NAIL

By Gary M. White, MD


The nail serves many purposes--both functional and aesthetic. It is a protector of the finger against trauma, and it may be used as a tool for manipulation of objects. The nail is commonly used for cosmetic adornment and with it a proxy for social status. Clinically, the nails may be valuable as a marker of systemic disease or a window into the underlying psyche. For example, social and psychological dysfunction may manifest as inattention to the cleanliness or maintenance of the nail plate, while behavioral disorders may present with the stigmata of repetitive injury, e.g. onychotillomania. See also lunula.

Congenital

Congenital Anonychia

Congenital Onychodysplasia of the Index Finger

Isolated Congenital Nail Dysplasia

Congenital Hypertrophy of the Nail Fold

Curved

Koilonychia. So called "spoon nails."
koilonychia

Parrot-Beak Nail. Longitudinal hypercurvature of the nails occurs in the parrot-beak nail.
parrot-beak nail

Pincer Nails
Pincer nails

Plummer-Vinson Syndrome

Double

Post trauma [Dermatology Online Journal].

Dystrophic

Onychomycosis
onychomycosis causing a yellow discoloration of the nail.

Psoriasis
psoriasis of the nail

Darier Disease
Darier disease of the nail

Cronkhite-Canada Syndrome

Dyskeratosis Congenita

Lichen Planus
lichen planus of the nail

Lichen Striatus. Usually in a child.
lichen striatus affecting the nail

Endonyx Onychomycosis
Endonyx Onychomycosis

Onychophagia
Onychophagia

Onychotillomania. In onychotillomania the patient picks constantly at the nails or tries to tear them off. It is not the same as onychophagia, where the patient bites the nails.

Trachyonychia
Trachyonychia

Groove

Digital Mucous Cyst
Digital Mucous Cyst

Acquired Periungual Fibrokeratoma

Malaligned

Congenital Malalignment of the Great Toenail
Congenital Malalignment of the Great Toenail

Lines

From chemotherapy

Mees' Lines

Muehrcke's Lines

Chevron Nails

Longitudinal Erythronychia

Onychopapilloma
Onychopapilloma

For further discussion of both solitary and polydactylous longitudinal erythronychia, see here.

Onycholysis

Onycholysis. Women with long nails classically get this.
Onycholysis

Pseudomonas. Secondary infection of onycholysis.
Pseudomonas of the Nail

Onychomycosis. Fungal infection of the nail can cause separation of the nail plate from the bed. There may be other signs of onychomycosis including subungual debris and nail dystrophy as shown here.
Onychomycosis

Psoriasis
Psoriasis of the nail

Photoonycholysis. A photosensitizing drug and the sun causes the onycholysis.

Pigmented Streak

Longitudinal Melanonychia of various causes.
Longitudinal Melanonychia

Nail Apparatus (Subungual) Melanoma. Advanced, showing destruction of the nail.
Nail Apparatus (Subungual) Melanoma

Frictional Melanonychia. The lateral part of the 4th or 5th toe, where the shoe rubs, is the classic place for this.
Frictional Melanonychia

Onychomycosis
Onychomycosis

Onychocytic Matricoma. For a picture, see JAMA Derm 2014;150;336

Onychomatricoma

Onychopapilloma. For a picture, see JAAD January 2011 Volume 64, Issue 1, Pages 167.e1–167.e11

Pigmentation

Drug-Induced Nail Pigmentation. Minocycline taken for 3 years for rosacea caused this bluish discoloration of the nails.
Nail pigmentation from minocycline

Topical 5-FU can induce melanosis of the nail. This child was treated with topical 5-FU for periungual warts and developed nail pigmentation near the proximal nail fold. The pigment has grown out now over several months and will soon be shed.
Nail pigmentation from fluorouracil or 5-FU

Pits

Psoriasis
Psoriasis of the nail

Alopecia Areata

Purpura

Subungual Hematoma
Subungual Hematoma

Splinter Hemorrhages
Splinter Hemorrhages

Ridges, Longitudinal

Aging Nails
Split nail

Longitudinal Ridging, Nails

Median Canalicular Dystrophy
Median Canalicular Dystrophy

Chevron Nails

Ridges, Transverse

Beau's Lines
Beau's Lines

Chronic Paronychia
Chronic Paronychia

Habit Tic Deformity
Habit Tic Deformity

Onychomadesis
Onychomadesis after Hand, Foot and Mouth Disease

Short

Brachyonychia
Brachyonychia

Thickened

Aging Nails

Onychomycosis
Onychomycosis

Onychogryphosis
Onychogryphosis

Chronic Mucocutaneous Candidiasis

Onychauxis

Pachyonychia Congenita
Pachyonychia Congenita of the Nails

Psoriasis
Psoriasis of the Nail

Colored

Blue

Various drugs can turn the nails blue including minocycline, AZT, 5-fluorouracil, and antimalarials.

Wilson's Disease: A bluish discoloration of the lunula may develop in hepatolenticular degeneration (Wilson's disease).

Green

Pseudomonas. See above.

White

Half And Half Nails

Leukonychia
Leukonychia

Leukonychia Punctata
Leukonychia Punctata

Mees' Lines (Transverse Leukonychia)

Muehrcke's Lines
Muehrcke's Lines

Terry's Nails

White Superficial Onychomycosis
White Superficial Onychomycosis

Proximal Subungual Onychomycosis
Proximal Subungual Onychomycosis

Endonyx Onychomycosis. For a picture, see Indian J Dermatol Venereol Leprol 2015;81:390-2

Yellow

Nail Discoloration. Many contactants may turn nails yellow, orange-brown, gray-blue, purple, red, black, or green. Gold therapy can turn the nails yellow.
Yellow Nail Discoloration

Yellow Nail Syndrome
Yellow Nail Syndrome

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