{"id":3810,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/common-nail-disorders\/"},"modified":"2024-10-11T09:36:36","modified_gmt":"2024-10-11T08:36:36","slug":"common-nail-disorders","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/dermatology\/common-nail-disorders\/","title":{"rendered":"Common Nail Disorders"},"content":{"rendered":"\n<div class=\"wp-block-media-text is-stacked-on-mobile\" style=\"grid-template-columns:31% auto\"><figure class=\"wp-block-media-text__media\"><img loading=\"lazy\" decoding=\"async\" width=\"640\" height=\"480\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Nail-Fungal-Infection-1.png\" alt=\"Nail fungal infection\" class=\"wp-image-19233 size-full\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Nail-Fungal-Infection-1.png 640w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Nail-Fungal-Infection-1-300x225.png 300w\" sizes=\"auto, (max-width: 640px) 100vw, 640px\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<p class=\"wp-block-paragraph\"><strong>Fungal Nail Infections (onychomycosis)<\/strong><\/p>\n\n\n\n<div class=\"wp-block-media-text is-stacked-on-mobile\" style=\"grid-template-columns:43% auto\"><figure class=\"wp-block-media-text__media\"><img loading=\"lazy\" decoding=\"async\" width=\"640\" height=\"480\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Nail-fungal-infection.png\" alt=\"Nail fungal infection\" class=\"wp-image-19232 size-full\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Nail-fungal-infection.png 640w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Nail-fungal-infection-300x225.png 300w\" sizes=\"auto, (max-width: 640px) 100vw, 640px\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<ul class=\"wp-block-list\">\n<li>Yellowish discolouration<\/li>\n\n\n\n<li>Soft subungual hyperkeratosis<\/li>\n\n\n\n<li>Spread from distal edge<\/li>\n\n\n\n<li>Superficial white onychomycosis<\/li>\n<\/ul>\n<\/div><\/div>\n<\/div><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">Differentiate from:<\/h2>\n\n\n\n<div class=\"wp-block-media-text is-stacked-on-mobile\" style=\"grid-template-columns:25% auto\"><figure class=\"wp-block-media-text__media\"><img loading=\"lazy\" decoding=\"async\" width=\"642\" height=\"482\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Finger-nails-Lichen-Planus.png\" alt=\"Finger nails Lichen Planus\" class=\"wp-image-19061 size-full\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Finger-nails-Lichen-Planus.png 642w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Finger-nails-Lichen-Planus-300x225.png 300w\" sizes=\"auto, (max-width: 642px) 100vw, 642px\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<p class=\"wp-block-paragraph\"><strong>Lichen Planus<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Usually a few nails but can involve all (fingernails most commonly affected).<br>Longitudinal ridges &amp; nail thinning.<\/p>\n\n\n\n<div class=\"wp-block-media-text is-stacked-on-mobile\" style=\"grid-template-columns:27% auto\"><figure class=\"wp-block-media-text__media\"><img loading=\"lazy\" decoding=\"async\" width=\"642\" height=\"482\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Lichen-planus.png\" alt=\"Lichen planus\" class=\"wp-image-19060 size-full\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Lichen-planus.png 642w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Lichen-planus-300x225.png 300w\" sizes=\"auto, (max-width: 642px) 100vw, 642px\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<p class=\"wp-block-paragraph\">If not treated can result in scarring and permanent nail loss.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-media-text is-stacked-on-mobile\" style=\"grid-template-columns:27% auto\"><figure class=\"wp-block-media-text__media\"><img loading=\"lazy\" decoding=\"async\" width=\"642\" height=\"482\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Lichen-planus-skin.png\" alt=\"Lichen planus skin\" class=\"wp-image-19062 size-full\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Lichen-planus-skin.png 642w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Lichen-planus-skin-300x225.png 300w\" sizes=\"auto, (max-width: 642px) 100vw, 642px\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<p class=\"wp-block-paragraph\">Lichen Planus skin rash-images from <a href=\"https:\/\/dermnetnz.org\/#gsc.tab=1&amp;gsc.q=lichen%20planus\">Search DermNet | DermNet (dermnetnz.org)<\/a><\/p>\n<\/div><\/div>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-media-text is-stacked-on-mobile\" style=\"grid-template-columns:24% auto\"><figure class=\"wp-block-media-text__media\"><img loading=\"lazy\" decoding=\"async\" width=\"642\" height=\"577\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Subungual-haematoma-1.png\" alt=\"Subungual haematoma\" class=\"wp-image-19106 size-full\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Subungual-haematoma-1.png 642w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Subungual-haematoma-1-300x270.png 300w\" sizes=\"auto, (max-width: 642px) 100vw, 642px\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<p class=\"wp-block-paragraph\"><strong>Subungual haematoma<\/strong><br>&#8211; History of trauma or vigorous physical activity (though may not be remembered).