Modern doctors give attention to direct survey of the patient ever less and is more increasing - to laboratory and tool methods of inspection. Not the dermatologist seldom pays close attention to nails which meanwhile often bear a well of every possible information: on them as according to the book, it is possible to learn not only about the general state of health of the patient but also to predict development of some diseases, it is necessary to get accustomed attentively to them.
In this article we will try to consider most often meeting changes of a form and the sizes of the nails, directly or indirectly connected with pathology of an internal.
Changes of a form and sizes of nails
Hippocrates's fingers (English Clubbing)
Also called «bulavovidny fingers», «fingers in the form of hour glasses» (fig. 1) and a hypertrophic osteoartropatiya (Mari-Bambergera syndrome) - practically always are rather late manifestations of diseases of lungs. Bulavovidnye fingers associate with a cancer of a lung, the diseases proceeding with a gipoksemiya, nagnoitelny diseases of lungs, but are quite often observed and at other pathology. The hypertrophic osteoartropatiya practically always is a paraneoplastic syndrome. It is considered that at the heart of the mechanism of formation of this pathology defeat of the pulmonary capillary course as a result of which there is an otshnurovyvaniye violation тромбоцитов from мегакариоцитов that leads to liberation of large numbers of a trombotsitarny factor of growth and formation of periostalny reaction lies.
Drawing Hippocrates's 1 Fingers
A.Seaton and соавт. (1989) systematised the main reasons for bulavovovidny deformation of fingers and a hypertrophic osteoartropatiya:
- Nekardiotorakalnye: Idiopathic (family) form; спру; portal and biliarny cirrhoses of a liver; inflammatory diseases of intestines (nonspecific ulcer colitis, illness Krone); pregnancy.
- Pulmonary diseases: bronkhogenny cancer and карциноид; pleura fibroma; mesothelioma; cancer or sarcoma metastasises in lungs; эмпиема pleurae; lung abscess; бронхоэктазы; муковисцидоз; chronic fibrous tuberculosis; idiopathic fibroziruyushchiya альвеолит; asbestosis; arterio-venous shunts.
- Pathological processes in a sredosteniye: лейомиома and cancer of a gullet; ulcer эзофагит; gullet akhalaziya; тимома; cancer of a thyroid gland and тиреотоксикоз; lymphoma; миелолейкоз.
- Heart troubles: the congenital defects proceeding with a gipoksemiya; infectious эндокардит; миксома auricles.
As a whole kardialny and pulmonary pathology make more than 80 % of all cases, ZhKT pathology about 5 %. Among crayfish of a lung prevails nemelkokletochny (54 %), melkokletochny - less than 5 % of cases. Also bulavovidny deformation of fingers is uncharacteristic for not complicated chronic obstructive bronchitis and emphysema of lungs, ekzogenny allergic альвеолита, саркоидоза, силикоза and антракоза.
In the development conditionally allocate five stages of formation of bulavovidny fingers:
- Puffiness, elation and small fluctuation of the basis of a nail bed
- Increase in a corner of Lovibond more than 165 ° (a corner between the basis of a nail bed and adjacent skin of the end of a finger (cuticle). (fig. 3)
- Swelling and more rare) giperemiya of a nail bed.
- Thickening of a distalny part of a finger.
- Emergence of shine and nail ischerchennost.
At achievement of a corner of Lovibond ?180 ° the test of the Schamroth window is carried out
The hypertrophic osteoartropatiya (fig. 2) is shown in a look периоститов long tubular bones. Distalny departments of shins and a forearm are most often involved. It can be accompanied by arthritises of luchezapyastny, ankle, knee joints, puffiness of a tip of a nose, a ginekomastiya.
Drawing 2 Hypertrophic osteoartropatiya
Drawing 3 Lovibomda Corner
Drawing 4 Test of the Schamroths window
Also called «Spoon-shaped nails» (fig. 5). For the first time Heller in 1898 are described. In norm meets at children's age. It is characteristic only for nails of fingers of the top extremities. The surface of nail plates becomes concave, a nail smooth, the thickness of a nail does not change. Koylonikhiya develops as a result of traumas of a nail bed, for example, at long influence of alkalis and acids, and also at various diseases - онихомикозах, Addison's illness, a typhoid, zhelezodefitsitny conditions, etc. More rare happens congenital (including - hereditary).
Koylonikhy's drawing 5
Mikronikhiya (micronycchia микр + Greek onyx, onychos nail)
Shortening of nails on fingers of brushes and quite often stop. As a rule, is congenital. It can be observed at neurotic conditions (gnawing nails), genuinny epilepsy, a system sklerodermiya.
Platonikhiya (platonychia) - flat nails. This symptom is described by Heller in 1906. Meets rather seldom. Similar to a mikronikhiya, a thicket is congenital. The acquired platonikhiya can develop owing to influence of professional factors, and also at some chronically proceeding diseases, for example, cirrhosis, psoriasis, etc. As a rule, all nail plates are involved in process. Some authors describe this symptom, as an initial stage of a koylonikhiya.
Onikhogrifoz (onychogryphosis; онихо + Greek gryposis a curvature) - a thickening, increase, a nail curvature therefore it becomes similar to a claw of a bird (fig. 6). Characteristic is the expressed thickening of the nogtetvy plate which colour usually gets yellow, is more rare - a dirty-grey, black shade. Most often онихогрифоз meets at advanced age, at mechanical traumas (long carrying of narrow inconvenient footwear), frostbites and burns of fingers, chronic generalizovanny (granulematozny) candidiasis, онихомикозах, the diseases connected with disorder of blood circulation in the bottom extremities.
< br /> Drawing 6 Onikhogrifoz
Onikhauksis (onychauxis; it + Greek auxe growth, increase) - similarly онихогрифозу is shown by a hypertrophy, a thickening and increase in the size of a nail plate owing to the strengthened development of podnogtevy horn educations. A nail plate утолщается in essentially smaller degree, thus its curvatures are not characteristic. Paronikhiya are often noted. This type of change of nails (thumbs of brushes, is more rare than feet and other fingers) find at eczema, psoriasis, inflammatory processes in nail rollers and a nail bed, including caused by mushrooms. Besides, traumas of nail rollers and a nail bed can be the development reason онихауксиса.
Skleronikhiya (scleronychia; skler + Greek onyx, onychos nail; син. the nail hypertrophied) - characteristic is the specific hypertrophy and hardness of nail plates which, losing transparency, get a yellowish-grey shade. Nails are involved in process on all fingers of brushes and feet. The nail thin skin disappears, gradually nail plates separate from a nail bed. An aetiology and патогенез diseases are not known now. It is possible that in патогенезе play a role endocrinological violations. Duration of a disease varies in a wide range: from several months to 10 years, as a rule, comes to an end with treatment.
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