Nail signs

Question 1

Pitting - what is it and what causes it?

Answer 1

Small indents in nail surface
Psoriasis
Eczema
Reactive arthritis

Question 2

Discolouration - what is it and what causes it?

Answer 2

Nail turns white/black/yellow/green etc, can also become brittle or break off
Fungal infection
Yeast infection - presents with painful red nail beds too

Question 3

Koilonychia/Spooning - what is it and what causes it?

Answer 3

Curving upwards and inwards of nails, may form a dish 
Iron-deficiency anaemia
Haemochromatosis 
Raynaud's 
Lupus

Question 4

Beau’s lines - what is it and what causes it?

Answer 4

Deep grooved lines/ridges running across nail horizontally

Injury, malnutrition, illness, cold temperatures

Question 5

Splinter haemorrhages - what is it and what causes it?

Answer 5

Brown/red streaks under the finger nail, if multiple affected likely due to 
Infective endocarditis 
Psoriasis 
Lupus 
(if on one - can be injury)

Question 6

Ram’s-horn nails/onychogryphosis) - what is it and what causes it?

Answer 6

Very overgrown nails that are hard and thick, look like claws/horns, Common in elderly

Question 7

Brittle nails - what is it and what causes it?

Answer 7

Thin nails that split/break easily 
Repeated trauma (or exposure to water, chemicals etc)
Fungal infection 
Hyper/hypothyroidism
Psoriasis

Question 8

Onycholysis what is it and what causes it?

Answer 8

Separation of distal nail from nail bed 
Repetitive trauma (or exposure to water/chemicals)
Psoriasis, dermatitis 
Infection - fungal, yeast, bacterial or viral 
Iron deficiency anaemia 
Hyper/hypothyroidism 
DM 
Multiple myeloma
Sarcoidosis 
Amyloidosis 
Drugs - tetracyclines, fluoroquinolones

Question 9

Leukonychia (totalis = Terry’s nails) - what is it and what causes it?

Answer 9

A whitening of the nail; 
Partial (spots/transverse/longitudinal) can be due to trauma
Total + red/dark tips = Terry's nails can be due to 
Liver cirrhosis 
CKD
Heart failure 
Protein malabsorption disorders 
DM 
Iron deficiency anaemia 
Hyperthyroidism

Question 10

Dystrophic - what is it and what causes it?

Answer 10

Discoloured and rough textured, may break away from nail bed, due to poor nail formation
Trauma or infection

Question 11

Paronychia - what is it and what causes it?

Answer 11

Inflammation and infection (S.aureus/S.pyogenes/Pseudomonas) of the skin around the nail, typically following a break in the skin - painful, red swelling

Question 12

Onychomycosis - what is it and what causes it?

Answer 12

Fungal infection of the nail, mainly toes, thickening and discolouration of nail, brittle