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Author: Dr Amanda Oakley, Clinical Associate Professor, Waikato Clinical School, Hamilton, New Zealand, 1997.
This page outlines the terms used by dermatologists to describe diseases of the fingernails and toenails.
Nail plate abnormalities are often due to inflammatory conditions affecting the matrix or nail bed. Specific diagnoses may be made from characteristic appearances.
A Beau line is a transverse depression affecting all nails, due to acute systemic illness stopping nail growth.
Nail trauma 4 months earlier
A horizontal groove can be the result of earlier nail trauma or subungual haematoma.
Median canaliform nail dystrophy presents as a feathered, central, longitudinal ridge with a fir-tree pattern usually involving both thumbnails. It is similar to the deformity caused by repetitively pushing back the cuticle (habit-tic deformity). Macrolunulae (large half-moons) may expose the nail matrix to trauma, as they are frequently present.
Angel-wing deformity describes nail plate thinning due to lichen planus.
Onychoschizia is distal lamellar or splitting/brittle nails due to water/detergent damage.
Longitudinal nail splitting is an extension of ridging seen in psoriasis, a fungal nail infection or lichen planus. Distal splitting in association with a pigmented or red linear band can be a sign of onychopapilloma.
Trachyonychia means rough nails. Trachyonychia is characteristic of lichen planus. Twenty nail dystrophy is trachyonychia of all nails.
These images show acrylic nails used as decorative cosmetics.
Distinguish a discoloured nail bed from a discoloured nail plate.
Yellow nail syndrome refers to multiple yellow nails due to lymphatic obstruction in cardiopulmonary disease.
If nails are brown coloured, consider staining (nicotine, potassium permanganate, nail varnish) and chemotherapy. Illustrated are staining from podophyllin and streaks due to oral hydroxyurea. Brown nails may also be due to onychomycosis and in dark-skinned individuals, inflammatory conditions like lichen planus. See also melanonychia and multiple brown linear streaks below.
White nails. Consider hypoalbuminaemia or chronic renal failure. May also be familial. Transverse leukonychia, in which there are multiple parallel white lines, is thought to be due to manicuring. It may also arise in association with Beau lines.
These images show white streaks due to trauma, such as manicuring.
These images show the lifting of the distal nail plate, which appears white or yellow. Consider idiopathic causes, trauma, psoriasis, thyrotoxicosis, irritant and allergic contact dermatitis, fungal nail infection (candida), drug photosensitivity (especially tetracycline and psoralens)
Superficial white onychomycosis
Half-and-half nails occur in renal failure as a white proximal nail, with a brown distal nail.
Terry nail occurring with liver cirrhosis presents as a white proximal nail, and reddened distal nail.
Mee lines are partial leukonychia due to arsenic intoxication or systemic disease.
Muehrcke lines are a double band of leukonychia in renal disease.
A red longitudinal streak or erythronychia is often due to onychopapilloma.
See Darier disease.
If a red spot is tender, consider glomus tumour.
If nails are discoloured blue, consider drugs if all nails are affected, in this case, due to minocycline.
A red or purple streak is known as a splinter haemorrhage.
A black nail may be due to a pseudomonas infection
The cuticle is a sheet of keratin joining the skin of the proximal nail fold to the nail plate, protecting the space under the proximal nail fold. Loss of cuticle results in paronychia.
Ragged cuticles are characteristic of connective tissue disease, and also occur in parakeratosis pustulosa.
Hangnail can be due to trauma (eg, nail biting).
Staphylococcus aureus is the main cause of acute paronychia.
Herpes simplex is another common cause of acute paronychia.
Retronychia refers to the embedding of the proximal nail plate into the proximal nail fold with subsequent painful nail fold inflammation and thickening, and granulation tissue, usually seen in the great toes. It typically results from trauma pushing the nail plate up with a new plate growing out underneath. Treatment is the removal of the nail.
Clubbing is due to hypertrophic osteoarthropathy or thyroid disease (acropachy); see hypertrophic osteoarthropathy.
Koilonychia is a thin, spoon-shaped nail, and can occur in normal children and adults. It is also associated with iron deficiency anaemia, diabetes, protein deficiency, connective tissue disease, nail exposure to solvents and acitretin treatment.
Pincer nail is sometimes familial or associated with psoriasis.
Usually, traumatic, such as nail-biting; in children parakeratosis pustulosa
Common skin lesions around nails include:
Books about skin diseases
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