Boards Fodder: Disease Amy Reinstadler, MD and Nazanin Saedi, MD boards’ fodder

Nail Disease Boards Fodder: Location Amy Reinstadler, MD and Nazanin Saedi, MD Amy Reinstadler, MD and Nazanin Saedi, MD. (UpdatedDisorder July 2015*) Definition Associated Conditions Image of Defect Beau’s lines Proximal Transverse indented BoardsMechanical Fodder: trauma, Nail Disease Location of matrix furrow from growthAmy Reinstadler,dermatologic MD and disease Nazanin of Saedi, MD Location Disorderarrest of nail matrix Definitionproximal nail Associated fold, systemic Conditions Image Disorder Defect Definition ofAssociated Defect Conditions Image disease/stressful event Beau’s lines Proximal Transverse indentedBoards Fodder:Mechanical Nail trauma,Disease matrix Locationfurrow from growth dermatologic disease of Beau’s lines Proximal matrix Transverse indented furrow Disorder MechanicalBoards trauma,Definition Fodder: dermatologic Nail DiseaseAssociated disease Conditions Image of Defectarrest Amy of nail Reinstadler, matrix MDproximal and Nazaninnail fold, systemic Saedi, MD from growth arrest of nail matrix of proximalAmy Reinstadler, nailBoards fold, MD Fodder: systemic and Nazanin Nail Diseasedisease/ Saedi, MD Blue lunula Distal Beau’s lines Proximal TransverseArgyria,Boards indented Fodder: antimalarials, disease/stressfulMechanical Nail Disease trauma,AZT, event stressfulAmy eventReinstadler, MD and Nazanin Saedi, MD matrix matrix Amyfurrow Reinstadler,Boardsbusulfan, from growth Fodder: MD Wilson’s, and dermatologicNail Nazanin Disease disease Saedi, of MD Amy arrestReinstadler, of nail matrix MD andproximal Nazanin nail fold, Saedi, systemic MD Blue lunula Distal Location Argyria, antimalarials, AZT, Disorder hemochromatosisDefinition disease/stressfulAssociated event Conditions Image matrixLocation of Defect busulfan, Wilson’s, Blue lunula Distal matrix Brachyonchia Nail plateDisorder Short nailsArgyria, antimalarials,DefinitionCongenital: AZT,Associated Rubenste busulfan, Conditionsin-Taybi, Image Beau’sof l inesDefect Proximal Transverse indentedhemochromatosis Mechanical trauma, Blue lunula Wilson’s,LocationDistalLocation matrix hemochromatosis furrow from growth Argyria,dermatologic antimalarials, disease AZT, of BrachyonchiaBeau’s Disorderlines(width>length) Disorder NailProximal plate TransverseShort nailsDefinition indented trisomyDefinition 21Mechanical Congenital:AssociatedAssociated trauma, Rubenste Conditions Conditionsin-Taybi, ImageImage of matrixDefectLocationof Defect arrest of nail matrix busulfan,proximal Wilson’s, nail fold, systemic RacquetDisordermatrix thumbs furrow(width>length) from DefinitionAcquired:growth dermatologic nailingtrisomyAssociated 21 biting, disease Conditions of Image Beau’s linesBeau’s lines ProximalofProximal Defect Transverse Transverse indented indented MechanicalhemochromatosisMechanicaldisease/stressful trauma, trauma, event arrestRacquet of nail thumbs matrix proximalAcquired: nail fold,nailing systemic biting, BrachyonchiaBeau’s lines matrixNailProximal platematrix furrowShortTransversefurrow from nailshyperparathyroidism, growth from indented growth dermatologicCongenital:Mechanicaldermatologic diseaseRubenstetrauma, disease ofin of-Taybi, Brachyonchia Nail plate Short nails (width>length) Congenital: Rubenstein-Taybi,arrest of nail matrixdisease/stressful hyperparathyroidism,proximal trisomy nail event fold, 21 systemic Blue lunula matrixDistal arrest (width>length)furrow of nail from matrix growth proximaltrisomydermatologicArgyria, nail 21 fold, antimalarials, disease systemic of AZT, psoriasis psoriasisdisease/stressful event Racquet thumbs Acquired:matrix nailing Racquet arrest of thumbsbiting, nail matrix disease/stressfulAcquired:proximalbusulfan, nail