Nail Abnormalities
DISORDERS OF NAILS
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Koilonychia (Spoon nail) The nail is concave with raised edges |
Iron deficiency anemia Lichen planus Hypothyroidism |
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Racquet Nail Width of nail bed & nail plate is greater than their length |
Premature obliteration of epiphyseal line |
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Anonychia Absence of all or part of one or several nails |
Lichen panus With tong. bone anomalies |
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Beau’s Line Poor nutrition to matrix 1/t a defective band of nail formation resulting in transverse groove of thin nail plate. |
Any severe systemic illness |
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Onychomadesis : Separation of nail from matrix |
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Longitudinal ridges with beaded and/or Fir tree appearance |
Median canaliform dystrophy of Heller |
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Trachyonychia (Rough sand paper nail) |
20 nail dystrophy (alopecia areata) External chemical treatment |
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Leuconychia : White discolouration of nail |
Nail matrix dysfunction |
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Apparent leuconychia White appearance d/t changes in underlying tissue |
Tery’s nail, half & half nail Muehrck’s paired narrow white band |
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Onychogryphosis (Ram’s horn or Oyster – Nail) Nail is severly distorted, thickened, opaque, brownish, sparaled & with out attachment to nail bed |
Pressure from foot wear in elderly |
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Hook Nail |
Lack of support from short bony phalynx |
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Pterygium |
Dorsal pterygium in lichen planus Ventral pterygium in scleroderma with Raynaud’s phenomenon, causalgia of median nerve, formaldehyde containing nail cosmetics. |
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Onycholysis : Detachment of nail plate from its bed starting at its distal &/or lateral attachment |
Psoriasis Reiter’s syndrome |
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Onychorrhexis : Splitting & roughness of nail plate |
Lichen planus |
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Onychoptosis defluvium (Alopecia unguim) Component of alopecia |
Alopecia areata |
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Koenen’s Periungal Fibroma |
Tuberous sclerosis (50% cases) |
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Mee’s Line |
Arsenic Poisoning. |
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Pitting |
Deep & irregular pits: psoriasis, atopic dermatitis Superficial & geometric pits in alopecia areata. |
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Melanonychia Presence of melanin in nail plate presenting as single / multiple longitudinal brown — black band. |
-Single band: nail matric nevus or melanoma (deserve biopsy), trauma (usually in 4/5th toe nail) -Multiple band: dark race, pregnancy, inflmatory nail disorder, Lauiger — Huntziker syndrome (with pigmented macules on lip & genitals), AIDS, Addison syndrome |
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Muehrck’s lines |
Hypoalbuminemia |
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Brown nail |
Arsenic poisoning Addison’s disease |
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Blue nail |
Wilson’s disease |
Exam Question
- Digital clubbing is seen in Endocarditis ,Pulmonary arteriovenous fistula ,Tricuspid atresia.
- Onycholysis is seen in Allergic dermatitis ,Psoriasis ,Antineoplastic therapy.
- A 60-year-old woman complains to a physician because several of her toe nails are discolored. Physical examination demonstrates crumbling, friable nails with distal-lateral separation from the nail bed. Hyperkeratotic debris is present under the affected part of the nail. Trichophyton is the most likely pathogen.
- Nails is formed in 10-12 week of IUL.
- Mees line is seen in Arsenic poisoning.
- Pterygium of nails is seen in Lichen Planus.
- Thimble Pitting of nails is seen in Psoriasis.
- Tinea ungum effects Nail plate.
- A patient presented with scarring alopecia, thinned nails, hypopigmented macular lesions over the trunk and oral mucosa. The diagnosis is Lichen Planus.
- 10 year old chid has violaceous papule and pterygium of nails. The diagnosis is Lichen Planus.
- Koenen’s periungual fibromas are seen in > 50% of cases with Tuberous Sclerosis.
- Nail and half nail sign, seen in uremia is increased capillary density at the distal half of the nails.
- Causes of Unilateral Clubbing
- Aneurysm of Aorta, innonimate artery, suhclavian artery or axillary artery
- Brachial AV fistulas / malformations
- Infected arterial grafts
- Pancoast tumors
- Arsenic poisoning presents with abdominal pain, diarrhea, Mees line on nails and myelosuppression.
- A middle aged man presented with paraesthesia of hands and feet. Examination revealed presence of ‘Mees’ lines in the nails and raindrop pigmentation in the hands.
- The most likely diagnosis is Arsenic poisoning.
- Muehrcke lines in nails are seen in Nephrotic Syndrome.
- A 60-year old male presented with discoloration, thickening and tunneling of 2 fingernails and one toenail. KOH mount will clinch the diagnosis at the earliest.
- Lovibond profile sign is seen in Clubbing.
- 40 yr old with koilonychias, iron deficiency & dysphagia, diagnosis is Plummer Vinson Syndrome.
