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Nail Diseases

Last updated on: July 11, 2023

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Nail Diseases include a wide range of diseases that could be due to systemic diseases or local factors affecting the nail.

Nail Diseases Diagnosis

The nails should be inspected to see if they are healthy and pink. Local trauma to the nails seldom involves more than one or two digits. The nails should be checked for finger nail infection or whether they appear ridged, which could indicate a RA dysfunction.

Clubbed nails are an indication of hypertrophy of underlying structures.

The presence of a paronychia or a pale paronychia should prompt the clinician to probe the axilla and neck lymph nodes for tenderness and swelling.

Beau lines are transverse furrows that begin at the lunula and progress distally as the nail grows. They result from a temporary arrest of growth of the nail matrix occasioned by trauma or systemic stress. With the knowledge that nails grow about 0.1 mm/day, by measuring the distance between the Beau lines and the cuticle, one may be able to approximately determine the date of the stress. For example, if the distance is 5 mm, the stress event occurred approximately 50 days before.

See Also: Hand Anatomy

Spoon nails (koilonychias) may occur in a form of iron deficiency anemia (Plummer–Vinson syndrome), coronary disease, and with the use of strong detergents.

Clubbing of the nails, characterized by a bulbous enlargement of the distal portion of the digits, may occur in association with cardiovascular disease, subacute endocarditis, advanced cor pulmonale, and pulmonary disease.

Glossary of Nail Pathology

Nail Disease	Description	Occurrence
Beau lines	Transverse lines or ridges marking repeated disturbances of nail growth	Systemic diseases, toxic or nutritional deficiency states of many types, trauma (from manicuring)
Defluvium unguium (onychomadesis)	Complete loss of nails	Certain systemic diseases such as scarlet fever, syphilis, leprosy, alopecia areata, and exfoliative dermatitis; dermatoses such as nail infection, toenail psoriasis, eczema; arsenic poisoning.
Diffusion of lunula unguis	Spreading of lunula	Dystrophies of the extremities
Eggshell nails	Nail plate thin, semitransparent bluish white, with a tendency to curve upward at the distal edge	Syphilis
Fragilitas unguium	Friable or brittle nails	Dietary deficiency, local trauma
Hapalonychia	Nails very soft, split easily	Following contact with strong alkalis; endocrine disturbances, malnutrition, syphilis, chronic arthritis
Hippocratic nails	Watch-glass nails associated with drumstick fingers	Chronic respiratory and circulatory diseases, especially pulmonary tuberculosis; hepatic cirrhosis
Koilonychia	“Spoon nails”; nails are concave on the outer surface	Dysendocrinisms (acromegaly), trauma, dermatoses, syphilis, nutritional deficiencies, hypothyroidism
Leukonychia	White spots or striations or rarely the whole nail may turn white (congenital type)	Local trauma, hepatic cirrhosis, nutritional deficiencies, and many systemic diseases
Mees lines	Transverse white bands	Hodgkin granuloma, arsenic and thallium toxicity, high fevers, local nutritional derangement
Moniliasis of nails	Infections (usually paronychial) caused by yeast forms (Candida albicans)	Occupational (common in food handlers, dentists, dishwashers, and gardeners)
Onychatrophia	Atrophy or failure of development of nails	Trauma, infection, dysendocrinism, gonadal aplasia, and many systemic disorders.
Onychauxis	Nail plate is greatly thickened	Mild persistent trauma, systemic diseases such as peripheral stasis, peripheral neuritis, syphilis, leprosy, hemiplegia, or at times may be congenital
Onychia	Inflammation of the nail matrix causing deformity of the nail plate	Trauma, infection, many systemic diseases
Onychodystrophy	Any deformity of the nail plate, nail bed, or nail matrix	Many diseases, trauma, or chemical agents (poisoning, allergy)
Onychogryposis	“Claw nails”; extreme degree of hypertrophy, sometimes with horny projections arising from the nail surface	May be congenital or related to many chronic systemic diseases (see “Onychauxis”)
Onycholysis	Loosening of the nail plate beginning at the distal or free edge	Trauma, injury by chemical agents, many systemic diseases
Onychophagia	Nail biting	Neurosis
Onychorrhexis	Longitudinal ridging and splitting of the nails	Dermatoses, nail infections, many systemic diseases, senility, injury by chemical agents, hyperthyroidism
Onychoschizia	Lamination and scaling away of nails in thin layers	Dermatoses, syphilis, injury by chemical agents
Onychotillomania	Alteration of the nail structures caused by persistent neurotic picking of the nails	Neurosis
Pachyonychia	Extreme thickening of all the nails; the nails are more solid and more regular than in onychogryposis	Usually congenital and associated with hyperkeratosis of the palms and soles
Pterygium Nail	Thinning of the nail fold and spreading of the cuticle over the nail plate	Associated with vasopastic conditions such as Raynaud phenomenon and occasionally with hypothyroidism

onychomadesis - lunula unguis - Leukonychia

Onychauxis - Moniliasis of nails - Fragilitas unguium

References

Berry TJ: The Hand as a Mirror of Systemic Disease. Philadelphia, PA: FA Davis Co, 1963; Judge RD, Zuidema GD, Fitzgerald FT: General appearance. In: Judge RD, Zuidema GD, Fitzgerald FT, eds. Clinical Diagnosis, 4th ed. Boston, MA: Little, Brown and Company, 1982:29–47.
Judge RD, Zuidema GD, Fitzgerald FT: General Appearance. In: Judge RD, Zuidema GD, Fitzgerald FT, eds. Clinical Diagnosis, 4th ed. Boston, MA: Little, Brown and Company, 1982:29–47.
Wollina U, Nenoff P, Haroske G, Haenssle HA. The Diagnosis and Treatment of Nail Disorders. Dtsch Arztebl Int. 2016 Jul 25;113(29-30):509-18. doi: 10.3238/arztebl.2016.0509. PMID: 27545710; PMCID: PMC5527843.
Bodman MA, Krishnamurthy K. Onychomycosis. [Updated 2021 Aug 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441853/
Rathod DG, Sonthalia S. Spoon Nails. [Updated 2021 Dec 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559311/
Abdullah L, Abbas O. Common nail changes and disorders in older people: Diagnosis and management. Can Fam Physician. 2011 Feb;57(2):173-81. PMID: 21321168; PMCID: PMC3038811.
Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.