What are Beau's Lines?
Transverse depressions of the nail plate.
What are Beau's Lines caused by?
Secondary to disruption of nail plate formation by the nail matrix. Usually trauma.
If Beau's Lines are present at the same level in all nails, what is this indicative of?
What are punctate depressions of the nail plate surface?
Pitting is due to what?
Foci of abnormal keratinization in the proximal nail matrix.
What diseases is pitting seen in?
Psoriasis, alopecia areata, and eczema.
What is trachyonychia?
Nails with a rough, ridged surface. Caused by proximal nail matrix damage.
What diseases is trachyonychia seen in?
Alopecia areata, lichen planus, psoriasis, eczema
What is True Leukonychia?
White opaque discoloration in punctate, striate, or diffuse patterns. Due to damage of the distal matrix. Most often caused by trauma.
How do you distinguish true leukonychia from apparent leukonychia?
True will be unchanged with pressure aka nail plate is opaque. Apparent will disappear with pressure aka nail plate is normal but nail bed is abnormal.
What are Mees' Lines?
A true leukonychia with transverse white bands associated with arsenic and thallium toxicity.
What is koilonychia?
Spoon nails. Thin, flat, spoon-shaped nails.
An iron deficient anemic pt would have what type of nails?
Spoon nails (kioilonychia)
What is onycholysis?
Distal nail plate detachment from the nail bed. Detached nail looks yellow-white.
What is onycholysis commonly due to?
Psoriasis or onychomycosis
What is apparent leukonychia commonly due to?
Chemotherapy drugs or systemic dz (e.g. hypoalbuminemia)
What would you call a sliver of extravasated blood visible beneath the nail plate?
Splinter hemorrhage...from damage to longitudinally oriented nail bed capillaries.
What is a splinter hemorrhage most commonly associated with? What is the most common systemic association?
1. Trauma 2. Bacterial Endocarditis
What is longitudinal melanonychia?
Single or multiple longitudinal brown-black bands due to deposition of pigment. Single: may be a sign of nail melanoma. Multiple: often due to drugs or systemic dz.
What is Hutchinson's Sign?
Longitudinal melanonychia but with extension of pigment on to the nail folds. Raises concern for melanoma.
What is Green Nail Syndrome? What is it caused by?
Greenish-black or greenish-blue nail plate discoloration. Due to P. aeruginosa: produces pyocyanin which is a blue-green pigment. Predisoposing factors=exposure to water, detergents, and soaps.
How does psoriasis affect nails?
Diagnostic signs of psoriasis with regards to nails=irregular pitting, Salmon patches, or onycholysis with erythematous border. Also, multiple nails will be affected. Psoriatic arthropathy is often associated and Koebner phenomenon worsens nail symptoms.
Lichen planus and nails?
Several nails usually affected. Nail thinning and fissuring present.
What is Dorsal Pterygium and what dz is it associated with?
Scarring of the proximal nail fold over the nail plate. It is associated with lichen planus.
What nail changes are seen with alopecia areata? What patient population is most commonly affected?
Geometric pitting and trachyonychia. Children.
Eczema and nails?
Irregular pitting and Beau's Lines. Subungal hyperkeratosis. Chronic paronychia.
How is clubbing defined?
Angle between the proximal nail fold and the nail plate > 180 degrees.
What nail abnormality will be seen in cardiopulmonary dz, sarcoidosis, cirrhosis, GI dz, toxin exposures, and trauma?
What are Muehrcke's Lines and what dz are they associated with?
Apparent leukonychia with transverse white bands. Hypoalbuminism.
What are Lindsay's nails? Terry's nails? What dz is each associated with?
Lindsay's: white proximally and brown-red distally (half and half). Chronic renal dz. Terry's: white proximally with bit of brown-red distally. Cirrhosis. Remember: Lindsay (top) is only a half bitch, Terry's (bottom) a whole bitch who doesn't deserve a liver.