NAIL DISORDERS 1 Morphologic Abnormalities of the Nails Classification in Objective-C

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NAIL DISORDERS 1 Morphologic Abnormalities of the Nails Classification
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Acquired nail disorders may be classified as local or those associated with systemic or generalized skin diseases
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A Local Nail Disorders
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1 Onycholysis (distal separation of the nail plate from the nail bed, usually of the fingers) is caused by excessive exposure to water, soaps, detergents, alkalies, and industrial cleaning agents Candidal infection of the nail folds and subungual area, nail hardeners, and drug-induced photosensitivity may cause onycholysis, as may hyperthyroidism and hypothyroidism and psoriasis 2 Distortion of the nail occurs as a result of chronic inflammation of the nail matrix underlying the eponychial fold Such changes may also be caused by warts, tumors, or cysts, impinging on the nail matrix 3 Discoloration and crumbly thickened nails are noted in dermatophyte infection and psoriasis 4 Allergic reactions (to resins in undercoats and polishes or to nail glues) are characterized by onycholysis or by grossly distorted, hypertrophic, and misshapen nails
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B Nail Changes Associated with Systemic or Generalized Skin Diseases
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1 Beau s lines (transverse furrows) may follow any serious systemic illness 2 Atrophy of the nails may be related to trauma or to vascular or neurologic disease 3 Clubbed fingers may be due to the prolonged hypoxemia associated with cardiopulmonary disorders (See 9) 4 Spoon nails may be seen in anemic patients 5 Stippling or pitting of the nails is seen in psoriasis, alopecia areata, and hand eczema
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6 Nail hyperpigmentation may be caused by many chemotherapeutic agents
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Differential Diagnosis
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Onychomycosis may cause nail changes identical to those seen in psoriasis Careful examination for more characteristic lesions elsewhere on the body is essential to the diagnosis of the nail disorders Cancer should be suspected (eg, Bowen s disease or squamous cell carcinoma) as the cause of any persistent solitary subungual or periungual lesion
Complications
Toenail changes may lead to an ingrown nail in turn often complicated by bacterial infection and occasionally by exuberant granulation tissue Poor manicuring and poorly fitting shoes may contribute to this complication Cellulitis may result
Treatment & Prognosis
Treatment consists usually of careful debridement and manicuring and, above all, reduction of exposure to irritants (soaps, detergents, alkali, bleaches, solvents, etc) Longitudinal grooving due to temporary lesions of the matrix, such as warts, synovial cysts, and other impingements, may be cured by removal of the offending lesion
treatment, the diagnosis should be confirmed The costs of the various treatment options should be known and the most cost-effective treatment chosen Drug interactions must be avoided Ketoconazole, due to its higher risk for hepatotoxicity, is not recommended to treat any form of onychomycosis For fingernails, ultramicronized griseofulvin 250 mg orally three times daily for 6 months can be effective Alternative treatments are (in order of preference) oral terbinafine 250 mg/d for 6 weeks, oral itraconazole 400 mg/d for 7 days each month for 2 months, and oral itraconazole 200 mg/d for 2 months Once clear, fingernails usually remain free of disease Onychomycosis of the toenails does not respond to griseofulvin therapy or topical treatments The best treatment, which is also FDA approved, is oral terbinafine 250 mg daily for 12 weeks Liver function tests and a complete blood count with platelets are performed monthly during treatment Pulse oral itraconazole 200 mg twice daily for 1 week per month for 3 months is inferior to standard terbinafine treatments, but it is an acceptable alternative for those unable to take terbinafine
Hay R Literature Onychomycosis J Eur Acad Dermatol Venereol 2005 Sep;19 (Suppl) 1:1 7 [PMID: 16120198] Heikkila H et al Long-term results in patients with onychomycosis treated with terbinafine or itraconazole Br J Dermatol 2002 Feb;146(2):250 3 [PMID: 11903235] Wilcock M et al Inappropriate use of oral terbinafine in family practice Pharm World Sci 2003 Feb;25(1):25 6 [PMID: 12661473]
2 Tinea Unguium (Onychomycosis)
Tinea unguium is a trichophyton infection of one or more (but rarely all) fingernails or toenails The species most commonly found is T rubrum Saprophytic fungi may rarely (< 5%) cause onychomycosis The nails are lusterless, brittle, and hypertrophic, and the substance of the nail is friable Laboratory diagnosis is mandatory since only 50% of dystrophic nails are due to dermatophytosis Portions of the nail should be cleared with 10% KOH and examined under the microscope for hyphae Fungi may also be cultured Periodic acid-Schiff stain of a histologic section of the nail plate will also demonstrate the fungus readily Each technique is positive in only 50% of cases so several different tests may need to be performed Onychomycosis is difficult to treat because of the long duration of therapy required and the frequency of recurrences Fingernails respond more readily than toenails For toenails, treatment is limited to patients with discomfort, inability to exercise, and immune compromise In general, systemic therapy is required to effectively treat nail onychomycosis Topical therapy has limited value and the adjunctive value of surgical procedures is unproven Fingernails can virtually always be cured and toenails are cured 35 50% of the time and are clinically improved about 75% of the time In all cases, before
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