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Physical Examination of the Hand
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
The lunula is a convex white area seen at the nail base. The nail plate separates the dorsal roof from the ventral roof of the nailfold. The nail bed has two portions namely germinal matrix and sterile matrix. The hyponychium is the keratinized skin between the distal nail and fingertip. The anastomosis between the lateral arteries of the finger forms two arterial arch, runs above the periosteum of the distal phalanx and supply nailbed.
Intralesional nail therapies
Published in Robert Baran, Dimitris Rigopoulos, Chander Grover, Eckart Haneke, Nail Therapies, 2021
Chander Grover, Geetali Kharghoria
The complex anatomy of the nail unit makes it a unique appendage. The germinative matrix is the core of the nail plate formation. It is guarded above by the impervious nail plate and the proximal nail fold, which is itself a fold of skin, thus forming a double epithelial barrier. The nail bed, also known as the sterile matrix, also contributes to some extent to nail plate formation and to its appearance. This too is protected by a thicker, more impervious nail plate (Figure 19.1). Both the nail matrix and nail bed are affected by various dermatoses like psoriasis, lichen planus and, in addition, disorders specific to nail epithelia including onychomycosis, subungual warts, trachyonychia, and nail unit tumors.
Topical Products Applied to the Nail
Published in Heather A.E. Benson, Michael S. Roberts, Vânia Rodrigues Leite-Silva, Kenneth A. Walters, Cosmetic Formulation, 2019
Apoorva Panda, Avadhesh Kushwaha, H.N. Shivakumar, S. Narasimha Murthy
The nail bed is a soft, thin and noncornified epithelium that is known to extend from the lunula to hyponychium (Fluhr et al., 2006). The nail bed helps in the growth of the nail plate and acts as a holder for the nail plate. The dorsal surface of the nail bed is comprised of longitudinal ridges that complement similar ridges found on the underside of the nail plate. These ridges are known to ensure the necessary adhesion between the nail plate and nail bed (Jarrett and Spearman 1966). The dermis of the nail bed is very thin and contains a very little amount of fat, sebaceous and follicular appendages (Cecchini et al., 2009 ; Farren et al., 2004).
Laser microporation facilitates topical drug delivery: a comprehensive review about preclinical development and clinical application
Published in Expert Opinion on Drug Delivery, 2023
Yiwen Zhao, Jewel Voyer, Yibo Li, Xinliang Kang, Xinyuan Chen
Human nail consists of nail plate and four epithelial tissues including nail matrix, nail bed, hyponychium and perionychium. Human nail plate is about 0.25–0.60 mm in thickness and comprised of roughly 25 layers of closely packed dead keratinocytes within a matrix of keratin filaments [90]. The upper layer of the human nail plate is slightly elastic and poorly permeable and acts as a primary barrier for topical drug delivery. Nail illnesses are difficult to cure due to poor permeation of topical medicine into the nail bed, pain from intralesional injections, and patients’ noncompliance with long-term therapy. AFL was used to treat nail plates to generate tiny channels to enhance topical drug delivery in vitro and in vivo (Table 4).
Optimal diagnosis and management of common nail disorders
Published in Annals of Medicine, 2022
Onychomycosis is grouped into subtypes based on the pattern of fungal invasion. Distal lateral subungual is by far the most common subtype, characterized by spread of infection starting from the distal-lateral border of the hyponychium and proceeding proximally [21]. It is commonly associated with scale on the plantar feet and web spaces (tinea pedis; Figure 3(A)) and presents with nail plate discolouration, subungual hyperkeratosis and onycholysis (Figure 3(B–D)) [22,23]. Proximal subungual onychomycosis is a less common subtype. Infection begins under the cuticle and proceeds from the proximal nail plate to the distal nail plate. This subtype is associated with immunosuppression (e.g. HIV) when onset is abrupt and progresses rapidly [21,24]. White superficial onychomycosis appears as milky white, opaque patches that are easily scraped away from the superficial nail plate [25]. Endonyx onychomycosis involves the majority of the nail plate without nail bed involvement. Lamellar splitting and whitish discolouration without hyperkeratosis or onycholysis are hallmarks of this subtype [24]. Finally, total dystrophic onychomycosis is the most advanced form and is the result of chronic distal lateral and proximal subungual onychomycosis [21]. The nail bed is deformed and thickened, containing fragments of the nail plate (Figure 3(E)) [26].
Efinaconazole topical solution (10%) for the treatment of onychomycosis in adult and pediatric patients
Published in Expert Review of Anti-infective Therapy, 2022
Tracey C. Vlahovic, Aditya K. Gupta
Onychomycosis, a fungal infection of the nail bed or plate, is a common nail disorder that affects approximately 10% of the general population [1]. Typically caused by the dermatophytes Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum [2], clinical signs of infection include thickening of the nail plate, discoloration of the nail, and separation of the nail plate from the bed [3,4]. Toenail onychomycosis can result in discomfort, interference with walking and wearing shoes, and deformity [5], and can also negatively impact the quality of life [4]. If left untreated, onychomycosis can increase the risk of secondary fungal or bacterial infections [6]. Risk factors for onychomycosis include diabetes, age, peripheral vascular disease, and immunosuppression [4,7].