Ψ Examining Fingernails in elderly patients - 3/5

APRIL 5, 2008

Examining Fingernails in elderly patients (3/5)
Abnormalities of the nail are often caused by skin disease, infection & medical conditions.

Author: Mark E. Williams - Medscape.com

Content:

INTRODUCTION

OBSERVING THE NAIL SHAPE AND SURFACE

OBSERVING THE NAIL COLOUR

PROCESSES AROUND THE NAIL

CASES

OBSERVING THE NAIL COLOUR

Abnormalities of the Lunula:

If the lunula is absent, consider anemia or malnutrition (Figure 16). A pyramidal lunula might indicate excessive manicure or trauma (Figure 17). A pale blue lunula suggests diabetes mellitus. If the lunula has red discoloration, consider the following causes among others (Figure 18):

Cardiovascular disease;
Collagen vascular disease; and
Hematologic malignancy.

Figure 16: Absent lunula.

Pyramidal lunula
Figure 17: Pyramidal lunula.

Figure 18: Lunula with red discoloration.

Lunula red discoloration

Transverse White Lines (Mee's lines)

Any acute illness can produce transverse milky white lines. In addition, they might be caused by heavy metal toxicity (classically arsenic) or chemotherapy. The time of event may be determined from the location of the lines on nail (Figure 19).

Figure 19: Note the Mee's line approximately one third of the way up the nail, suggesting a significant illness 2 months previously.

Leukonychia Striae

Leukonychia striae are white splotches caused by minor trauma to the nail matrix (Figure 20). The timing can be determined by the location of the splotches on the nail.

Figure 20: Example of leukonychia striae. Note location of white splotches, which can indicate timing of the traumatic event.

Longitudinal Brown Lines

Longitudinal brown lines form because of increased melanin produced by nail matrix melanocytes (Figure 21). They are associated with:

Addison's disease;
Nevus at the nail base;
Breast cancer;
Melanoma (check for periungal pigmentation);
Trauma.

Figure 21: Longitudinal brown lines.

Splinter Hemorrhages

Splinter hemorrhages are caused by hemorrhage of the distal capillary loop (Figure 22). Note the thickness of these areas. They are associated with the following:

Subacute bacterial endocarditis;
Systemic lupus erythematosus;
Trichinosis;
Pityriasis rubra pilaris;
Psoriasis;
Renal failure.

Figure 22: Splinter hemorrhages tend to be fat.

Terry's Half and Half Nails

With Terry's half and half nails, the proximal portion is white (edema and anemia) and the distal portion is dark. These nails imply either renal or liver disease (Figures 23).

Figure 23: This example of Terry's half and half nails suggests liver disease (no brown lines).

White Nails

White nails can be caused by anemia, edema, or vascular conditions (Figure 24). Consider the following:

Anemia;
Renal failure;
Cirrhosis;
Diabetes mellitus;
Chemotherapy; and
Hereditary (rare).
Figure 24: Example of white nails.

Pink or Red Nails

With pink or red nail discoloration, the following should be considered (Figure 25):

Polycythemia (dark);
Systemic lupus erythematosus;
Carbon monoxide (cherry red);
Angioma;
Malnutrition.

Figure 25: Example of pink and red nails.

Pink and red nails Nails

Brown-Gray Nails

Brown-gray nails may suggest the following (Figure 26):

Cardiovascular disease;
Diabetes mellitus;
Vitamin B12 deficiency;
Breast cancer;
Malignant melanoma;
Lichen planus;
Syphilis;
Topical agents, including hair dyes, solvents for false nails, varnish, and formaldehyde (among many others)

Figure 26: Example of brown-gray nails.

Yellow Nails

Yellow nails suggest the following (Figure 27):

Diabetes mellitus;
Amyloidosis;
Median/ulnar nerve injury;
Thermal injury;
Jaundice.

Consider yellow nail syndrome if a patient has lymphedema and bronchiectasis.
Figure 27: Example of yellow nails.

Green or Black Nails

Green or black nails indicate the following (Figure 28):

Topical preparations, including chlorophyll derivations, methyl green, and silver nitrate (among others);
Chronic Pseudomonas spp infection; and
Trauma.

Figure 28: Example of black nails.

CONTINUE THIS ARTICLE:

Previous Page - Page 3 of 5 - Next Page

FINGERNAILS NEWS | NAILS NEWS | FINGER NAIL NEWS

PALM READING | PALMISTRY

MORE NAIL RESOURCES:

Nail Tutor

Nail Disorder Index

Diseases & Nail Disorders

Nail Biting

Nail Products

HANDS IN THE NEWS

MORE HAND RESEARCH TOP ITEMS: