16 - Nail Manifestations of Systemic Disease Flashcards
Introduction
- Nails can be a first sign in detecting a systemic disease
- “Pathological processes responsible for most nail changes are unknown”
Normal nails
- Thin, shiny, firm
- Melanonychia (black streak) common in African-Americans
- Aging nails lose luster, thicken and become yellow
- Longitudinal ridging occurs with aging
Abnormalities in color, shape and texture of the nail may reflect…
- Abnormality of nail, itself
- Abnormality of subungual area
- Abnormality of periungual area
- Systemic disease
Anonychia
Anonychia: absence of nail, seen in alopecia areata and nail-patella syndrome
Brittleness
- Brittleness: normal nail contains 18% H2O in the form of vapor
o Normal aging loses this H2O and nail growth rate decreases
o Keep nails short and moisturize at night
*** (all underlined)
Clubbing
- Clubbing: loss of the normal angle between the nail and the posterior nail fold-later the distal phalanx becomes enlarged and there may be an increase in the size of the nail
Etiology of clubbing
o Result of an angulation of the matrix secondary to an increase in connective tissue (increased circulation?) – distal end of matrix is high compared with the proximal end *
o Most common cause is lung disease (bronchiogenic CA) ***
Schamroth’s test
o Schamroth’s test is positive-when the two index fingers are put nail to nail, there is a loss of the normal diamond-shaped recess between the base of the nail plates; there is also an increase in the length of the “V” at the tip of the plates
Chromonychia
- Color changes (Chromonychia): can be altered by external stains (nicotine), partial destruction, abnormal formation
White nail
White nail (Terry’s nail)-hepatic cirrhosis-disease of nail bed and not nail plate
Muehrcke’s lines
Paired, narrow white bands that run parallel with the lunula and are separated from one another and from the lunula by areas of normal pink nail-hypoalbuminemia-changes not in nail plate
Mee’s lines
Mee’s lines-punctate or striped white bands associated with arsenic poisoning
White nail (leukonychia)
White nail (leukonychia): in nail plate, itself (partial leukonychia is very common)
Blue-green nail
Pseudomonas, subungual hematoma
Red half-moons
Congestive heart failure
Blue half-moons
Hepato-lenticular degeneration (Wilson’s disease)
Half-and-half nail
Half-and-half nail (proximal nail bed is white and the distal half red, pink, or brown)
o Renal disease and azotemia
Black streak
o Think Melanoma, common and normal in African-Americans
o Multiple streaks common in Addison’s disease
o Most common cause of blackened toenail is a subungual hematoma due to trauma
If diagnosis uncertain, remove nail and perform superficial shave biopsy of lesion. Submit both shave and nail for pathology
Mee’s lines are associated with: o Cardiac disease o Pulmonary disease o Hypoalbuminemia o Arsenic poisoning o Renal disease
Answer: 4 – Arsenic poisoning
ABCDEF of Subungual Melanoma
- African-American, Native American, Asian
- Band is brown-black, breath is > 3mm, border is irregular
- Change is rapid in size or growth rate
- Digit-hallux
- Extension into surrounding skin (Hutchinson’s sign)
- Family or personal history of melanoma or dysplastic nevus syndrome
Yellow nail syndrome
Yellow nail syndrome: nails cease, or almost cease, to grow and some months later take on a yellow color-nails remain smooth, but may be excessively curved form side to side, the lateral margins are less covered by soft tissue, cuticle is deficient-may have a distinct hump
o Bronchiectasis, bronchitis, pleural effusion
Subungual hemorrhage
Subungual hemorrhage: bleeding of nail bed
o Trauma
o Psoriasis, eczema, fungus
Hypertrophy
o Trauma (little toe normally thickened due to chronic nail pressure) o Psoriasis, fungus, eczema, Darier’s disease
Koilonychia
- Koilonychia:”spoon-shaped” nail (concave dorsally)-distal end of nail depressed below its normal level due to anoxia and atrophy of the distal connective tissue
- Iron-deficiency anemia
