Terry's Nails
Proximal paleness
extending halfway up the nail, often eliminating the lunula. Darker distal
band. Seen in states of stress (e.g. advanced age, liver disease/cirrhosis,
CHF, DM2)
Lindsay's Nails (Half-and-half Nails)
Distal brown transverse band seen in kidney disease. Caused by
increased pigment deposition.
Beau's Lines
Transverse depressed ridges seen in severe infection, MI,
hypotension/shock, hypocalcemia, post-surgical, malnutrition and with certain
chemotherapy.
Muehrcke's Lines (Leukonychia striata)
Narrow while transverse lines (Not depressed, compared to Beau's
lines). Usually 2 or more lines on one nail. Seen in states of decreased
protein synthesis or increase protein loss such as with hypoalbunemia (usually
less than < 2.2 g/dL), certain chemotherapy and nephrotic syndrome.
Mee's Lines
Transverse while lines
(usually one per nail, no depressions) that often can will disappear if
pressure is placed over the line. It is strongly associated with arsenic poisoning,
thallium poisoning and to a lesser extent other heavy metal poisoning.
Acral Lentiginous Melanoma (involving nail)
While acral lentinginous melenoma is often seen anywhere on the
palms, soles, and even in the mouth, when it occurs within the nail, a clue
that this is melanoma is involvement of the periungal regions as seen in this
picture.
Splinter Hemorrhages
Nonspecific finding associated with trauma most commonly but
also seen in subacute bacterial endocarditis and scleroderma.
Nail Pitting
Non-specific sign for psoriasis (additional signs include
onycholysis, thickening, and 'oilspot' lesions which are yellow patches on the
nail).
Quitter's Nail
Nicotine stained distally, but not proximally with clear line of
demarcation. See also article in Chest and NEJM clinical image. May also appear when
patientt switches to "lower tar" tobacco.
Finger nails grow at a rate of about 0.8-1.0 mm
per week. Using this, you can approximate when the clinical scenario causing
the nail finding occurred. For example, approximating when someone has stopped
smoking who has quitter's nails.
Paronychia
Inflammation of the nail folds - red, swollen, often tender.
Frequent immersion in water a risk factor for chronic paronychia.
Clubbing
Angle between nail plate and proximal nail fold greater than 180
degrees.
Important causes of
clubbing in the adult:
- Lungs
- Lung Cancer (clubbing is in
general an ominous sign for this, and remember "beware of the yellow
clubbed digit". (Yellow from nicotine, and clubbed from cancer).
- Pus in the lung
(bronchiectasis as in CF, but also lung abscess and empyema)
- Pulmonary Fibrosis
- COPD IS NOT A CAUSE OF
CLUBBING (if you seen clubbing in
a COPD patient, think lung cancer)
- Heart
- R to L shunts
- Endocarditis
- Pericarditis
- There are other causes of
clubbing, outside the heart and lungs, but these are the important ones.
- If a patient has painful
wrists, painful ankles and comes to see you and you miss that they also
have clubbing, you will go down the wrong path looking for RA etc, when
what they have is Hypertrophic Pulmonary Osteoarthropathy. The
causes of HPOA are the same as those of clubbing.
Pseudoclubbing: distinguished from clubbing by the
preservation of the nail-fold angle and bony erosion of the terminal phalanges
on radiography. Pseudoclubbing is also more likely to be asymmetric.
Special courtesy to Standford Medicine
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