Boards Fodder: Nail Disease

Amy Reinstadler, MD and Nazanin Saedi, MD

boards fodder Disorder

Location
of Defect
Definition Associated Conditions Image
Beaus lines Proximal
Transverse indented Mechanical trauma,
Boards Fodder: Nail Disease matrix
furrow from growthBoards dermatologic
Fodder: Nail disease
Disease of
arrest of nail Amy matrix
Reinstadler, proximal
MD and nailNazanin
fold, systemic Saedi, MD
Amy Reinstadler, MD and Nazanin Saedi, MD disease/stressful
Boards Fodder: Nail event Disease
Boards Fodder: Nail
Amy Reinstadler, MD and Nazanin Saedi, MD Disease
Disorder Location of Blue Definition Amy Reinstadler,
Associated Boards
Conditions MD
Fodder: and Nazanin
NailNailDiseaseSaedi, MD
lunula Distal Location Amy Amy Reinstadler,
Boards
Boards
Argyria, MD
Fodder:
Fodder:
antimalarials,
and
NailDisease
Nazanin AZT, MD Image
Disease
Saedi,
Disorder Amy Boards
Reinstadler,
Definition
Reinstadler, Fodder:
MD MD Nail
and
Associated
and Disease
Nazanin
Nazanin Saedi,
Conditions
Saedi, MD
MD Image
Defect matrix of Defect Amy Reinstadler, busulfan, Wilsons,
MD and Nazanin Saedi, MD
Beaus lines Proximal Location Transverse hemochromatosis
indented Mechanical trauma,
Beaus lines Proximal matrix Brachyonchia
Transverse indented furrow Disorder
Nail plateDisorder
Mechanical
Location
matrix
Short nails of Defect furrow trauma,Definition
from growth
Definition
dermatologic
Congenital:
Associated Conditions
dermatologic disease
Rubenstein-Taybi,
Associated
disease of
Conditions
Image
Image
Beaus lines of
from growth arrest of nail matrix ofDefect
proximal
Proximal
Location arrestnail
Location
Location of nail
Transverse matrix
fold, systemic
indented proximal nail fold,
disease/
Mechanical trauma,systemic
(width>length)
Disorder Disorder
Disorder trisomy
Definition Definition
Definition 21 Associated
Associated
Associated
disease/stressful Conditions
Conditions
Conditions
event of Image
Image
Image
Beaus lines
of matrix
Proximal
stressful of
of Defect
Location
Defect furrow
Transverse
Defect
event
from growth Mechanical
indented dermatologic
trauma,disease
Racquet
Disorder
Beaus lines
matrix
Beaus
Beaus lines thumbs
lines
Proximal
furrow
Proximal
ofProximal
Defect
arrest
from Acquired:
Definition
of nail matrix
growth
Transverse
Transverse
Transverse indented nailing
indented
indented
proximal
dermatologic biting,
Associated
disease
Mechanical
Mechanical
Mechanical
Conditions
nail fold,ofsystemic
trauma,
trauma,
trauma,
Image
arrest of nail
matrix matrix
furrow from growth disease/stressful
proximaldermatologic
nail fold, systemic
dermatologic event
diseaseofof
Blue lunulaBeaus linesDistalmatrix matrix
Proximal furrow hyperparathyroidism,
furrow
from
Transverse from
growth
arrest
growth
indented
of nail
dermatologic
matrix
Mechanical
Argyria, proximal
disease/stressful
disease
disease
trauma,
antimalarials,
nail
event
ofAZT,
fold, systemic
matrix arrest arrest
of nail
furrow ofmatrix
from nail matrix
growth proximal
proximal nail
dermatologic nail
fold,fold, systemic
systemic
disease of
Blue lunula Distal matrix Blue lunula
Argyria,
matrix
Distal
antimalarials, psoriasis
arrest of nail matrix AZT, busulfan,
busulfan, Wilsons,
disease/stressful
disease/stressful
proximal
Argyria, nail fold,
antimalarials,
disease/stressful
event
event
systemic
event AZT,
hemochromatosis
Clubbing Proximal
Blue lunula Greater
Brachyonchia Wilsons,
than
Distal
Nail plate
180-Short
matrix hemochromatosis
Distal nails
Hypertrophic pulmonary
disease/stressful
busulfan,
Argyria,
Congenital:
Wilsons,
antimalarials, event
AZT,
Rubenstein-Taybi,
BlueBlue
and distalBlue lunula
degree
lunula
lunula angle
matrix between
Distal osteoarthropathy, busulfan,
Argyria,
hemochromatosis antimalarials,
thyroid
Argyria, antimalarials,
Wilsons,
AZT,
AZT,
Distal (width>length)
matrix trisomy
Argyria, 21
antimalarials,
busulfan, Wilsons, AZT,
Brachyonchia Nail plate Short nails (width>length) Blue lunula Congenital:
Brachyonchia
matrixBrachyonchia proximal
Nail
nail
matrix
plate
matrix
Distal
fold and
Racquet Rubenstein-Taybi,
Short nails
disease
thumbs
(width>length) (acropachy)
Acquired:
busulfan,
trisomy
trisomy
Congenital:
busulfan,
hemochromatosis
Argyria, antimalarials,
nailing biting,
hemochromatosis
Wilsons,
hemochromatosis
21
21AZT,
Rubenstein-Taybi,
Wilsons,
Nail plate Short
matrixNail nails Short nails Congenital: Rubenstein-Taybi,
busulfan, Wilsons,
Racquet thumbs nail plateAcquired:
Brachyonchia
Brachyonchia platenailing
plate
Nail (width>length) biting,trisomy
Shortthumbs
Racquet nails
Congenital:
hyperparathyroidism,