<br>-Discolouration migrates with nail growth, with clearance of proximal nail bed with time.<br>&#8211; Discolouration is usually red or red\/black but not brown.<br>&#8211; No management required.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">image from <a href=\"https:\/\/dermnetnz.org\/#gsc.tab=1&amp;gsc.q=subungal%20haematoma\">Search DermNet | DermNet (dermnetnz.org)<\/a><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-media-text is-stacked-on-mobile\" style=\"grid-template-columns:23% auto\"><figure class=\"wp-block-media-text__media\"><img loading=\"lazy\" decoding=\"async\" width=\"482\" height=\"482\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Chronic-paronychia-1.png\" alt=\"Chronic paronychia\" class=\"wp-image-19107 size-full\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Chronic-paronychia-1.png 482w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Chronic-paronychia-1-300x300.png 300w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Chronic-paronychia-1-150x150.png 150w\" sizes=\"auto, (max-width: 482px) 100vw, 482px\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<p class=\"wp-block-paragraph\"><strong>Chronic paronychia<\/strong><br>&#8211; Often associated with &#8220;wet work&#8221; e.g. hairdressing\/childcare.<br>&#8211; Nail fold becomes painful, red and swollen.<br>&#8211; Treat with clotrimazole cream four times daily.<br>&#8211; Protect hands with gloves for wet work.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">image from <a href=\"https:\/\/dermnetnz.org\/#gsc.tab=1&amp;gsc.q=chronic%20paronychia\">Search DermNet | DermNet (dermnetnz.org)<\/a><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-media-text is-stacked-on-mobile\" style=\"grid-template-columns:23% auto\"><figure class=\"wp-block-media-text__media\"><img loading=\"lazy\" decoding=\"async\" width=\"322\" height=\"322\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Nail-Psoriasis.png\" alt=\"Nail Psoriasis\" class=\"wp-image-19065 size-full\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Nail-Psoriasis.png 322w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Nail-Psoriasis-300x300.png 300w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Nail-Psoriasis-150x150.png 150w\" sizes=\"auto, (max-width: 322px) 100vw, 322px\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<p class=\"wp-block-paragraph\">Psoriasis<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">&#8211; Pitting and onycholysis<br>&#8211; Oil drops&#8221; and sub-ungual hyperkeratosis.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">images from <a href=\"https:\/\/dermnetnz.org\/#gsc.tab=1&amp;gsc.q=psoriasis%20nail\">Search DermNet | DermNet (dermnetnz.org)<\/a><\/p>\n<\/div><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Many skin conditions can affect nails including benign naevi, melanoma, NMSC and inflammatory conditions such as eczema.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Nail growth can also be affected by medications, illness and systemic conditions, as well as over-zealous manicuring.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">All images on this page are sourced from <a href=\"https:\/\/dermnetnz.org\/\">DermNet | Dermatology Resource (dermnetnz.org)<\/a> <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>R.C 25-04-24<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h3 class=\"wp-block-heading\">Dermatology Referral Criteria<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Diagnosis uncertain<\/li>\n\n\n\n<li>Suspicion of subungual tumour<\/li>\n\n\n\n<li>Failure of fungal nail infections to respond to treatment<\/li>\n\n\n\n<li>Potentially destructive lichen planus.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Consider referral to podiatrist<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Toe nail dystrophy secondary to trauma<\/li>\n\n\n\n<li>Painful psoriatic toe nails<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h3 class=\"wp-block-heading\">Management<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Fungal Nail Infections (onychomycosis)<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Perform mycological examination of nail clippings INCLUDING soft subungual material to detect fungal elements.