Nail diseases (overview) L60.8

Change of the nail plate(s) in the context of integumentary or general (systemic) diseases occurring or as an independent entity limited to the nail organ. See also the respective clinical picture. S.a. Nail care.

Onychodystrophies (changes in the nail plate)

• Longitudinal grooves (special form: dystrophia mediana canaliformis); frequent age-related growth disorder of the nails. Can lead to triangular tears and splitting at the free edge of the nail.
• Transverse grooves(Beau-Rilsche transverse grooves of the nails)
• Onychauxis (nail thickening with preserved transparency)
• Leukonychia punctata
• Leukonychia linearis
• Stippled nails
• Lacunar pitting
• Lunulae triangulares (triangular lunulae, e.g. in nail-patella syndrome)
• Onychoschisis (lamellar splitting of the nail in longitudinal and transverse direction, see below) Onychorrhexis)
• Onycholysis (detachment of the nail plate - for causes see there)
• Atrophy of the nail plate up to anonychia (often with pterygium formation)
• Soft, brittle nails(iron deficiency anemia, vitamin A overdose)
• Onychorrhexis (hard, thickened and splintering nails)
• Pachyonychia congenita
• Tubular nail (unguius in turricolo)
• Watch glass nails(see also macroonychia)

• Washboard nails (recurrent traumatic nail root damage; tics)

Nail signs due to diseases of the nail bed

• Onycholysis (psoriasis, diabetes, circulatory disorders, Lyell syndrome, phototoxic effects of NSA and tetracyclines)
• Psoriatic oil spot
• Pterygium inversum unguis
• Subungual hematoma (mostly traumatic)
• Splinter hemorrhages (mostly traumatic; liver cirrhosis; PSS)
• Janeway's spots (ecchymoses and petechiae on the fingertips and under the nails as a result of small emboli in endocarditis lenta)
• Watch glass nails (pachydermoperiostosis; chronic obstructive pulmonary disease)
• Drumstick fingers (chronic pulmonary diseases; cyanotic heart diseases)
• Glomus tumor (circumscribed "nail pain")

Diseases of the peri-paro- and epinychium

• Bulla repens
• Fibrokeratoma digital acquired
• Paronychia in dyskeratosis congenita (rare)
• Paronychia, bacterial
• Paronychia candidamycetica
• Paronychia, syphilitic (vesicular or pustular skin changes with infestation of the paronychium and nail detachment in syphilis connata)
• Hyperkeratotic nail fold (in dermatomyositis and progressive systemic scleroderma)
• Megacapillaries in dermatomyositis and progressive systemic scleroderma

Nail discoloration see below Chromonychia

Congenital and hereditary nail diseases (see also under"Genetic non-syndromic nail anomalies")

• Twenty-nail dystrophy
• Acropachyderma with pachydermoperiostosis
• Dysplasia, chondroectodermal
• Dyskeratosis congenita
• Large toe nail dystrophy of childhood (OBF S689)
• Leukonychia totalis (autosomal dominant)
• Nail-patella syndrome
• Pachyonychia congenita
• "Pincer" nail (see pincer nail syndrome below)
• Unguis duplex
• Watch glass nails (e.g. in keratosis palmoplantaris with watch glass nails and bone hypertrophy)

Nail dystrophies in dermatological diseases

• Acrodermatitis continua suppurativa (severe pustular onychodystrophy up to anonychia)
• Atrichia congenita diffusa
• Dyskeratosis follicularis (Darier's disease)
• Epidermolysis bullosa hereditaria
• Dermatomyositis (hyperkeratotic nail fold)
• Ectodermal dysplasia
• Onycholysis (see there)
• Lichen nitidus (thickening of the nail plate, onychorrhexis; longitudinal stripes)
• Onychodystrophy in Reiter's disease
• Onychodystrophy in lichen planus
• Onychodystrophy in psoriasis (see psoriasis of the nails below)
• Shiny nail in atopic eczema
• Onychogrypose in chronic eczema of the hands, also known as "senile nail"
• Systemic scleroderma

Nails in internal diseases

• Acromegaly (macroonychia)
• Chronic obstructive pulmonary diseases(watch glass nails)
• "Glossy skin and fingers" in paralysis of the extremities
• Hypalbuminemia (white nails/leukonychia)
• Hypoparathyroidism (brittle nails)
• Hyperthyroidism (brown discoloration, brittle nails (see thyroid skin changes below)
• Iron deficiency (thin, brittle nails)
• Icterus (yellow nails)
• Liver cirrhosis (diffuse leukonychia)
• Laxatives (containing phenolphthalein) (purple nails)
• M. Wilson (bluish nails)
• Peutz-Jeghers synd rome (brown discoloration)
• Yellow nail syndrome (yellow nails)
• Zinc deficiency(Beau-Reil's transverse furrows)
• Vit. B 12 deficiency (brown discoloration)
• Cytostatic drugs (thin, brittle nails)
• Cytostatic drugs(onycholysis)

The painful nail (Definition: Frequent and non-specific symptom of many changes in the nail apparatus. Pressure pain of the nail or the nail wall are symptoms of various diseases).

• Unguis incarnatus
• Acute (and chronic) paronychia
• Acrodermatitis continua suppurativa
• Subungual foreign bodies
• Tuberculosis cutis verrucosa
• Osteitis terminalis
• Acral herpes simplex
• Cryosurgery (can lead to very long-lasting bone pain)
• Pterygium inversum unguis
• Dorsolateral fissures
• Tubular nail, especially severe forms that encircle the bone
• Sarcoid dactylitis

Tumors of the soft tissue and bone:

• Subungual glomus tumor
• Granuloma pyogenicum
• Subungualwart (verrucae perionychiales)
• Subungual clavus
• Subungual papilloma with incontinentia pigmenti
• Subungual exostosis
• Enchondroma(Maffucci syndrome)
• Aneurysmal bone cyst
• Mucoid dorsal cyst

Vascular causes:

• Systemic scleroderma
• Peripheral arterial occlusive disease (PAVK)
• Raynaud's syndrome

Traumatic nail changes

• Polishing or shiny nail (caused by constant rubbing of the nails, e.g. scratching in atopic eczema)
• Traumatic onycholysis
• Onychodystrophia mediana canaliformis
• Onychogrypose (big toe or 2nd toe in soccer players)
• Subungual hematomas
• Unguis incarnatus
• Retronychia
• Splinters and other foreign bodies
• Chronic injuries to the nail matrix caused by sports shoes (due to frequent bumping of the toes)
• Traumatic nail bruising due to dorsal or frontal pressure.
• Nail obliquity in childhood
• Washboard nail (habit-tic deformity)

Nail tumors (periungual or subungual)

• Granuloma pyogenicum
• Periungual or subcutaneous warts
• Fibromas, periungual (traumatic)
• Juvenile fibromas
• Koenen's tumor in Pringle's disease
• Subungualexostoses
• Subungual osteochondroma
• Glomus tumor
• Melanocytic nevus (clinically melanonychia)
• Bowen's disease
• Verrucous carcinoma
• Acrolentiginous melanoma

1. Altmeyer P (2012) Dermatological differential diagnosis. Springer, Heidelberg, New York
2. Daniel CR et al (1985) Nails in systemic disease. Dermatol Clin 3: 465-483
3. Effendy I (2003) Nail changes during childhood. dermatologist 54: 41-44
4. Helfand AE (2003) Assessing onychial disorders in the older patient. Clin Podiatry Med Surgery 20: 431-442
5. Langnickel R (2002) The yellow-nail syndrome. Laryngorhinootology 81: 56-59