Nail Abnormalities

Koilonychia (Spoon nail)The nail is concave with raised edges Iron deficiency anemiaLichen planus
Racquet Nail Premature obliteration of epiphyseal line
Width of nail bed & nail plate is greater than their length
AnonychiaAbsence of all or part of one or several nails Lichen panusWith tong. bone anomalies
Beau's LinePoor nutrition to matrix 1/t a defective band of nail
formation resulting in transverse groove of thin nail plate.
Any severe systemic illness
Onychomadesis : Separation of nail from matrix
Longitudinal ridges with beaded and/or Fir tree appearance Median canaliform dystrophy of Heller
Trachyonychia (Rough sand paper nail) 20 nail dystrophy (alopecia areata) External chemical treatment
Leuconychia : White discolouration of nail Nail matrix dysfunction
Apparent leuconychiaWhite appearance d/t changes in underlying tissue Tery's nail, half & half nailMuehrck's paired narrow white band
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
Hook Nail Lack of support from short bony phalynx
Pterygium Dorsal pterygium in lichen planusVentral pterygium
in scleroderma with Raynaud's phenomenon, causalgia
of median nerve, formaldehyde containing nail cosmetics.
Onycholysis : Detachment of nail plate from its bed starting at its distal &/or lateral attachment PsoriasisReiter's syndrome
Onychorrhexis : Splitting & roughness of nail plate Lichen planus
Onychoptosis defluvium (Alopecia unguim) Component of alopecia Alopecia areata
Koenen's Periungal Fibroma Tuberous sclerosis (50% cases)
Mee's Line Arsenic Poisoning.
Pitting Deep & irregular pits: psoriasis, atopic dermatitis Superficial & geometric pits in alopecia areata.
MelanonychiaPresence 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
Muehrck's lines Hypoalbuminemia
Brown nail Arsenic poisoning
Addison's disease
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.
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