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Do not prescribe systemic antifungal drugs without laboratory confirmation of the diagnosis. The decision to proceed in the absence of this lies with the individual clinician.<\/li>\n\n\n\n<li>&nbsp;No treatment is an option especially in the elderly.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Terbinafine 250mg od for six weeks for finger and 12\u201316 weeks for toe nails and review progress. Caution in patients with liver and auto- immune diseases.<\/li>\n\n\n\n<li>BNF recommends monitoring of hepatic function before treatment and then periodically after 4\u20136 weeks of treatment\u2014discontinue if abnormalities in liver function tests.<\/li>\n\n\n\n<li>Itraconazole 200mg bd for one week pulsed monthly for two courses (fingernail) or three courses (toenail) is a second line option.<\/li>\n\n\n\n<li>Topical amorolfine lacquer for superficial white distal and lateral nail involvement only. Apply 1\u20132 times a week for 6 months to treat finger nails and for toe nails 9\u201312 months (review at intervals of 3 months).<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Psoriasis<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Treatment of nails is difficult and results are often disappointing. Patients should be encouraged to keep their nails short. The use of nail varnish will not cause harm and can help disguise nail changes<\/li>\n\n\n\n<li>Distal nail involvement<strong>&nbsp;<\/strong>&#8211; advise the patient to cut the nail back as far as possible then use topical Vitamin D analogue\/potent steroid &nbsp;or topical steroids once a day for a trial period of three months&nbsp;<\/li>\n\n\n\n<li>Systemic treatment for more widespread psoriasis may improve nail appearance but the risks usually outweigh benefits if using for nails alone and is generally not prescribed..<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Link to PCDS&nbsp;<a href=\"http:\/\/www.pcds.org.uk\/clinical-guidance\/nails\" target=\"_blank\" rel=\"noreferrer noopener\">Nails guidance<\/a><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">For Patients<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.bad.org.uk\/patient-information-leaflets\/\" target=\"_blank\" rel=\"noreferrer noopener\">Patient Information Leaflets &#8211; British Association of Dermatologists (bad.org.uk)<\/a><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">For Health Professionals<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Link to PCDS&nbsp;<a href=\"https:\/\/www.pcds.org.uk\/clinical-guidance\/nails\" target=\"_blank\" rel=\"noreferrer noopener\">Nail disorders (pcds.org.uk)<\/a><\/p>\n\n\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Differentiate from: Subungual haematoma&ndash; History of trauma or vigorous physical activity (though may not be remembered).-Discolouration migrates with nail growth, with clearance of proximal nail bed with time.&ndash; Discolouration is usually red or red\/black but not brown.&ndash; No management required. image from Search DermNet | DermNet (dermnetnz.org) Chronic paronychia&ndash; Often associated with &ldquo;wet work&rdquo; e.g.<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3853,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[100],"class_list":["post-3810","page","type-page","status-publish","hentry","category-commonnaildisorders"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/dermatology\/commonnaildisorders\/\" rel=\"tag\">Common Nail Disorders<\/a>","rttpg_excerpt":"Differentiate from: Subungual haematoma&ndash; History of trauma or vigorous physical activity (though may not be remembered).-Discolouration migrates with nail growth, with clearance of proximal nail bed with time.&ndash; Discolouration is usually red or red\/black but not brown.&ndash; No management required. image from Search DermNet | DermNet (dermnetnz.org) Chronic paronychia&ndash; Often associated with &ldquo;wet work&rdquo; e.g.","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3810","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3810"}],"version-history":[{"count":12,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3810\/revisions"}],"predecessor-version":[{"id":21173,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3810\/revisions\/21173"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3853"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3810"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3810"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}