Nail Diseases and Disorders: Recognition and Referral
Nail disease and disorder questions test recognition and boundaries, not treatment. You must know which findings are contagious, which are cosmetic, and exactly when to stop and refer.
Vocabulary you must distinguish
- Onychomycosis / tinea unguium - fungal infection: thick, yellow-brown, crumbling, lifting plate.
- Paronychia - inflammation or infection of tissue around the nail; bacterial forms are red, swollen, painful, sometimes with pus.
- Onycholysis - painless separation of plate from bed, often from trauma, over-filing or moisture.
- Onychorrhexis - splitting and ridging; onychauxis - thickening; onychatrophia - wasting; onychogryphosis - thickened ram's-horn nail.
- Koilonychia - spoon nails; leukonychia - white spots; Beau's lines - transverse grooves after illness or trauma.
- Onychocryptosis - ingrown nail; subungual hematoma - blood under the plate; agnail - hangnail.
- Verruca - viral wart; contagious. Herpetic whitlow - viral, blistering, contagious.
- Noninfectious but refer: psoriasis, lichen planus, a dark longitudinal streak (possible melanoma).
Infection-control decisions
- Do not service tissue that is red, swollen, hot, painful, oozing, blistered, or has an unidentified dark streak.
- Do not diagnose. Say what you observe, explain that treatment is outside your license, and refer to a physician or podiatrist.
- Clean and disinfect everything that touched the area; discard porous items.
Worked example
Under a lifted acrylic, the plate shows a green-black patch. Reasoning: the color points to Pseudomonas colonization in a moist pocket. The technician removes the enhancement, does not apply new product, cleans and disinfects tools, and refers if the plate itself is discolored, separated or painful. Antifungal creams and oral treatment are medical decisions.
Traps that cost marks
- Calling every discoloration 'fungus', or promising a product will cure it.
- Servicing around a wart or a herpetic blister because 'it's just the skin'.
- Ignoring a new dark streak or a suddenly lifting plate.
- Filing or cutting an ingrown corner instead of referring.