Baran & Dawber’ s Diseases of the Nails and their Management ffffiirrss..iinndddd ii 55//22//22001122 1122::2211::2211 PPMM Baran & Dawber’ s Diseases of the Nails and their Management FOURTH EDITION EDITED BY Robert Baran MD Honorary Professor, University of Franche-Comté Consultant Dermatologist, Gustave Roussy Cancer Institute, Villejuif Nail Disease Center, Cannes, France David A.R. de Berker MD Consultant Dermatologist and Senior Clinical Lecturer Bristol Dermatology Centre Bristol Royal Infi rmary Bristol, UK Mark Holzberg MD Clinical Assistant Professor of Dermatology Department of Dermatology Emory University School of Medicine Atlanta, GA, USA Luc Thomas MD, PhD Professor and Chairman Department of Dermatology Lyon 1 University Centre Hospitalier Lyon Sud Pierre Bénite, France A John Wiley & Sons, Ltd., Publication ffffiirrss..iinndddd iiiiii 55//22//22001122 1122::2211::2211 PPMM This edition first published 2012, © 2012 by John Wiley & Sons, Ltd Wiley-Blackwell is an imprint of John Wiley & Sons, formed by the merger of Wiley ’ s global Scientific, Technical and Medical business with Blackwell Publishing. 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(Robert) II. Dawber, R. P. R. (Rodney P. R.) III. Title: Baran and Dawber’s diseases of the nails and their management. IV. Title: Diseases of the nails and their management. [DNLM: 1. Nail Diseases. 2. Nails–physiology. 3. Nails, Malformed. WR 475] 616.5′47–dc23 2011042075 A catalogue record for this book is available from the British Library. Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. Set in 9.5/12 pt Palatino by SPi Publisher Services, Pondicherry, India 1 2012 ffffiirrss..iinndddd iivv 55//22//22001122 1122::2211::2211 PPMM v Contents List of Contributors, vii 8 Drug-induced Nail Changes, 413 Robert Baran, Bruno Fouilloux and Caroline Robert Preface, ix 9 Occupational Abnormalities and Contact List of Abbreviations, xi Dermatitis, 443 Robert Baran and Richard J.G. Rycroft 10 Cosmetics: the Care and Adornment of the Nail, 471 1 Science of the Nail Apparatus, 1 Douglas Schoon and Robert Baran David A.R. de Berker and Robert Baran 11 Hereditary and Congenital Nail Disorders, 485 2 Physical Signs, 51 Smail Hadj-Rabia, Lennart Juhlin and Robert Baran Adam I. Rubin and Robert Baran 12 Nail Surgery and Traumatic Abnormalities, 549 3 Imaging the Nail Unit, 101 Luc Thomas, Elvin G. Zook, Timothy J. Rosio, Luc Thomas, Myriam Vaudaine, Ximena Wortsman, Rodney P.R. Dawber, Eckart Haneke and Robert Baran Gregor B.E. Jemec and Jean-Luc Drapé 13 Tumors of the Nail Apparatus 4 The Nail in Childhood and Old Age, 183 and Adjacent Tissues, 637 David A.R. de Berker, Bertrand Richert and Robert Baran Luc Thomas, Elvin G. Zook, Eckart Haneke, Jean-Luc Drapé and Robert Baran 5 Fungal (Onychomycosis) and Other Infections ( with the participation of Jürgen F. Kreusch ) Involving the Nail Apparatus, 211 Roderick J. Hay and Robert Baran Appendix: Differential Diagnosis of Nail Findings, 745 6 The Nail in Dermatological Disease, 257 Mark Holzberg Mark Holzberg and Robert Baran Index, 799 7 The Nail in Systemic Disease, 315 Mark Holzberg ffttoocc..iinndddd vv 55//22//22001122 1122::2277::5588 PPMM vii List of Contributors Rodney P.R. Dawber, MA, MB, ChB, FRCP Lennart Juhlin, MD (Deceased) Formerly, Consultant Dermatologist and Clinical Senior Lecturer Formerly, Professor and Head Department of Dermatology Department of Dermatology The Churchill Hospital University Hospital Oxford, UK Uppsala, Sweden Jean-Luc Drapé, MD, PhD Jürgen F. Kreusch, MD, PhD Department of Radiology Moislinger Allée 95 Hôpital Cochin 23558 Lübeck, Germany University Paris Descartes Paris, France Bertrand Richert, MD, PhD Dermatology Department Bruno Fouilloux, MD University Hospitals Brugmann – Saint Pierre and Children’s Hospital Reine Fabiola Onychology Unit Université Libre de Bruxelles Department of Dermatology Brussels, Belgium CHU Hôpital Nord Saint-Etienne, France Caroline Robert, MD, PhD Gustave Roussy Cancer Institute Smail Hadj-Rabia, MD, PhD Villejuif, France Department of Dermatology Hôpital Necker-Enfants Malades Timothy J. Rosio, MD Paris, France Anew Skin Dermatology El Dorado Hills, CA, USA Eckart Haneke, MD Dermatology Department Adam I. Rubin, MD University Hospital Director, Nail Practice of the University of Pennsylvania Bern, Switzerland Assistant Professor of Dermatology Perelman School of Medicine Roderick J. Hay, DM, FRCP, FMedSci University of Pennsylvania Dermatology Department Philadelphia, PA, USA King’s College NHS Trust London, UK Richard J.G. Rycroft, MD, FRCP, FFOM, DIH Formerly, St John’s Institute of Dermatology Gregor B.E. Jemec, MD, DMSc St Thomas’s Hospital London, UK Professor, Chairman Department of Dermatology Douglas Schoon, BSc, MSc (Chem) Roskilde Hospital Health Sciences Faculty President University of Copenhagen Schoon Scientifi c + Regulatory Consulting, LLC Roskilde, Denmark Dana Point, CA, USA ffbbeettww..iinndddd vviiii 55//22//22001122 1122::1199::4488 PPMM viii List of Contributors Myriam Vaudaine, MD Elvin G. Zook, MD Department of Dermatology Emeritus Professor Lyon 1 University Formerly, Plastic Surgery Institute Centre Hospitalier Lyon Sud Southern Illinois University Pierre Bénite, France School of Medicine Springfi eld, IL, USA Ximena Wortsman, MD Adjunct Associate Professor Department of Radiology Clinica Servet, Faculty of Medicine University of Chile Santiago, Chile ffbbeettww..iinndddd vviiiiii 55//22//22001122 1122::1199::4488 PPMM ix Preface Since our first edition appeared in 1984, B aran & Dawber's all-important addition of an original appendix providing Diseases of the Nails and their Management has been one differential diagnosis of nail findings in both color and of the most important sources for nail specialists. This shape by anatomic site ensures overall continuity. fourth edition has been enriched by numerous additional I would like to express my particular gratitude to con tributions, and now constitutes a true encyclopedia of Martin Sugden, the commissioning editor, for his support the nail. and encouragement all along, and my heartfelt thanks to We owe this to the young collaborators who were Nicole Baran, my wife, for her unflagging energy and entrusted with either writing new chapters such as ‘Imaging dedication in taking up and sharing the challenge. the Nail Unit’, or with thorough updating, as in the chapter on ‘Hereditary and Congenital Nail Disorders’. Finally, the Robert Baran ffpprreeff..iinndddd iixx 55//22//22001122 1122::2255::0077 PPMM xi List of Abbreviations 3D three-dimensional EGFR epidermal growth factor receptor ACA anticardiolipin antibody EM electron microscopy ACTH adrenocorticotropic hormone EMA epithelial membrane antigen ADFK acquired digital fi brokeratoma EO endonyx onychomycosis ADL activities of daily living FDA Food and Drug Administration AER apical ectodermal ridge FEDL fl ashlamp excited dye laser AIDS acquired immunodefi ciency syndrome FEF forced expiratory fl ow ALHE angiolymphoid hyperplasia with FEV forced expiratory volume in 1 sec 1 eosinophilia GVHD graft-versus-host disease ALM acrolentiginous melanoma H&E hematoxylin and eosin AORN Association of Operating Room Nurses HEMA hydroxy-ethylmethacrylate APACHE acral pseudolymphomatous angiokeratoma HFMD hand, foot and mouth disease of children HIV human immunodefi ciency virus APES aminopropyltriethoxysilane HOOD hereditary osteoonychodysplasia AVA arteriovenous anastomoses HPV human papillomavirus AVF arteriovenous fi stula HSR high spatial resolution AZT azidothymidine HSV herpes simplex virus BDD blistering distal dactylitis HTLV human T-cell leukemia virus BMP bone morphogenetic protein IDS International Society for Dermoscopy BMZ basement membrane zone ILM incident light microscopy BPNH bilateral periventricular nodular heterotopia ILVEN infl ammatory linear verrucous epidermal CA cyanoacrylate nevus CARI congenital autosomal recessive ichthyosis IP incontinentia pigmenti CDC Centers for Disease Control IU international units CEA carcinoembryonic antigen IVT ischemic venous thrombosis CMC chronic mucocutaneous candidiasis KA keratoacanthoma CMV cytomegalovirus KID keratosis, ichthyosis and deafness COIF congenital onychodysplasia of the index LE lupus erythematosus fi ngers LED light-emitting diode CT computed tomography LM longitudinal melanonychia DBP dibutyl phthalate MES multiple exostoses syndrome DEB dystrophic epidermolysis bullosa MIC minimum inhibitory concentration DIP distal interphalangeal MIM Mendelian Inheritance in Man DLSO distal and lateral subungual onychomycosis MIP maximum intensity projection DMPS dimercapto-propane-sulfonate MMA methylmethacrylate DMSA dimercaptosuccinic acid MRI magnetic resonance imaging DMSO dimethyl sulfoxide MSH melanocyte-stimulating hormone EB epidermolysis bullosa NAPSI Nail Psoriasis Severity Index EBA epidermolysis bullosa acquisita NTOM nerve territory-orientated macrodactyly ED ectodermal dysplasia PA posteroanterior ffllaasstt..iinndddd xxii 55//22//22001122 1122::2233::4422 PPMM xii List of Abbreviations PAI plasminogen activator inhibitor SM subungual melanoma PaO partial pressure of oxygen in arterial blood SNR signal-to-noise 2 PAS periodic acid-Schiff SO subungual