序
生活中若沒瞭指甲，要比沒瞭頭髮更麻煩 / Eckart Haneke
瞭解指甲瞭解健康 / 楊誌勛
透露身體密碼的指甲 / 李勇毅

第一章  你是否細看過你的指甲
小小一片指甲的大大學問
指甲闆 / 指甲基質 生長麵（甲根）/ 指緣上皮 / 甲床 / 指甲月牙
這些變瞭形的指甲
指甲很粗糙 / 指甲嚮上彎 / 指甲像鐵錘 / 指甲有凹槽 / 指甲很脆弱 / 指甲斷層 / 指甲坑坑洞洞
不是彩繪的指甲變色
指甲變白 /不規則的點狀白點 /橫嚮規則排列的白線 / 由前嚮後延伸的白直線 / 橫嚮白線 / 指甲全白化 / 指麵變灰白閤併錶麵粗糙 / 波浪狀的白色線條 / 指甲變綠 / 指甲變黃 / 全部指甲都變黃 / 指甲齣現黃線條 / 指甲變紅 / 指甲齣現黃線條 / 指甲變黑 / 長條狀縱嚮指甲黑色線條 / 不規則黑色、大塊「指甲下瘀血」/ 紅色線狀齣血

第二章  灰指甲
先有香港腳，黴菌再順著腳趾皮膚入侵
灰指甲的特徵 / 最常被誤診為灰指甲的「捲甲」
為什麼不直接把指甲拔掉
使用「二氧化碳飛梭雷射」或「汽化性雷射」治療 / 改善減少潮濕環境是防堵黴菌的最好方法

第三章  甲溝炎
手指甲溝炎
最常見原因是過度碰水 / 急性感染甲溝炎須控製感染 / 徹底治療纔能治癒慢性甲溝炎
腳趾的甲溝炎
最常造成腳趾甲溝炎是腳趾甲修剪過短 / 甲溝炎的指甲該怎麼剪 / 腳趾甲溝炎的治療 / 拔側麵部分指甲 / 拔除部分指甲+指甲基質局部破壞 / 電燒或是二氧化碳雷射 / 液態氮冷凍治療 / 硝酸銀治療 / 手術處置 / 矯正指甲  

第四章  美甲的背後問題
關於指甲油，你瞭解多少
指甲油其實類似「油漆」/ 卸除指甲油的「去光水」/ 硬甲油 / 指甲油化學溶劑產生的過敏
指甲決定你的好人緣
指甲的修剪 / 指甲也要保濕 / 指甲保養

第五章  指甲雜癥
鉗甲
指甲變厚變灰，側麵捲麯嚴重 / 鉗甲的治療
甲床剝離，指甲下麵空掉瞭
甲床分離的原因 / 甲床分離癥拖越久，治癒機會越來越少
門診病人常見的疑惑
指甲下總有層汙垢 / 指甲化濃 / 指甲倒插 / 指甲皰診感染 / 病毒疣感染 / 指甲雞眼 / 咬指甲，摳指甲的壞習慣 / 指甲旁的「皮膚倒刺」/ 指甲腫瘤 / 化膿性肉芽腫 / 纖維瘤 / 黏性囊腫 / 脈絡球瘤 / 指甲下硬骨增生 / 惡性鱗狀細胞癌  / 複型第六小趾甲 / 老人指甲

附  錄 指甲異常外觀和全身性疾病關聯

 

序

生活中若沒瞭指甲，要比沒瞭頭髮更麻煩
Eckart Haneke

　　Hanake教授為德國知名的皮膚科醫師，專精於指甲疾病的診斷與治療，尤其是指甲手術。Hanake教授過去曾擔任德國皮膚科醫學會主席、歐洲指甲醫學會主席、歐洲皮膚外科醫學會主席、德國皮膚病理醫學會主席。目前是瑞士伯恩大學的客座教授，受邀在世界各盛大的醫學會中教育晚輩醫師指甲的知識。2017年05月，颱灣也曾邀請Hanake教授來颱為皮膚科醫學會演講，與颱灣有很好的友誼。

　　The nails represent functionally and aesthetically very important cutaneous appendages. Although often seen as the little brother of hair and being of lesser importance life without nails is much harder than without hair. Wigs are available in all sizes and colours at virtually all prices but nothing similar can be bought even for a lot of money. Hair  can be hidden under a hat or scarf but the hands and fingers and their nails are virtually always visible.

　　不論是在功能或外觀上，指甲都是皮膚重要的延伸構造。雖然指甲常被認為比頭髮不重要，但生活中若沒瞭指甲是要比沒瞭頭髮更為麻煩。市麵上有各種尺寸、顏色與價位的假髮，但不管花多少錢也買不到相似指甲的替代物。你可以用帽子或是頭巾來掩飾頭髮的問題，但手指上的指甲疾病是無法隱藏，一定會被看到的。

　　The nail starts developing with the formation of the limbs at the 8th to 9th week of gestation. Its development depends on the concerted action of many growth and signalling factors, and only one lacking or one false signal will make normal nail development impossible. Much research has concentrated on hair and it turned out that nail development is even more complex. It is not surprising that so many ectodermal dysplasia syndromes are associated with nail deformations.

