20 nail dystrophy

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The OPD was very busy today so didn't get to take a history from this patient but from the look of it, this seems quite long standing.
I know its not a good pic and not a complete one too but I promise to click better ones from next time.

Now, getting back to the case. The boy was in his early teens and presented with changes present on all his nails. Some of them being:

He was a follow up case and was earlier put under the spectrum of LP nail changes. The treatment was continued as was given earlier which included dapsone.

Another similar case I saw was melaonychia( transverse) in the great toe also the nail plate looked unhealthy... and describing it seems to an ordeal for me, atleast for now. Anyhow, similarity in between the above two cases was the diagnosis ie LP nail. Though, I'm still trying to accept the diagnosis. At the first look it seemed like subungual melanoma but then I thought it would more likely be due to oncychomycosis. The patient was giving the history of previous treatments with fluconazole which failed to result in any improvement. My senior adviced the patient to go for nail evulsion as she seemed too conserned about the colour change. I wish I could post a pic but my camera ran out of battery just then so I don't have a pic.

Search the net for causes of melaonychia and here are some:
Melanocytic activation/hyperplasia–related :

• Nevi
• Subungual melanoma

Physiologic causes of melanonychia :

• Racial melanonychia  (multiple bands)
• Pregnancy (multiple bands)

Dermatologic causes:

• Psoriasis (multiple bands)
• Lichen planus (multiple bands)
• Chronic radiodermatitis (single bands)
• Scleroderma (multiple bands)
• Systemic lupus erythematosus (multiple bands)
• Fungal infection of the nail bed (Aspergillus, Scopulariopsis, Candida, Blastomyces, Fonsecaea pedrosoi) (multiple bands)
• Subungual fibrous histiocytoma (single band)
• Lichen striatus (multiple bands)

 Local and regional causess:

• Nail biting (single band)
• Trauma (acute or chronic) (single band)
• Poor-fitting shoes (single band)
• Foreign body (subungual) (single band)
• Radiation therapy (multiple bands)
• Ultraviolet light (multiple bands)
• Postinflammatory hyperpigmentation (single band)

Systemic causes :

• Addison disease (multiple bands)
• Cushing syndrome (multiple bands)
• Hyperthyroidism (multiple bands)
• Hyperbilirubinemia (multiple bands)
• Alkaptonuria (multiple bands)
• Porphyria (multiple bands)
• Acquired immunodeficiency syndrome (multiple bands)
• Graft versus host disease (multiple bands)
• Malnutrition (multiple bands)

Iatrogenic causes:
Chemotherapeutics (multiple bands)

• Cyclophosphamide
• 5-Fluorouracil
• Hydroxyurea