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Information about Nails

Published on February 5, 2014

Author: jasonbartsch



NAIL EXAM     Shape Color Flexbility Growth rate: ~6 months from the cuticle to free edge, 0.1mm/day

COLORS Pink/Red: polycythemia, SLE, carbon monoxide poisoning, angioma, malnutrition White: anemia, cirrhosis, DM, chemo, renal failure Yellow: Amyloidosis, yellow nail syndrome, median/ulnar nerve injury, thermal injury, jaundice, DM Green/Black: solvents, trauma, chronic Pseudomonas infection

SPOONED NAILS (KOILONYCHIA)  Water drop test: imagine placing a drop of water on the nail. If it would not fall of f it is spooned  Causes:  Iron deficiency  DM  Protein deficiency especially in sulfur-containing amino acids (cysteine or methionine)

CENTRAL NAIL RIDGE  Causes:  Iron deficiency, folic acid deficiency, protein deficiency

CENTRAL NAIL CANAL/HELLER’S FIR TREE DEFORMIT Y  Cuticle usually normal  Associations:  Severe arterial disease  Severe malnutrition  Repetitive trauma

NAIL BEADING  Endocrine Conditions: DM, thyroid disease, Addison’s

ROUGH  Sandpaper/dull appearance  Seen in:     Psoriasis Chemical exposures Lichen planus Autoimmune diseases

NAIL THICKENING  Slow growth produces thickness  Causes:      Onychomycosis Chronic eczema PVD Yellow nail syndrome Psoriasis

ONYCHOLYSIS  Associated with:  Thyrotoxicosis, trauma, contact dermatitis, chemicals, porphyria cutanea tarda

CLUBBING  Angle between nail plate and fold greater than 180 degrees

CLUBBING  Causes:  Cardiac/Pulmonary (80%): R to L shunts, endocarditis, pericarditis, lung CA, bronchiectasis, lung abscess, empyema, pulmonary fibrosis. NOT COPD  GI (5%): IBD, celiac, neoplasms (esophagus, liver, bowel)  Hyperthyroidism (1%)

SPLINTER HEMORRHAGE  A s s o c i a te d w i t h t r a u m a , I E , s c l e r o d e r m a , t r i c h i n o s i s , p i t y r i a s i s r u b r a p i l a r i s , p s o r i a s i s , r e n a l f a i l ur e

TERRY’S NAILS  Proximal paleness extending at least half -way up (often eliminating the lunula) with a dark band distally. Seen in states of stress (liver disease, CHF, DM2, advanced age)

LINDSAY’S NAILS/HALF AND HALF NAILS  Pale proximal (edema and anemia) in kidney and liver disease. In renal disease there is a brown transver se distal brown transver se band at the junction of the er ythema and free edge

BEAU’S LINES  Transverse depressed ridges caused by growth arrest. Seen in severe infection, MI, hypotension/shock, hypocalcemia, postsurgical, malnutrition, some chemotherapies

MUEHRCKE’S LINES (LEUKONYCHIA STRIATA)  Due to edema to the nail plate. Usually 2 or more on one nail. Seen in states of decreased protein synthesis or increased protein loss, hypoalbunemia (<2.2), nephrotic syndrome and certain chemotherapies. Don’t move and disappear when albumin increases.

MEES’ LINES  Transverse white lines (usually one per nail, no depressions) that often will disappear if pressure is applied. Heavy metal poisoning (strong association with arsenic and thallium), chemo, severe illness

PITTING  Non-specific sign for psoriasis, alopecia areata, eczema, lichen planus

QUITTER’S NAIL  Distal nicotine stains with demarcation and no staining proximally seen when a patient quits smoking or changes to a lower tar tobacco.

PERIUNGAL Periungal telangiectasias: strong association with CVD: SLE, dermatomyositis, scleroderma Fibroma Mucus cyst Paronychia Herpetic Whitlow

ACRAL LENTIGINOUS MELANOMA  Seen on palms, soles, mouth but when occurs within the nail a clue is that it involves the periungal region

HANDS Pope’s Hand (Hand of Benediction) What nerve is af fected? Claw Hand

HANDS Bouchard’s and Heberden’s Nodes

HANDS Boutonniere Deformity Swan Neck Deformity Ulnar Deviation


A) B) C) D) E) Turner’s Syndrome Holt-Oram Syndrome Down’s Syndrome Edwards Syndrome Fragile X

C) Down’s Syndrome

62yo F with history of proximal muscle weakness, weight loss and dysphagia What is causing this?

DERMATOMYOSITIS Periungal telangiectasias Gottron’s papules

REFERENCES  The Stanford 25 –  Published presentation on nail exam – Mark Williams, MD at UVA

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