　　指甲的生長開始於懷孕過程的第八到第九周，需要很多的生長與訊號因子的互相配閤。倘若有任何一個因子缺乏或訊號齣錯，指甲的生長便無法正常。有許多針對頭髮的研究發現，指甲的生長過程比頭髮複雜多瞭。因此不意外的，很多外胚層的發育障礙癥候群都跟指甲有關連性。

　　Recent research has shown the close and intimate reltionship  of the musculo-skeletal system with the nail unit. Some rheumatologists now call the nail a musculo-skeletal appendage and explain part of the psoriatic nail changes with their close anatomic relationship with the bone and joint of the distal phalanx refuting the long-held anticipation of the nail changes as being immuno-mediated.

　　最近的研究顯示，指甲單元與肌肉骨骼係統有非常重要的關係。有些風濕免疫學的專傢現在把指甲歸類為肌肉骨骼的附屬物，並認為部分乾癬性指甲的變化是因為指甲與遠端手指骨及關節的構造十分靠近，所以造成乾癬指甲變形。
 
　　As a cutaneous appendage, the nail apparatus may react with the skin and demonstrate a number of nail changes, many of which are specific allowing the correct diagnosis to be made, but even more are less or non-specific and have to be seen with the corresponding dermatosis. When no accompanying skin lesions are present a correct diagnosis is even more difficult to reach and often requires a biopsy and expert histopathological diagnosis. This touches another difficult area: nail surgery.

　　指甲是皮膚的延伸構造，所以指甲也會被皮膚疾病影響而導緻指甲的很多變化。很多指甲的疾病會有特殊且一緻的改變，因此醫師很容易做齣正確的診斷。但是更多的指甲疾病的外觀改變是不具特異性，因此需要搭配周遭皮膚的病變來做診斷。當沒有伴隨的皮膚疾病來幫助診斷時，醫師要做齣診斷就更為睏難瞭。為瞭解決這個難題，皮膚切片以及專業的皮膚病理診斷就顯得非常重要。當然，這裡又談到另一個睏難的醫學領域¬¬¬-指甲手術。

　　Nail surgery is an integral part of dermatologic surgery. Although many patients primarily consult surgeons because „they can do everything“ even plastic and hand surgeons usually have only rudimentary knowledge of the nail’s biology, physiology, growth pattern, normal and pathologic anatomy and histopathology. Therefore, their foremost diagnostic-therapeutic approach is often nail avulsion, which by itself is almost never a treatment. It is self-evident that nail surgery requires in-depth knowledge of all aspects of the nail and it is the dermatologist who takes time and all efforts to learn this. Unfortunately, the huge number of mal-treated ingrown toenails with permanent mutilation of the bit toe gives strong evidence that this situation has not really changed to the better. And here we are at another important issue: function and aesthetics.

　　指甲手術是皮膚外科手術中重要的一環。雖然很多病人一開始去諮詢外科醫師，但即使是整形外科或是手外科的醫師，通常能提供的治療就是拔指甲。非常可惜的是，很多嵌甲被整片拔除後，在大腳趾甲留下不可迴復的傷害。皮膚科醫師的養成訓練對指甲有深入的知識與瞭解，最能勝任執行指甲的手術。

　　Finger and toe nails have important functions for the protection of the distal phalanx, which in turn is a very important sensory organ, a most versatile tool and a weapon for defence and to scratch. For the great toe, the nail exerts counter-pressure for the soft tissue of the toe tip and thus prevents it from being heaped up and dorsally disclocated; thus the big toenail even adds to the safety of gait. Malformed finger nails are embarrassing and may cause considerable concern. In our world of youth and well-being, healthy good-looking nails are important features.

　　手腳指的指甲有多種重要功能，包括保護遠端指骨，同時指甲也是重要的感覺構造。指甲也可當作是防衛的武器與抓癢的工具。在我們行走踏地時，大腳趾的趾甲會施加一個反作用力在甲床組織上，避免甲床組織會因地闆的作用力而往上移位，因此指甲也在穩定走路的安全機製扮演一個角色。另外，變形的手指甲是會引人注目且令人難為情的。在我們青春與身體健康情況時，健康美麗的指甲是重要的特徵。

　　Finally, the nails may reflect general health as was already mentioned by Hipokrates more then 2000 years ago when he noted that clubbed fingers were associated with serious pulmonary and heart problems.

　　最後，如醫學之父希波剋拉底在超過兩韆年所提到的，指甲可以反映我們整體的健康狀況。當時他指齣杵狀指與嚴重的肺部和心臟問題有關。

　　An up-to-date nail book in Chinese is overdue. The authors are reputed experts in this field that unfortunately was a bit neglected for many years. I hope that this book will be a great success in all respects.

　　指甲領域已經被忽略很多年瞭，且目前專門針對指甲的中文書籍是過時的。這二位作者是這個領域的專傢，我希望這本書將在各方麵獲得很大的成功。