nailing fold,Wilson’s, event biting,systemic Clubbing Proximal Greater than 180- Hypertrophihyperparathyroidism,c pulmonary Clubbing ProximalBlue lunula GreaterDistalhyperparathyroidism, than 180 - Hypertrophi psoriasisArgyria,c disease/stressfulpulmonary antimalarials,hemochromatosis eventAZT, and distal degreeBlueBrachyonchia lunulaandmatrix angle distal between DistalNaildegree plate angle osteoarthropathy,Short between nails busulfan,osteoarthropathy,psoriasisArgyria, Wilson’s,Congenital: th antimalarials,yr oid Rubenste th yroid AZT,in -Taybi, BlueClubbing lunula matrixDistalProximal matrix proximal Greater nail(width>length) than fold 180 and- diseaseArgyria,Hypertrophibusulfan,trisomy (acropachy) antimalarials, Wilson’s,21c pulmonary AZT, Blue lunula Distal hemochromatosisArgyria, antimalarials, AZT, matrix proximalmatrix nailand fold distal anddegree diseaseRacquet angle between thumbs (acropachy) busulfan,osteoarthropathy,hemochromatosisAcquired: Wilson’s, nailing th biting,yroid Brachyonchia Nail platematrix Short nail plate nails Congenital:busulfan, Rubenste Wilson’s,in- Taybi, Clubbing Proximal and Greater than 180-degree angleBrachyonchia Bilateral: Nail platePulmonary Short nails or CV hemochromatosis(bronchiectasis,Congenital:hyperparathyroidism, Rubenste in- Taybi, nail plate matrix (width>length)proximal nail fold andtrisomy diseasehemochromatosis 21 (acropachy) Brachyonchia Nail plate Shortnail nails (width>length)plate Congenital:trisomypsoriasis Rubenste21 in-Taybi, distal matrix between proximal nail fold andBrachyonchia emphysema, Nail plateRacquet Short pneumonia,thumbs nails Acquired: pulmonaryCongenital: nailing Rubenste biting, lym in--Taybi, Clubbing Proximal(width>length) RacquetGreater thumbs than 180 -trisomyAcquired:Hypertrophi 21 nailingc pulmonary biting, Distal notching Nail bed (width>length) hyperparathyroidism,Darier,trisomy lichen 21 planus nail plate phoma, andCHF), Racquetdistal IBD, thumbsdegree liver angle betweencirrhosis.Acquired: hyperparathyroidism,osteoarthropathy, nailing biting, th yroid Racquet thumbs psoriasisAcquired: nailing biting, Distal notching Nail bedmatrix proximal nail fold andhyperparathyroidism,Darier, psoriasisdisease lichen (acropachy) planus Distal notching Nail bed Unilateral: vascularDarier,nail plate abnormality lichen hyperparathyroidism,planus (fistula, 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Syndrome, Distal notchingDistal notchingNail bed Nail bed Darier, lichenDarier, planus Distal notching Nail bed Darier, lichen(Length/width planus >1) Marfans, hypopituitary Distal Distalnotching notching Nail bedNail bed Darier,Darier, lichen lichen planus planus Dolichonychia Nail plate LongDolichonychia nails Nail plate EhlLonger’s nails Danlos Syndrome,Ehler’s Danlos Syndrome, (Length/width >1) Marfans, hypopituitary Habit tic Cuticle and Horizontal parallel Trauma to the cuticle Habit(Length/width tic Cuticle >1) and HorizontalMarfans, parallel hypopituitaryTrauma to the cuticle nail plate ridges; absent cuticle nail plate ridges; absent cuticle Dolichonychia Nail plate Long nails Ehler’s Danlos Syndrome, Dolichonychia Nail plate Long nails Ehler’s Danlos Syndrome, Habit tic Cuticle and(Length/width Horizontal parallel >1) Marfans,Trauma h toypopituitary the cuticle Dolichonychia Nail plate Long nails (Length/width >1)DolichonychiaEhler’s Nail plateDanlosnail(Length/width plateLong syndrome, nailsridges; >1) absent Marfans,cuticle Marfans,Ehl er’s hypopituitary Danlos Syndrome, HellerDolichonychia median NailNail plate plate LongitudinalLong nails fissures IdiopathicEhler’s Danlos Syndrome, Heller median Nail plate Longitudinal(Length/width fissures >1) IdiopathicMarfans, h ypopituitary canaliform