EXAMINATION OF NAILS

 1. Nail Abnormalities 

   - Onychodystrophy:

     - Definition:Any structural abnormality affecting the nail.

     - Differential Diagnostic Features: Color changes, ridges, and thickness alterations.

     - Suggestive Tests: Clinical examination, imaging if required.

   - Onycholysis:

     - Definition:Separation of the nail plate from the nail bed.

     - Differential Diagnostic Features: Typically associated with psoriasis, fungal infections, or trauma.

     - Suggestive Tests: Fungal culture, nail biopsy.

   - Onychomycosis:

     - Definition: Fungal infection of the nail.

     - Differential Diagnostic Features: Yellowing, thickening, and crumbling of nails.

     - Suggestive Tests:Fungal culture, KOH examination.

   - Paronychia:

     - Definition: Inflammation of the nail fold.

     -  Differential Diagnostic Features:Redness, swelling, and tenderness around the nail.

     - Suggestive Tests: Microbial culture, clinical examination.

   - Beau's Lines:

     - Definition: Transverse depressions in the nail plate.

     - Differential Diagnostic Features: Often associated with systemic illness or trauma.

     - Suggestive Tests: Assess medical history, no specific diagnostic tests.

   - Koilonychia:

     - Definition: Spoon-shaped nails.

     - Differential Diagnostic Features: Often associated with iron deficiency anemia.

     - Suggestive Tests:Complete blood count (CBC), iron studies.

2. Nail Examination and Suggestive Tests:

   - Inspection:

•   Observe colour
•    Texture
•    Shape
•    Thickness 
•    Changes in surrounding tissues.

     

   - Fungal Culture:

     - Indication: Presence of discoloration, thickening, or onycholysis.

     - Procedure: Collect nail clippings for laboratory culture.

     - Confirm fungal infections.

   - Complete Blood Count (CBC):

     - Indication: Koilonychia or systemic symptoms.

     - Procedure:Blood sample analysis for hemoglobin levels.

     - Identify anemia or other blood disorders.

   - Iron Studies:

     - Indication: Suspected iron deficiency associated with Koilonychia.

     - Procedure:Blood tests for serum iron, ferritin, and transferrin saturation.

     - Assess iron status.

   - Microbial Culture:

     - Indication:Paronychia or signs of infection.

     - Procedure:Collect samples from the affected area for laboratory testing.

     - Identify causative bacteria or fungi.

   - Imaging Studies :

     - Indication: Severe or persistent abnormalities.

     - Procedure: X-rays or other imaging modalities for deeper assessment.

     - Evaluate structural issues or underlying conditions.

Conclusion:

Nail abnormalities can serve as important indicators of underlying health conditions. A thorough clinical examination, along  with specific tests based on clinical features, is required for accurate diagnosis and appropriate management.