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Assessment – Nutrition-Focused Physical Exam to Detect Micronutrient Deficiencies
Published in Jennifer Doley, Mary J. Marian, Adult Malnutrition, 2023
Nails that present as flaky, dry, brittle and with cracked nail beds may be caused by vitamin C deficiency, while possible non-nutrient causes include trauma. Splinter hemorrhages appear as reddish-brown lines under the nail beds and can indicate scurvy or hemochromatosis (see Figure 7.18).4,14
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Published in Ashfaq A Marghoob, Ralph Braun, Natalia Jaimes, Atlas of Dermoscopy, 2023
Amélie Boespflug, Félix Pham, Ralph P. Braun, Luc Thomas
Splinter hemorrhages under the nail plate are associated with numerous medical conditions, including connective tissue diseases, onychotillomania, coagulation abnormalities, undernutrition, infectious endocarditis, and hematological disorders. In such cases, splinter hemorrhages usually affect multiple nails. When splinter hemorrhages are present in one digit and are associated with leuko-xanthonychia or polychromia, an epithelial tumor of the nail matrix should be suspected. Splinter hemorrhages associated with amelanotic melanoma of the nail are often randomly distributed and are associated with erythronychia. Splinter hemorrhages can also be seen in benign tumors, including onychopapilloma and onychomatricoma (discussed later).
Psoriasis
Published in Nilton Di Chiacchio, Antonella Tosti, Therapies for Nail Disorders, 2020
Stamatis Gregoriou, Eftychia Platsidaki, Dimitris Rigopoulos
Psoriatic nail disease can resemble several other nail disorders. Although the oil-drop sign and the red lunula spots are more specific for nail psoriasis, the presence of the rest of the psoriatic nail signs can make the diagnosis more difficult to establish. Nail pitting has been described in alopecia areata, eczema, trauma, and less often in parakeratosis pustulosa, pemphigus vulgaris, sarcoidosis, dermatomyositis, drug-induced erythroderma, secondary syphilis, Reiter disease, chronic renal disease, and chronic paronychia. Subungual hyperkeratosis may be seen in eczema, lichen planus, pityriasis rubra pilaris, and even cutaneous T-cell lymphomas. Onycholysis is commonly idiopathic, observed in women dealing with household tasks, but also observed in hand eczema, lichen planus, tumors, hyperthyroidism, bullous disease, and connective tissue disorders. Splinter hemorrhages are most commonly seen in trauma. Proximal splinter hemorrhages may be indicative of systemic disorders, such as infective endocarditis, renal or pulmonary disease, diabetes mellitus, vasculitis, and antiphospholipid syndrome. On the other hand, distal splinter hemorrhages can be found in onychomycosis and eczema.
Personalized approaches for the management of glaucoma
Published in Expert Review of Precision Medicine and Drug Development, 2020
Shiama Indu Balendra, Piero Zollet, Gloria Cisa Asinari Di Gresy E Casasca, Maria Francesca Cordeiro
Vascular dysregulation can lead to over and under perfusion of a particular supply territory and may be either primary or secondary to another disease process [42]. Primary vascular dysregulation (PVD) has been a recognized association in NTG patients, particularly in females, and sufferers of PVD syndrome also had a higher rate of migraines [43–45]. Splinter hemorrhages are known to be linked to PVD syndrome, so may explain why hemorrhages often occur in patients with NTG [46]. Ocular blood flow has been shown to be correlated with peripheral circulation in PVD patients [47]. Changes in ocular blood flow due to disturbed autoregulation can lead to unstable oxygen supply and oxidative stress, which is a recognized mechanism of glaucomatous optic neuropathy [42].
Onychopapilloma: a rare cause of longitudinal melanonychia. Usually benign (but not always). A case report
Published in Case Reports in Plastic Surgery and Hand Surgery, 2021
Stuart H. Kuschner, Bonnie Balzer, Ryan DellaMaggiora
Most cases of onychopapilloma present with longitudinal erythronychia (red streak in the nail) [8]. Halteh et al. noted that onychopapilloma is the most common cause of localized (single digit) longitudinal erythronychia [9]. Onychopapilloma can also present as longitudinal leukonychia (white stripe) [4] or longitudinal melanonychia (brown or black) [6]. There is often a corresponding longitudinal groove in the nail plate. Tosti et al. reported that onychopapilloma can present with splinter hemorrhages without any obvious band or stripe. There may be a distal focal subungual keratotic mass and/or distal onycholysis (loss of nail plate adherence) [7].