Color Atlas of Nails by Antonella Tosti Ralph Daniel B.M. Piraccini & Matilde Iorizzo

Author:Antonella Tosti, Ralph Daniel, B.M. Piraccini & Matilde Iorizzo
Language: eng
Format: epub
Publisher: Springer Berlin Heidelberg, Berlin, Heidelberg

Fig. 11.22.Chronic paronychia in a child due to finger sucking.

Fig. 11.23.Chronic paronychia in onychotillomania.

Fig. 11.24. Candida paronychia.

11.2 Pyogenic Granuloma

Pyogenic granuloma is a benign vascular tumor that frequently ulcerates and bleeds. Location on the nail apparatus is a common finding where its formation is most commonly due to trauma or ingrown toenail.

Multiple pyogenic granulomas may arise from proximal and lateral nail folds as a typical side effect of treatment with retinoids (isotretinoin >> acitretin), cyclosporin, as well as with the antiretroviral protease-inhibitor indinavir. Paronychia associated with pyogenic granulomas is also a common side effect of treatment with antiepidermal growth factor receptor antibodies (cetuximab/C225) and epidermal growth factor receptor inhibitors with kinase activity (gefatinib, imatinib, sorafenib, and sunitinib) used as chemotherapic agents.

The pathogenesis of pyogenic granuloma is still unknown. It has been supposed that drugs may activate angiogenic factors. Changes in nail appear from 1 to 3 months after starting treatment and fade with interruption of treatment. The reason why some fingers are affected when others are not is unknown.

Cast immobilization and reflex sympathetic dystrophy have also been reported as causing pyogenic granulomas with onychomadesis and a mild peripheral nerve injury might be the causative agent.

Fig. 11.25.Periungual pyogenic granuloma of the lateral nail fold and nail bed.

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