Figure 957

(a) Acute paronychia with pus tracking into the nail bed; (b) treatment by transverse section of the nail plate.

Radionecrosis

Figure 9.58

Radiodermatitis and radionecrosis of the bony phalanx following treatment of epidermal carcinoma.

Figure 9.58

Radiodermatitis and radionecrosis of the bony phalanx following treatment of epidermal carcinoma.

Benign Subungual Nevi

Figure 9.59

Herpes zoster.

Ingrowing Nail Treatment

Figure 9.60

Glomus tumour.

Implantation Cyst

Figure 9.61

Implantation cyst following surgical treatment for ingrowing toe nail.

Figure 9.61

Implantation cyst following surgical treatment for ingrowing toe nail.

pulp, is richly innervated. Each 'space-occupying' process, whether inflammatory or neoplas-tic, may produce pain because the subungual tissue consists of dense fibrous tissue closely adherent to the bone and without the 'elastic' pad of subcutaneous fat. Inflammatory condi-tions and tumours are squeezed in this firm subungual tissue between the hard nail plate and hard bone; slowly enlarging processes may lead to clubbing and pressure-induced bone erosion. Pain is therefore to be expected under these conditions. In addition, the tumour itself may be inherently painful, as for example with the glomus tumour. If pain subsequent to simple trauma or acute inflammation does not respond to adequate therapy, either an X-ray or biopsy or both should be performed to rule out a malignant tumour. Radiographs may be difficult to interpret, especially in the elderly with degenerative arthritis, and it may be necessary to repeat the X-rays or other imaging techniques if the disease does not follow the expected course, or fails to respond to treatment. Ultrasound and MRI may be useful tools but the latter is very expensive.

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