By Eric Guaguere, Pascal Prelaud, D.W. Scott, M. Craig
A realistic advisor to pussycat Dermatology
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Extra resources for A Practical guide to Feline Dermatology
The clinical manifestations of the disease reflect the anatomic site of involvement. 7 Other possible nail changes include splinter hemorrhages, a spotty leukonychia, and thickening, splitting, or splintering of the nail plate. 2 In some cases, there is a spotted, reddish lesion in the 1unu1a, which is distinct from the oil drop change. Secondary invasion by Candida, Pseudomonas, or dermatophytes is not uncommon. 2 Other characteristics of Darier's disease include a thickened, and possibly malodorous, hyperkeratosis in the intertriginous folds and alopecia of the scalp, beard and other areas on the body Flat keratotic papules generally appear in the nail folds and may also be detected at other cutaneous sites.
H. Differential Diagnosis It is important to obtain a patient history to determine the cause of eczematous dermatitis and the course of onset. The main clue which suggests that the condition is contact dermatitis, and not onychomycosis, is the involvement of both hands. The presence of eczema in the periungual area or surrounding skin also can be used to help rule out onychomycosis. S. a. Clinical Presentation Onycholysis is a common condition seen in dermatologic practice and may be caused by numerous TABLE 6 exogenous, endogenous and idiopathic, acquired or inherited factors (Tables 6 and 7).
It has been observed in children and adults with alopecia areata, psonasls, lichen planus, eczema, Darier's disease, and other dermatologic conditions, but may also occur in the absence of other systemic or cutaneous inflammatory disorders. Thus, it is unclear whether twenty-nail dystrophy is a distinct clinical entity or a clinical manifestation of lichen planus, psoriasis, or another disorder. Figure 37. Fingernails in a patient with 20-nail dystrophy associated with lichen planus (Courtesy of Gary Palmer.