hemochromatosis
Congenital:
Acquired:
Rubenstein-Taybi,
Rubenstein-Taybi,
21trisomynailing
hemochromatosis biting,
Brachyonchia Nail plate Short nails(width>length) psoriasis Congenital:
(width>length)
21
Rubenstein-Taybi,
trisomy 21
Clubbing
Brachyonchia
Proximal
hyperparathyroidism,
RacquetShort
Nail plate
(width>length)
Greater Racquet
than
thumbs
180-
psoriasis
nails thumbs
Racquet hyperparathyroidism,
Acquired:
trisomy
thumbs Hypertrophic
nailingRubenstein-Taybi,
Congenital:
Acquired:biting,
21 pulmonary
Acquired:
psoriasis
nailing biting,
nailing biting,
(width>length) hyperparathyroidism,
hyperparathyroidism,
trisomy 21
and distal
Clubbing Racquet
Proximal degree thumbs
angle
Greater between
than Acquired: nailing
osteoarthropathy,
180- psoriasisHypertrophic
psoriasis biting,
hyperparathyroidism,
thyroid
pulmonary
Racquet thumbs Acquired: nailing biting,
psoriasis
hyperparathyroidism,
Clubbing Proximal and Distal notching
Greater than Nail bed
180-degree angle
Clubbing matrixand distal
Hypertrophic
Clubbing
ClubbingProximal
proximal
Proximal
Greater
Proximal
degree Darier,
nail
angle
pulmonary
than Greater
180-
Greater than
lichen
foldbetween
and
than
180-
planus
disease (acropachy)
osteoarthropathy,
hyperparathyroidism,
osteoarthropathy,
180-
HypertrophicHypertrophic
psoriasis pulmonary
Hypertrophic
thyroid
pulmonary
pulmonary
and
matrix
and distal degree angle between osteoarthropathy, thyroid thyroid
distal
nail plate degree
proximal nail angle
fold between
and osteoarthropathy,
disease
psoriasis(acropachy)
distal matrix between proximal nail fold and
Clubbing thyroid
Proximal
Clubbing matrix disease
andmatrix
distal
Proximal Greater
nail
proximal
matrix
(acropachy)
degree
than
plate
Greater
nail
angle
180-
proximal
than
fold
proximal
180-
and
between
nail fold and
nail folddisease
and
osteoarthropathy,
Hypertrophic
disease pulmonary
Hypertrophic
(acropachy)
disease
thyroid
(acropachy)
pulmonary
(acropachy)
and distal
and distal degree
degree nail
angle plate
between
angle between osteoarthropathy,
osteoarthropathy,thyroid
thyroid
nail plate Distal notching matrix
Nail bedmatrix
nail plate
proximal
nail plate
nail fold and disease
proximal nail fold and Darier, disease(acropachy)
(acropachy)
lichen planus
Distal notching Nail bed nail nail
plateplate Darier, lichen planus
Distal notching Nail bed Darier, lichen planus
Distal notching
Distal notching Nail bed Nail bed Darier,planus
Darier, lichen lichen planus
Distal notching Nail bed Darier, lichen planus
Distal Distal notching Nail bed
notching Nail bed Darier,
Darier, lichen
lichen planus
planus
Dolichonychia Nail plate Long nails Ehlers Danlos Syndrome,
Dolichonychia
(Length/width >1)
Nail plate Long nailsnails
Marfans, hypopituitary
Ehlers Danlos Syndrome,
Dolichonychia Nail plate
Dolichonychia Nail Long
plate Long nails Ehlers Danlos
Ehlers Syndrome,
Danlos Syndrome,
Dolichonychia (Length/width
Nail plate Long >1) >1) >1)Marfans,
(Length/width
nails
(Length/width hypopituitary
Marfans,
Ehlers
Marfans, hypopituitary
Danlos Syndrome,
hypopituitary
Dolichonychia Nail plate Long nails Ehlers Danlos Syndrome,
Dolichonychia Nail plate Long nails (Length/width >1) Ehlers
Dolichonychia Danlos LongSyndrome,
(Length/width >1)
(Length/width
Nail plate >1)
nails Marfans,
Marfans, hypo-
Marfans, hypopituitary
hypopituitary
Ehlers Danlos Syndrome,
Dolichonychia Nail plate Long nails Ehlers Danlos Syndrome,
pituitary Cuticle (Length/width >1)
(Length/width
Marfans, hypopituitary
>1) parallelMarfans, hypopituitary
Habit tic Cuticle and
Habit ticHabitHorizontal
Habit tic
tic parallel
and Horizontal
CuticleCuticle
and and Trauma
Horizontal
Horizontal
nail
parallelto the
Trauma
parallel
plate Horizontal
ridges; absent
cuticle
to the cuticle
Trauma
Trauma
cuticle to to
thethe cuticle
cuticle
Habit tic Cuticle
nail plate andridges; absent parallel
cuticle Trauma to the cuticle
nail plate
Habit tic ridges;nail absent
plate
Cuticle cuticle
andnail ridges;
Horizontal
plate absent cuticle
parallel
ridges; Trauma to the cuticle
absent cuticle
Habit tic Cuticle and nail Horizontal parallel ridges; Habit tic nail
Habit tic Trauma
Cuticle
Heller median nailand
to
and the
plateCuticleridges; cuticle
Horizontal
absent
Nail Horizontal
plate
parallel
cuticle
parallelcuticle
plateridges;Longitudinal
absent
Trauma to the cuticle
TraumaIdiopathic
fissures to the cuticle
plate absent cuticle Heller median
Heller median Heller
nailNail
canaliform
median
Nail plate
plate ridges;
plate
Nail plate
Longitudinal
absent fissures
cuticle
with oblique
Longitudinal
Longitudinal fissures lines, Idiopathic
fissures Idiopathic
Idiopathic
canaliformdystrophy with oblique lines,tree
Christmas
Heller median Nail plate
canaliform Longitudinal
Heller median
dystrophy Nail platefissures
canaliform with oblique
Longitudinal Idiopathic
with oblique
lines,
fissures lines,Idiopathic
Heller median
dystrophy Nail plate Christmas
Longitudinal
Christmas tree
pattern fissures Idiopathic
canaliform dystrophy
canaliform with oblique lines, Christmas
with oblique
pattern lines, tree
tree
Heller median Nail plate Longitudinal fissures with Hellercanaliform
dystrophy Idiopathic
medianKoilonychia
Nail plate
spoon nails
Longitudinal
Proximalwith
Christmas
pattern
and with
distal
fissures
Thinned
oblique
pattern
tree
lines, Idiopathic
concave nails LEOPARD, ectodermal
dysplasia, nail-patella,
canaliform dys- dystrophy
oblique lines, Christmas tree Christmas
canaliform
dystrophy
Koilonychia
Koilonychia tree
Proximal
Proximal
pattern
matrix
oblique
Christmas
Thinned
Thinned lines,
tree nails
concave
concave nails LEOPARD,
LEOPARD,ectodermal
ectodermal
trichothiodystrophy,
Koilonychia
dystrophy
spoon Proximal
nailsnails and distal
spoon Thinned concave
pattern
Christmas
and distal tree nails LEOPARD,
dysplasia, ectodermal
dysplasia,nail-patella,
nail-patella,
Koilonychia pattern Proximal Thinned concave nails nailsLEOPARD, Plummer-Vinson,
ectodermal Iron
trophy pattern spoon nails
Koilonychiaand
spoon nails
distal
matrixmatrix
Proximal pattern
Thinned
and distal
concave dysplasia, nail-patella,
trichothiodystrophy,
trichothiodystrophy,
LEOPARD, ectodermal
dysplasia, deficiency, hemochromatosis,
nail-patella,
spoon matrix
nails and distal Plummer-Vinson,
trichothiodystrophy,
Plummer-Vinson,
dysplasia, Iron
nail-patella,Iron
Koilonychia ProximalKoilonychia
Thinned concave
Proximal
matrix nails LEOPARD,
Thinned concave nails ectodermal
LEOPARD, ectodermal
physiologic
trichothiodystrophy,
deficiency,
deficiency,
in children
hemochromatosis,
hemochromatosis,
matrix trichothiodystrophy,
Plummer-Vinson, Iron
Koilonychia Proximal and Thinned
spoon concaveand
nails distalspoon nails LEOPARD,
nails and distal
matrix
ectodermal
dysplasia, dysplasia,
dysplasia,
nail-patella,
Plummer-Vinson,
nail-patella,
physiologic
physiologic
deficiency, in
Plummer-Vinson, nail-
Iron
in children
children
Iron
hemochromatosis,
trichothiodystrophy,
spoon nails distal matrix matrix Boards
patella, trichothiodystrophy, Fodder: Nail
deficiency,
trichothiodystrophy, Disease
hemochromatosis,
Plummer-
deficiency,
physiologic inhemochromatosis,
Plummer-Vinson, children
Iron
AmyIron Reinstadler,Boards MDFodder:
and Nailin Disease
physiologic
Nazanin
deficiency,
children
physiologic in children
Saedi, MD
hemochromatosis,
Vinson, Plummer-Vinson, Iron
Amydeficiency,
Reinstadler, MD hemochromatosis,
and Nazanin
physiologic Saedi, MD
in children
physiologic in children deficiency, hemochromatosis,
Apparent Nail bed Boards Fodder:Hypoalbuminemia,
White discoloration
physiologic Nail Disease
Apparent Nail bed White discoloration in children
Hypoalbuminemia,
Apparent leuk- Nail bed White discoloration thatleukonychia
fadesleukonychia AmythatReinstadler,
Hypoalbuminemia, fades with chemotherapy
MD and
that fadeschemotherapy
pressure
with Nazanin Saedi, MD
chemotherapy
pressure
onychia with pressure Apparent Nail bed White discoloration Hypoalbuminemia,
leukonychia that fades with chemotherapy
pressure
Boards Fodder: Nail Disease
Amy Reinstadler, MD and Nazanin Saedi, MD
Nazanin Saedi, M.D., True leukonychia Distal matrix Punctate: small opaque whiteApparentTrauma,
True leukonychia
True leukonychia
matrix matrix
Distal
hereditary,
opaqueopaque
Distal Punctate:
Punctate:
small small
infection,
white
whitediscoloration
spots spots anemia,anemia,
anemia,
lowlow low
calcium,
calcium,
Trauma,
Trauma, hereditary,
hereditary, infection,
infection,
Nail bed White Hypoalbuminemia,
is the chief resident spots calcium, heart/renal
leukonychia
True leukonychia Distal transverse
Striate: multiple
Striate:that fades disease,
multiple
transverse
Punctate: small
with
white
heart/renal disease, drugs
drugs
heart/renal disease, drugs
chemotherapy
Trauma, hereditary, infection,
white
pressure
in dermatology at Striate: multiple transverse matrix parallel
opaque
parallelDiffuse:
linesspots
white
lines completely or
Striate: multiple
anemia, low calcium,
heart/renal disease, drugs
the University of white parallel lines Diffuse: completely
almost
transverse
or
completely
white
almost completely
white
Diffuse: completely or almost Lindays nails parallel lines
California, Irvine. completely white (half and half)
Lindays nails
whiteDiffuse:
Nail bed Distal completely
proximal
Nail bed Distal Distalalmost
nail
nail is normal,
or Chronic renal failure
nail is whiteChronic renal failure
iscompletely
normal,
True leukonychia Punctate: small Trauma, hereditary, infection,
(half and half) matrixproximal
whitenail iswhite
opaque whitespots anemia, low calcium,
Lindays nails Nail bed Distal nail is normal, proximal
(half
Chronic
Lindays nails
and half)
renalDistal
Nail bed
failure
nail is
Striate: normal,
multiple Chronic renal failure
heart/renal disease, drugs
Longitudinal Proximal or proximal nail is
Longitudinal
transverse white
white Nevus/melanoma of matrix,
(half and half) nail is white melanonychia distal pigmented bands
parallel lines Laugier-Hunziker, Peutz-
Longitudinal Proximal
(melanonychia or
matrix Longitudinal
extending Nevus/melanoma
from the or Jegher, AZT, AIDS, of matrix,
normal
Diffuse: completely
melanonychiastriata) distal Proximal pigmented bands
proximal nail fold to Laugier-Hunziker,
almost completely
Peutz-
variant in dark skinned
Longitudinal or Longitudinal Nevus/melanoma of matrix,
(melanonychia matrix extending
the from the
distalbands
white margin. Jegher, AZT, AIDS,
individuals, trauma normal
Longitudinal Proximal or Longitudinal pigmented bands melanonychia
striata) (melanonychia
Macronychia Nevus/melanoma of matrix, Laugier-
Lindays nails
distal
Nail
Nail plate
matrix bed
pigmented
proximal nailnail
Distal
extending foldis to
from normal,
the
Laugier-Hunziker,
variant inAZT,
dark
Neurofibromatosis
Chronic
Jegher, renal
AIDS,
Peutz-
skinned
failure
normal1,
melanonychia distal matrix extending from the proximal nail Hunziker, Peutz-Jegher, AZT, AIDS, normal
(half and half)
striata) the distal margin.
proximal
proximal nailnail whiteindividuals,
foldis to Tuberous
variant trauma
in dark sclerosis,
syndrometrauma1,
skinnedProteus
Macronychia Nail plate the distal margin. Neurofibromatosis
individuals,
(melanonychia fold to the distal margin. Mees lines
Macronychia variant in dark skinned individuals, trauma
Proximal
Nail plate Transverse white lines Arsenic
Tuberous poisoning,
sclerosis,
Neurofibromatosis 1, rheumatic
Proteus
matrix that affect all nails syndrome fever, congenital heart failure,
striata) Longitudinal Proximal or Longitudinal Tuberous sclerosis, Proteus
Nevus/melanoma
leprosy
syndrome
of matrix,
Mees linesmelanonychiaProximaldistal Transverse white bands
pigmented lines Arsenic poisoning, rheumatic
Laugier-Hunziker, Peutz-
Muehrckes
Mees lines Proximal
lines matrix Nail bed Transverse
Double white
white Nephritic syndrome, low
fromlines Arsenic poisoning, rheumatic
Macronychia Nail plate striata)
Neurofibromatosis 1, Tuberous sclerosis,
(melanonychia matrixthat affect
matrix
extending
that
all nails
transverse
affect all
proximal
lines
nails
nail
the fever,
from
fold to fever,
Jegher,
albumin,
AZT, AIDS,
congenital heart normal
liver disease,
congenital
variant in dark heart
skinned
failure,
failure,
abnormal vascular leprosy malnutrition
Muehrckes
Muehrckes
Proteus syndrome
lines lines
Nail bedNailNail Double
bedplate
the distal margin. Nephritic
white
bed.
Double Disappear
white
leprosy
individuals, traumalow
with Nephriticsyndrome,
syndrome, low
Macronychia Neurofibromatosis 1,
transverse lineslines
squeezing
transverse from
of thefromnail albumin,
albumin, liver disease,
liversclerosis,
disease, Proteus
Tuberous
Mees lines Proximal matrix Transverse white lines that Oil spots Arsenic poisoning, rheumatic fever,
Nail bedabnormal vascular
Brownish macules
abnormal vascular malnutrition
Psoriasis
malnutrition
syndrome
beneath
bed. bed.
Disappear the
with nail
withplate
affect all nails Mees lines congenital heart failure, leprosy
Proximal Disappear
Transverse white lines Arsenic poisoning, rheumatic
matrixsqueezing thatof
squeezing the nail
of the nail
Amy Reinstadler, Oil spotsOil spots Nail bedNail bed Brownish
Brownish
affect all nails
macules
macules
fever, congenital heart failure,
Psoriasis
Psoriasis
leprosy
Muehrckes lines Nail bed Double white transverse lines Nephritic syndrome, low albumin, beneath
the the nail plate
M.D., is a from abnormal vascular bed.
Muehrckes lines Nail bed
liver disease, malnutrition
beneath Double nail plate
white
transverse lines from
Nephritic syndrome, low
albumin, liver disease,
Onychogryphosis Nail plate Rams nail;vascular
long, Neglect, trauma
dermatology resident Disappear with squeezing of
abnormal
curving
bed. Disappear with
malnutrition

at the University of the nail Onychogryphosis

Oil spots NailNail
plate
squeezing of the nail
bed Rams nail; long,
Brownish macules Neglect, trauma
Psoriasis
California, Irvine. Oil spots Nail bed Brownish macules beneath the
Onychogryphosis Nail plate
Psoriasis
Rams nail;
curving
curving
long,the nail plate
beneath Neglect, trauma

nail plate
Onychogryphosis Nail plate Rams nail; long, Neglect, trauma
Onychogryphosis Nail plate Rams nail; long, curving Neglect, trauma
curving

DRirections
in
esidency p. 4 Winter 2010
 boards fodder
Boards Fodder: Nail Disease (continued)
Amy Reinstadler, MD and Nazanin Saedi, MD
Boards Fodder:
Boards Fodder:Nail
NailDisease
Disease
Disorder Location of Definition Associated Boards Fodder:
Conditions Nail Disease
Amy Reinstadler,
Amy MD
Boards
Boards
Reinstadler,
Boards
Amy MDand
andNazanin
Fodder:
Fodder:
Fodder:
Reinstadler,
Nail
Nail
Nail
MD
Saedi,
Disease
Nazanin
Disease
and MD Image
Saedi,MD
Disease
Defect Amy Reinstadler,
Amy MD
Amy Reinstadler, andNazanin
Reinstadler, MD NazaninSaedi,
MD and Saedi,MD
and Nazanin MD
Nazanin Saedi,
Saedi, MD
MD
Onycholysis
Onycholysis Nail Nail
bed bed Distal separation.
Distal separation. Psoriasis, trauma,
Psoriasis, trauma,drugs,
drugs,
Onycholysis Nail Nail
bed bed Distal
Appears separation.
white Psoriasis, trauma,
trauma,drugs,
Onycholysis Nail bed Distal separation. Appears Onycholysis Psoriasis,
Onycholysis
Onycholysis Nail bed trauma,
Nail bed
Distal
Appears
Distal
Appears drugs, contact
separation.
Distalwhite
separation.
Boards
whitewhite Fodder:
separation. contactdermatitis
Psoriasis,
contact
Psoriasis,
Nail
Psoriasis,
contact derma-
dermatitis
trauma, drugs,
trauma, drugs,
Disease
dermatitis drugs,
because of
because the
Appears
of
Appears the
white contact
contact dermatitis
dermatitis
white because of the presence titis Amy
Appears
becauseof of
because
presence
because
presence
because
white
the
Boards
Reinstadler,
of of
air inthe
of
air
of the
the Fodder:
in the
the
MD and
contact dermatitis
NailNazanin
DiseaseSaedi, MD
presence of air
presence in the
of air
air in MD
the and Nazanin Saedi, MD
of air in the subungual space Amy Reinstadler,
subungual
subungualspace
presence
presence
subungual
subungual
of
of air in
space
spacespace
in the
the
subungual
Onycholysis space
Nail bed subungual
Distal separation.
space Psoriasis, trauma, drugs,
Onychomadesis
OnychomadesisProximal
Onycholysis NailDetachment
Proximal bedDetachmentofseparation.
Appears
Distal the
of white
the PCN, TEN,
PCN, TEN,SJS,
contact SJS,
Psoriasis, syphilis,
syphilis,
dermatitis
trauma, drugs,
Onychomadesis
Onychomadesis
Onychomadesis ProximalProximal
Proximal Detachment
Detachment
Detachment of the
of the
of the PCN,
PCN, TEN,
TEN,
PCN, SJS,syphilis,
SJS,
TEN, syphilis,
SJS,
Onychomadesis Proximal and Detachment of the nail
nailplate Onychomadesis
shedding
nail shedding PCN,
and distal
and TEN,
Proximal
distal SJS,
nailnail
plate syphilis,
because
Detachment
from
plate from
Appears the of
ofthe
the
white pemphigus,
the pemphigus,
PCN,
pemphigus,TEN,
contact SJS, syphilis,
syphilis,
radiation
radiation
dermatitis
nail shedding
nail shedding
nail and distal
and distal nail nail plate
plate from fromof the
the pemphigus,
pemphigus, radiation
radiation
nail shedding
shedding and
and distal
matrix
matrix
nail
distal proximal
nail plate
plate
nail from
presence
from
fold the
the pemphigus,
air in Medications:
theMedications:
pemphigus, radiation
radiation
carbamazepine,
matrix proximal nail fold
because of the carbamazepine,
nail shedding distal matrix from the proximal nail fold radiation
matrix
matrix
matrix
proximal
proximal nail
proximal nail
fold
nail
subungual
proximal
presencenail
fold
fold
space
of fold
air in the
Medications:
Medications:
Medications:
Medications:
lithium,
lithium,
carbamazepine,
carbamazepine,
carbamazepine,
carbamazepine,
doxycycline
doxycycline
lithium, doxycycline (photo-
(photo-
(photo-
lithium,
lithium,
lithium,doxycycline
doxycycline(photo-
doxycycline (photo-
(photo-
Medications:
Onychomadesis Proximal carbamazepine,
subungual space onychomedesis)
Detachment of the onychomedesis) lithium,
onychomedesis)
onychomedesis)
PCN, TEN, SJS, syphilis,
onychomedesis)
onychomedesis)
Onychorrhexis
nail
Onychorrhexis
doxycycline
shedding
Onychomadesis
Onychorrhexis
Onychorrhexis Proximal
and
Proximal
ProximalProximal
matrix
(photo-onychomedesis)
distal nail
ProximalLongitudinal plate
Detachment
Longitudinal
Longitudinal ridging
proximal
Longitudinal
from
ridging
ridging
nail
the
of the Lichen
fold Lichen
ridging
pemphigus,
PCN,planus,
Lichen
Lichen planus,
planus,
radiation
TEN, SJS,impaired
syphilis,
impaired
impaired
Medications:
planus, carbamazepine,
impaired
Onychorrhexis
Onychorrhexis Proximal
nail shedding Proximal Longitudinal
and distal Longitudinalridging
nail plate from the Lichen
ridging planus,
pemphigus,
Lichen impaired
radiation
planus, impaired
matrix
matrix matrix
matrix andand fissuring
and
fissuring
and of the
fissuring
of the
fissuring offold
of the vascular
the vascular
vascular supply,
lithium,
vascular trauma
supply, trauma
doxycycline
supply, trauma
supply, (photo-
trauma
matrix
matrix andandfissuring
matrix of the
fissuring vascular
proximal
of the nail
vascular supply,
supply,trauma
Medications:
trauma carbamazepine,
Onychorrhexis Proximal matrix Longitudinal ridging and fissur- Lichen planus,
nailnail
nail
plate
nail
nail
plate
plate
nail
impaired
plate
plate
plate
vascular supply,
onychomedesis)
lithium, doxycycline (photo-
ing of the nail plate trauma Proximal Longitudinal ridging onychomedesis)
Onychorrhexis Lichen planus, impaired
Onychorrhexis matrix
Proximal and fissuring
Longitudinal of the
ridging vascular
Lichen supply,
planus, trauma
impaired
matrix and nail plate
fissuring of the Dehydration
vascular supply, trauma
Onychoschizia
Onychoschizia Nail Nail
plateplate Brittle
plate Brittle nails,
nails, fragility
fragility Dehydration ofof the nail plate
Onychoschizia
Onychoschizia
Onychoschizia
Onychoschizia Nail Nail
Nail
plateNail
plateplate
Brittle
Brittle
Brittle
Brittle
nails,
nails,
nails,
nails,
nail
fragility
fragility
fragility
plate
Dehydration
fragility Dehydration
Dehydration
Dehydration ofthe
of
ofthe
ofof
the
the
the
nail
nail
nail
nail
nail
plate
plate
plate
plate
plate
as
as as aaa result
result
a result of of environmental
as result ofenvironmental
environmental
environmental
Onychoschizia Nail plate Brittle nails, fragility Dehydration of the nail plate as aas
as factorsresult
a result
factors
factors
factors
a
of
suchresult
of environmental
environmental
such
such
such
as
asas
as
frequent
frequent
frequent
frequent
factors
factors suchasasfrequent
handwashing
such frequent
of environmental
Onychoschizia Nail plate factors
Brittle such
nails, fragility as frequent
handwashing
handwashing
Dehydration
handwashing
handwashing
handwashing
of the nail plate
as a result of
ofenvironmental
handwashing
Onychoschizia Nail plate Brittle nails, fragility Dehydration
asfactors
a resultsuch
the nail plate
as frequent
of environmental
Pachyonychia Pachyonychia Nail bed Thickened nails with handwashingcongenital
Pachyonychia
Pachyonychia Nail Nail
Pachyonychia bed bed
Nail Thickened
bed Thickened
Thickened nails
nails with
nails with Pachyonychia
with Pachyonychia
Pachyonychia ascongenital
factors such congenital
frequent
congenital
an increased
increased
Pachyonychia Nail bed an Pachyonychia Nail
Thickened nails with Pachyonychia Nail bed
Pachyonychia
bed
Thickened
Thickened
nails with
an congenital
an nails with
increased
an increased
transverse
an increased
transverse curvature
curvature
Pachyonychia
handwashing
Pachyonychia
congenital
congenital
an transverse
increased
transverse curvature
curvature
increased transverse curvaturePachyonychia due Thickened
transverse
Nail bed due
due
to severe
to
to
severe
severe
duehyperkeratosis
transverseto severe
curvature
nail bed
curvature
nails
nail
nailnail
bed
with
bedbed
Pachyonychia congenital
an increased
duehyperkeratosis
toThickened
severe nail bed
due to severe nail bed hyper- Pachyonychia
Pitting
Pitting
Nail bedhyperkeratosis
Proximal
Proximal to hyperkeratosis
duehyperkeratosis
severe
Punctate
Punctate
an
nail
nails
bed
with
depressions
transverse
Pachyonychia congenital
Psoriasis, alopecia
curvature Psoriasis,
depressions
increased alopecia areata,
areata,
PittingPitting Proximal Punctate
Proximal Punctate depressions
depressions Psoriasis,
Psoriasis, alopeciaareata,
alopecia areata,
keratosis Pitting nail
nail
Proximal hyperkeratosis
matrix
nail matrix
matrixof
nail matrix
of
of due
the
the to severe
nail
nail
of transverse
Punctate
the the
nail
plate
nail plate
nail bed
curvature
depressions
plate
eczema,
eczema,
Psoriasis,
eczema,
paronychia
paronychia
alopecia
paronychiaareata,
Pitting Proximal
nail matrix Punctate
of the due
surface
nail
surface toplate
hyperkeratosis
surface
depressions
severe nail bed
plate
eczema,
Psoriasis,
eczema,
paronychia
alopecia
paronychia areata,
Pitting Proximal
surface Punctate depressions Psoriasis, alopecia areata,
Pitting Proximal nail Punctate depressions of the nail nail matrix
Psoriasis,
Pitting
of the nail plate areata,
alopecia
surface
nail matrix
hyperkeratosis
of the nail plate
Proximal
eczema,
eczema,paronychia paro-
eczema, paronychia
surface Punctate depressions Psoriasis, alopecia areata,
matrix plate surface nychianail matrix ofsurface
the nail plate eczema, paronychia
Pincer nails
nails Nail plate
plate surface excessive
Transverse Hereditary, trauma
trauma from
Pincer
Pincer nails Nail
Nail plate Transverse
Transverse excessive
excessive Hereditary,
Hereditary, trauma from
from
Pincer nails Nail plate curvature
Transverse
curvature from
excessive
from shoes, osteoarthritis,
Hereditary,
shoes, trauma from psoriasis
Pincer nails Nail plate curvature
Transverse from
excessive shoes, osteoarthritis,
osteoarthritis,
Hereditary, trauma from
psoriasis
psoriasis
widened
curvature
widened base of
from
base of shoes, osteoarthritis, psoriasis
Pincer nails Nail plate widened base of
Transverse excessive Hereditary, trauma from
Pincer nails Nail plate Transverse excessive curvature Hereditary, trauma from shoes, osteoarthri-
Pincer nails Nail plate curvature
Transverse from
excessive
terminal
widened base
terminal
terminal
phalanx
of from
phalanx
curvature
phalanx
shoes, osteoarthritis,
Hereditary, trauma frompsoriasis
shoes, osteoarthritis, psoriasis
Pincer nails
curvature from widened
Nail plate base
Transverse ofexcessive Hereditary,
shoes, osteoarthritis, psoriasis trauma from
from widened base of terminal
Dorsal
tis, psoriasis
Dorsal pterygium
pterygium Proximal
terminal phalanx
widened
curvature
Scarring
terminal
widened base
base of
from
of the
the
phalanx
of shoes, planus,
Lichen osteoarthritis, psoriasis
acrosclerosis,
Dorsal pterygium Proximal
Proximal Scarring
Scarring of
of base
terminalthe
phalanx Lichen
Lichen planus,
planus, acrosclerosis,
acrosclerosis,
phalanx nail
nail
Dorsal pterygium Proximal
Dorsal pterygium Proximal
fold
terminal
nail fold
fold
widened
proximal
phalanx
proximal
Scarring
nail
nail
of the
proximal
terminalnail
Scarring of the
of
fold
fold
fold
phalanx
Lesch-Nyhan
Lesch-Nyhan
Lichen
Lichen
syndrome,
syndrome,
planus, acrosclerosis,
Lesch-Nyhan
planus,
chronic GVHD,
syndrome,
acrosclerosis,
SJS/TEN,
Dorsal pterygium
nail fold Proximal Scarring
proximal of the
nail fold LichenGVHD,
chronic
Lesch-Nyhan
chronic planus,
GVHD, acrosclerosis,
SJS/TEN,
syndrome,
SJS/TEN,
nail fold nail fold
proximal
the of nail proximal nail fold cicatrical pemphigoid
Lesch-Nyhan syndrome,
Dorsal pterygium Proximal nail Scarring of the proximal
Dorsalnail
pterygium LichenProximal
Dorsal Proximal
pterygium planus,
Scarring of
Scarring the fold Lichen
acrosclerosis, Lesch-Nyhan
Lesch-Nyhan
cicatrical
planus,
cicatrical
chronic
LichenGVHD, syndrome,
pemphigoid
acrosclerosis,
pemphigoid
planus,SJS/TEN,
acrosclerosis,
nail fold nailproximal
fold chronic
nail foldnail fold Lesch-Nyhan
proximal GVHD,
chronic
Lesch-Nyhan SJS/TEN,
GVHD, SJS/TEN,
syndrome,
syndrome,
cicatrical pemphigoid
fold fold syndrome, chronic GVHD, BoardschronicSJS/TEN,
Fodder: cicatrical
cicatricalNail
chronic
GVHD, cicat-
pemphigoid
pemphigoid
Disease
GVHD, SJS/TEN,
SJS/TEN,
cicatrical pemphigoid
rical pemphigoid Amy Reinstadler, MD
cicatricaland Nazanin
pemphigoid Saedi, MD
Boards Fodder: Nail Disease
Ventral pterygium Distal nail plate Adherence of the ventral sur- Systemic
Ventral
pterygium
sclerosis,
Distal nail
Amy congenital
Adherence of the
plate Reinstadler, MD
ventral surface
Systemic sclerosis, congenital
and Nazanin Saedi, MD
of the
face of the distal nail plate to distal nail plate to the
Boards Fodder:
hypochium Nail Disease
the hypochium Ventral Distal nail Amy Adherence of the MD and
Reinstadler, Systemic
Nazaninsclerosis,
Saedi,congenital
MD
BoardsofFodder:
pterygiumRed lunula plate Distal ventral surface the Nail Disease
Alopecia areata, psoriasis,

Red lunula Distal matrix Ventral Amy Reinstadler,

Alopecia areata, psoriasis, carbon monox-
matrix distal
Distal nail
nail plate to
Adherence of the MD
the and Nazanin
carbon Saedi,
monoxide MD
poisoning,
Systemic sclerosis, congenital
cardiac failure, SLE,
pterygium plate hypochiumventral surface of the
ide
Ventralpoisoning, cardiac
Distal nail distal nailfailure,
Adherence of theto the SLE,
plate rheu-
rheumatoid arthritis, COPD,
Systemic
cirrhosis;sclerosis, congenital
hypochium
matoid
pterygium
Red lunula arthritis,
Red spottedDistal plate
Distal COPD,
ventral
cirrhosis;Alopeciaareata,
surface of the Alopecia
distal nail plate to the
areata, psoriasis,
psoriasis,
lunula matrix matrix carbon
lichen monoxide poisoning,
planus, rheumatoid
Red lunula Distal hypochium Alopecia
arthritis, areata,
SLE SLE,psoriasis,
cardiac failure,
Red spotted Distal matrix Alopecia
Splinter areata,
Nail bed psoriasis,
matrix Dark red thin lichen planus,
carbon monoxide
Endocarditis,
rheumatoid
poisoning,
vasculitis,
arthritis, COPD,
Red lunula
hemorrhage Distal longitudinal lines cardiac
trauma,failure,
Alopecia areata,SLE,
psoriasis,
psoriasis, trichinosis
lunula rheumatoid
Terrys nails arthritis,
matrix
Nail bed SLE
Nails
cirrhosis;
rheumatoid
are evenly white, carbon arthritis,
monoxide
Cirrhosis, COPD,
poisoning,
congenital heart
Red spotted Distal except for the distal
Alopecia areata,
cirrhosis;
cardiac
failure,failure,
diabetes
psoriasis,
SLE,
Splinter hemor- Nail bed Dark red thin longitudinal lineslunula Endocarditis,
Red spottedmatrix Distal
lunula matrix vasculitis,
2mm
trauma, lichen planus,
Alopecia
psoriasis,
rheumatoid
arthritis,
lichen
rheumatoid
areata, psoriasis,
arthritis,
SLE rheumatoid
planus,
cirrhosis;
COPD,

rhage Splinter trichinosis

Red spotted Nail bed
Trachyonychia
Splinter
lunula
ProximalDark red
Distal
Nail bed
matrix
Excessive
Dark red thin
arthritis,
thin longitudinal Endocarditis,
Alopecia SLE vasculitis,
Alopeciaareata,
areata,
Endocarditis,
lichen
psoriasis,
lichen
planus, vasculitis,
rheumatoid
(20 nail
hemorrhage matrix longitudinal
ridging producing
lines nail trauma,
planus,psoriasis,
psoriasis trichinosis
hemorrhage
dystrophy, longitudinal
roughness lines trauma, psoriasis,
arthritis, SLE trichinosis
Terrys nails Nail bed Nails are evenly white, except Terrys nails
Cirrhosis,
Terrys
Splinter nails
sandpaper
Nail bedNail bed Nails Nails
congenital
Nail bed
are evenly
heart
arethin
Dark red
except for the
white, Cirrhosis,
failure,
evenly white,
distal
Cirrhosis,
congenital
diabetes
congenital
Endocarditis,
heart
heart
vasculitis,
hemorrhage
nails) except for the
longitudinal distal failure,
lines failure,diabetes
trauma, diabetes
psoriasis, trichinosis
for the distal 2mm Terrys nails Nail bed 2mmNails
2mmare evenly white, Cirrhosis, congenital heart
except for the distal failure, diabetes
Triangular Proximal
Trachyonychia
Trachyonychia Distal Excessive
Proximal Excessive
2mm longitudinal Nail-patella
longitudinal Alopecia
Alopecia syndrome
areata,
areata, lichen
lichen
Trachyonychia Proximal matrix Excessive longitudinal ridging (20 nail Alopecia
lunulae
(20 nail
Yellow nail
dystrophy,
Trachyonychia
areata,
matrix lichen
matrix ridging
matrix ridging
planus,
producing
producing
Slow growth,
roughness
Proximal roughness
Excessive absent
longitudinal
psoriasis
nailnail planus,
planus,psoriasis
Alopecia
psoriasis
Pulmonary disorders;
areata, lichen
dystrophy,
(20 nail dystrophy, producing nail roughness sandpaper
syndrome
sandpaper
(20 nail
nails)
matrix cuticle/lunulae,
ridging producing nail
transverse ridging
Medications:
planus, D-penicillamine,
psoriasis
bucillamine
dystrophy, roughness
sandpaper nails) nails) sandpaper
nails)
Triangular Distal Nail-patella syndrome

Triangular lunulae Distal matrix Triangularlunulae

References:
Yellow
Distal matrix
Nail-patella syndrome
nail matrix Distal
lunulae Triangular Slow growth, absent
Nail-patella syndrome
Pulmonary disorders;
Nail-patella syndrome
nd
Bolognia
syndrome
lunulae J, Jorizzo j, Rapini R. Dermatology,
cuticle/lunulae,
matrix Slow growth, absent 2 Edition. Mosby Publishing,
Medications: 2007.
D-penicillamine,
Yellow nail Pulmonary disorders;
Yellow nail syn- Slow growth, absent cuticle/ Pulmonary disorders;
syndromeYellow nail
syndrome
transverse
Slow growth,
cuticle/lunulae,
ridging
cuticle/lunulae,
absent bucillaminedisorders;
Pulmonary
Medications: D-penicillamine,
Medications: D-penicillamine,
transverse ridging bucillamine
drome lunulae, transverse ridging Medications: D-penicillamine, bucillamine
PHOTO CREDITS: transverse ridging bucillamine
Nazanin Saedi, M.D., is the chief resident in dermatology at the University of California, Irvine.
Amy Reinstadler, M.D., is a dermatology resident at the University of California, Irvine.
References:
Bolognia J, Jorizzo j, Rapini R. Dermatology, 2nd Edition. Mosby Publishing, 2007.
References: In a box:
References:
References:
J, Jorizzo j, Rapini R. Dermatology,nd2nd Edition. Mosby Publishing, 2007.
1. Bolognia J, Jorizzo j, Rapini R. Dermatology, 2nd Edition. Mosby Publishing, 2007. BologniaBolognia
J, Jorizzo j, Rapini R. Dermatology, 2 Edition. Mosby Publishing, 2007.
PHOTO CREDITS:
The American
Nazanin Board
Saedi, M.D., of chief
is the Dermatology
resident in (ABD) has at
dermatology produced a content
the University outline Irvine.
of California, to
Nail images reproduced from Dermatology, 2nd Edition. Mosby Publishing, 2007,
PHOTO
Amy Bolognia
helpReinstadler,
dermatology
CREDITS:
PHOTO CREDITS:
J, etunderstand
M.D.,residents al. resident
is a dermatology Usedatthethe
by permission
scope of California,of
of information
University Elsevier.
covered
Irvine. in the
Nazanin Saedi, M.D., is the chief resident in dermatology at the University of California, Irvine.
NazaninAmy
InSaedi, M.D., M.D.,
Reinstadler,
a box: is theischief residentresident
a dermatology in dermatology at the
at the University University
of California, of California, Irvine.
Irvine.
Amy Reinstadler, M.D., is a dermatology resident at the University of California, Irvine.
In a box:
In a box: The American Board of Dermatology (ABD) has produced a content outline to
help dermatology residents understand the scope of information covered in the
The American Board of Dermatology (ABD) has produced a content outline to
help dermatology residents understand the scope of information covered in the
The American Board of Dermatology (ABD) has produced a content outline to
help dermatology residents understand the scope of information covered in the

Winter 2010 p. 5 DRirections

in
esidency