onychomycosis PCB polychlorinated biphenyl SSM superfi cial spreading melanoma PCR polymerase chain reaction STIR short time inversion recovery PIU pterygium inversum unguis SWO superfi cial white onychomycosis PNF proximal nail fold T tesla PRP pityriasis rubra pilaris TAR thrombocytopenia absent radius PSO proximal subungual onychomycosis TDO total dystrophic onychomycosis PUVA psoralen ultraviolet A TGF transforming growth factor PVC polyvinyl chloride TNF tumor necrosis factor PWSO proximal white subungual TOWL transonychial water loss onychomycosis TTD trichothiodystrophy RA rheumatoid arthritis TUDDS transungual drug delivery system ROS reactive oxygen species TUNEL terminal deoxynucleotidyl transferase dUTP RV residual volume nick end labelling SCC squamous cell carcinoma US ultrasonography SE spin echo UV ultraviolet SLE systemic lupus erythematosus UVB ultraviolet B SLN sentinel lymph node VEGF vascular endothelial growth factor SLR single lens refl ex ffllaasstt..iinndddd xxiiii 55//22//22001122 1122::2233::4422 PPMM 1 CHAPTER 1 Science of the Nail Apparatus David A.R. de Berker1 and Robert Baran2 1 Bristol Dermatology Centre , Bristol Royal Infi rmary , Bristol, UK 2 Nail Disease Center, Cannes; Gustave Roussy Cancer Institute, Villejuif, France Gross anatomy and terminology, 1 Venous drainage, 19 Physical properties of nails, 35 Embryology, 3 Effects of altered vascular supply, 19 Strength, 35 Morphogenesis, 3 Nail fold vessels, 19 Permeability, 35 Tissue differentiation, 4 Glomus bodies, 20 Radiation penetration, 37 Factors in embryogenesis, 4 Nerve supply, 21 Imaging of the nail apparatus, 37 Regional anatomy, 5 Comparative anatomy and function, 21 Radiology, 37 Histological preparation, 5 The nail and other appendages, 22 Ultrasound, 37 Nail matrix and lunula, 7 Phylogenetic comparisons, 23 Profi lometry, 38 Nail bed and hyponychium, 9 Physiology, 25 Dermoscopy (epiluminescence), 38 Nail folds, 11 Nail production, 25 Photography, 38 Nail plate, 15 Normal nail morphology, 27 Light, 40 Vascular supply, 18 Nail growth, 28 Other techniques, 41 Arterial supply, 18 Nail plate biochemical analysis, 31 Gross anatomy and terminology with the ventral aspect of the proximal nail fold. The intermediate matrix (germinative matrix) is the epithe- Knowledge of nail unit anatomy and terms is important for lial structure starting at the point where the dorsal clinical and scientific work [1]. The nail is an opalescent win- matrix folds back on itself to underlie the proximal nail. dow through to the vascular nail bed. It is held in place by The ventral matrix is synonymous with the nail bed the nail folds, origin at the matrix and attachment to the nail and starts at the border of the lunula, where the inter- bed. It ends at a free edge distally, overlying the hyponych- mediate matrix stops. It is limited distally by the hypo- ium. These structures are illustrated in Figures  1.1 and 1.2 . nychium. Definitions of the components of the nail unit are as follows. • Lunula (half moon) : the convex margin of the interme- • Nail plate (nail) : durable keratinized structure which diate matrix seen through the nail. It is paler than the continues growing throughout life. adjacent nail bed. It is most commonly visible on the • Lateral nail folds : the cutaneous folded structures pro- thumbs and great toes. It may be concealed by the proxi- viding the lateral borders to the nail. mal nail fold. • Proximal nail fold (posterior nail fold) : cutaneous • Nail bed (ventral matrix, sterile matrix) : the vascular folded structure providing the visible proximal border bed upon which the nail rests, extending from the of the nail, continuous with the cuticle. On the under- lunula to the hyponychium. This is the major territory surface this becomes the dorsal matrix. seen through the nail plate. • Cuticle (eponychium): the layer of epidermis extend- • Onychodermal band : the distal margin of the nail ing from the proximal nail fold and adhering to the dor- bed has a contrasting hue in comparison with the rest sal aspect of the nail plate. of the nail bed [3]. Normally, this is a transverse band • Nail matrix (nail root) : traditionally, this can be split of 1–1.5 mm of a deeper pink (Caucasian) or brown into three parts [2]. The dorsal matrix is synonymous (Afro-Carribean). Its colour, or presence, may vary Baran & Dawber’s Diseases of the Nails and their Management, Fourth Edition. Edited by Robert Baran, David A.R. de Berker, Mark Holzberg and Luc Thomas. © 2012 John Wiley & Sons, Ltd. Published 2012 by John Wiley & Sons, Ltd. cc0011..iinndddd 11 55//22//22001122 1111::3366::5577 AAMM