dermatologic disorders
Nail Deformities and Dystrophies
Nail deformities and dystrophies associated with systemic problems
In Esophageal Web (esophageal webs caused by severe, untreated iron deficiency), 50% of patients have koilonychia (concave, spoon-shaped nails). Yellow nail syndromeis a rare condition characterized by slow-growing, thickened, hypercurved, yellow nails. This condition typically occurs in patients with lymphedema and/or chronic respiratory disorders. Chronic bronchial infections are present in about half of reported cases. (Lindsay nails) occur usually with Chronic Kidney Disease ; the proximal half of the nail is white, and the distal half is pink or red-brown. Half-and-half nails occur in 20 to 50% of patients who have chronic kidney disease; however, this nail abnormality has been reported in various other chronic diseases including Crohn disease, cirrhosis, pellagra, and Kawasaki disease. This abnormality also occurs in healthy people ( are characterized by whiteness of about 80% of the nail bed with a 0.5- to 3.0-mm brown-to-pink distal band. Terry nails are often associated with cirrhosis, chronic heart failure, and adult-onset diabetes mellitus. Differentiation from half-and-half nails can be difficult ( Systemic nail deformities and dystrophies reference ). occur with Cirrhosis , although the distal third may remain pinker. Intensely white nails, also called Terry nails, can be present in patients with chronic liver or kidney failure, heart failure, or diabetes. Terry nails are a type of leukonychia; the abnormality is not in the nail itself but rather the nail bed, causing the nail the appear white. In Terry nails, nearly the entire nail is opaque white and the lunula is not visible. There is a thin zone of normal pink nail bed at the distal edge of the nail. Terry nails may sometimes occur as part of normal aging ( are horizontal grooves in the nail plate that occur when nail growth temporarily slows, which can occur after infection, trauma, systemic illness, or during cycles of chemotherapy. Onychomadesis similarly results from temporary growth arrest of the nail matrix and differs from Beau lines in that the full thickness of the nail is involved, causing a proximal separation of the nail plate from the nail bed. Onychomadesis most frequently occurs several months after Hand-Foot-and-Mouth Disease (HFMD) but can occur after other viral infections. Nails affected by Beau lines or onychomadesis regrow normally with time. Characteristic spoon-shaped (concave) nail of a patient with iron-deficiency anemia. DR P. MARAZZI/SCIENCE PHOTO LIBRARY This image shows yellow nails with increased thickening and hypercurvature characteristic of yellow nail syndrome. © Springer Science+Business Media In this image of Terry nails, almost all of the nail is opaque white except for a narrow brown-to-pink band at the distal edge of the nail. © Springer Science+Business Media This image shows Beau lines in a patient undergoing multiple cycles of chemotherapy. Each line corresponds to a cycle of treatment. © Springer Science+Business Media The transverse depression of the nail plate is easily appreciated looking at the nail from the side. © Springer Science+Business Media 