Dermatology Online Journal

Nail dystrophies due to infections
Eckart Haneke
Abstracts of the Fifth Meeting of the European Nail Society:DOJ 9(1): 17A

Nail dystrophy is defined as a temporary or permanent damage of the nail plate and or other visible structures of the nail organ. It may be developmental, drug- or toxin-induced, traumatic, iatrogenic, due to a variety of diseases affecting the nail, particularly infections. By far the most common ungual infection causing nail dystrophy is onychomycosis. The pathogenic fungus may invade the nail plate and make it so fragile that the nail simply breaks away. More often is late matrix involvement with disturbed production of nail substance eventually leading to total dystrophic onychomycosis. Nail dystrophy may also be caused by fungal paronychia with irregular ridging and discoloration being the most frequent signs. Repeated acute exacerbations of its generally protracted course are common and may aggravate the nail dystrophy. Both acute and subacute-subchronic bacterial infections under the nail, particularly when located in the matrix area may cause severe and potentially permanent nail dystrophy, especially in children. Proper diagnosis and prompt treatment are therefore crucial. Chronic infections with atypical mycobacteria may involve the parungual tissues. Nail dystrophies and digit mutilations in leprosy are indirect consequences of this mycobacterial infection. Leishmaniasis sometimes causes a chronic paronychia with secondary nail dystrophy. Warts rarely cause nail dystrophy whereas this is not rarely observed after inadequate or too radical therapy. Finally, even parasitic infestations, particularly crusted scabies, may lead to nail dystrophy.

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