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Nail Diseases

  • Damage to the nail as a result of trauma or disease results in nail dystrophy
  • This is defined as the presence of a misshapen or partially destroyed nail plate
  • Soft yellow keratin often accumulates between the dystrophic nail plate, resulting in elevation of the plate

Types of Nail diseases:


  • Fungal infection is an extremely common cause of toenail dystrophy
  • Great toe nail is extremely prone to infection
  • Infection of fingernails may occur in nails previously traumatized or when nail involvement is part of tinea mannum
  • Onycholysis: separation of nail plate from nail bed
  • Subungual hyperkeratosis: buildup of soft yellow keratin in the space created by the onycholysis, usually asymptomatic
  • Most due to Trichophyton rubrum, but in a few cases, Epidermyophyton floccosum and Trichophyton mentagrophytes may be recovered. Diagnosis can be made by culture
  • Treatment is terbenafine or itraconazole orally


  • Onycholysis, subungual hyperkeratosis, nail pitting, yellowish discoloration
  • More serious nail dystrophies are often accompanied by inflammatory, arthritic changes in the distal interphalangeal joint
  • Extremely difficult to treat

Beau's Grooves:

  • 1 mm wide depression in the nail plate that extends horizontally from one lateral nail groove to the other
  • All nails are simultaneously affected
  • Most commonly develop following dramatic illness such as MI and periods of high fever or malnutrition


  • Lovibond’s angle greater than 180 degrees, most commonly seen with chronic pulmonary or cardiopulmonary disease but also occurs with some tumors, especially those of the lung parenchyma

Periungual Warts:

  • Often distort the nail plate
  • In most instances, the dystrophy is not permanent and the nail plate returns to normal following therapeutic or spontaneous resolution of the warts

White banding of nails:

  • Horizontal white banding or opacification occurs in hypoalbuminemia accompanying chronic hepatic or renal disease

Brown banding of nails:

  • Vertical - secondary to nevus or melanoma
  • Horizontal - Addison's disease, cancer chemotherapy

Splinter hemorrhages:

  • Thin dark red lines 1-3 mm in length, representing small hemorrhages at the junction of the nail plate and the nail bed. They move out as the nail grows.
  • Seen with bacterial endocarditis, trichinosis, but frequently seen in normal individuals

Candidal Paronychia:

  • Most common cause of paronychial inflammation and swelling of the fingers
  • Seen in dishwashers, bartenders and waitresses
  • Characterized by lack of pain, lack of warmth, absence of pus, chronicity

Bacterial Paronychia:

  • Usually caused by Staphylococcus
  • Redness, warmth, swelling and tenderness


  • Spoon-shaped nails may be due to iron deficiency

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