hypopituitarywith(Length/width oblique lines, >1) Marfans, hypopituitary Habit tic Cuticle andcanaliform Horizontal parallel with obliqueTrauma lines, to the cuticle dystrophydystrophy HabitHeller tic median CuticleNail“Christmas and plate“Christmas Horizontal Longitudinaltree tree parallel fissures TraumaIdiopathic to the cuticle nail plateHabit tic ridges;canaliformCuticle absent andnail cuticle Horizontalplate ridges; parallelwith absent oblique cuticle lines,Trauma to the cuticle pattern”pattern” Habit ticdystrophy nail plate Cuticle ridges; and absentHorizontal“Christmas cuticle parallel tree Trauma to the cuticle Habit tic deformity Cuticle and nail Horizontal parallel ridges;KoilonychiaHabit tic ProximalTraumaCuticleProximal and to Thinned HorizontaltheThinned concavecuticle parallelconcave nails nails LEOPARD,TraumaLEOPARD, to ectodermal the ectodermal cuticle nail plate ridges;pattern” absent cuticle “spoon “spoonnails” nails” andnail distaland plate distal ridges; absent cuticle dysplasia,dysplasia, nail nail-patella-patella, , plate absent cuticle HellerKoilonychia median NailProximal plate LongitudinalThinned concave fissures nails IdiopathicLEOPARD, ectodermal matrixmatrix trichothiodystrotrichothiodystrophy,phy, Heller median Nail plateHeller medianLongitudinalcanaliform “spoonNail nails” plate fissures andLongitudinal distal with Idiopathicfissures oblique lines,Idiopathic dysplasia, nail-patella, PlummerPlummer-Vinson,-Vinson, Iron Iron canaliformHeller dystrophy median Nail platematrixwith oblique Longitudinal“Christmas lines, fissures tree Idiopathictrichothiodystro phy, canaliform Heller medianwith obliqueNail plate lines, Longitudinalpattern” fissures deficiency,Idiopathicdeficiency,Plummer hemochromatosis, hemochromatosis,-Vinson, Iron Heller median Nail plate Longitudinal fissures withdystrophy canaliform Idiopathic“Christmaswith tree oblique lines, canaliformdystrophy with“Christmas oblique lines, tree physiologicdeficiency, in children hemochromatosis, dystrophy “ChristmasKoilonychia treeProximal pattern” Thinned concave nailsphysiologic LEOPARD, in childrenectodermal canaliform dys- oblique lines, “Christmasdystrophy tree“spoon nails” and distal“Christmas pattern” tree dysplasia,physiologic nail in-patella children, Koilonychiapattern” Proximal Thinned concave nails LEOPARD, ectodermal Koilonychia Proximalmatrix pattern”Thinned concave nails LEOPARD,trichothiodystro ectodermalphy, trophy pattern” “spoon nails” and distal dysplasia, nail-patella, Koilonychia ProximalKoilonychia “spoonThinned nails” concaveProximaland distal nails Thinned concaveLEOPARD, nails ectodermalLEOPARD,dysplasia,Plummer ectodermal nail-Vinson, -patella Iron , matrix , “spoon nails” and distalmatrix dysplasia,trichothiodystrodeficiency, nail -hemochromatosis,patellaphy, , Koilonychia Proximal and “spoonThinned nails” concave and nails distal LEOPARD, ectodermaldysplasia, dysplasia,Plummer nail-patella-Vinson, nail- , Iron matrix trichothiodystroPlummerphysiologic-Vinson, inphy, children , hemochromatosis, “spoon nails” distal matrix matrix patella, trichothiodystrophy,Boardstrichothiodystro Fodder: PlummerNaildeficiency, Plummer- phy,Disease-Vinson, hemochromatosis, Iron Boards Fodder:physiologicphysiologic Nail in Diseasechildren in children Amy Reinstadler,Plummer MD -andVinson,deficiency, Nazanin Iron hemochromatosis, Saedi, MD Vinson, IronAmy deficiency, Reinstadler, MDhemochromatosis, and Nazanin Saedi, MD deficiency, hemochromatosis,physiologic in children physiologic in children Apparent Nail bed White discolorationBoardsphysiologic Fodder: inHypoalbuminemia, Nailchildren Disease leukonychiaApparent Nail bedthat fadesWhite with discoloration chemotherapyHypoalbuminemia, Amy Reinstadler,that fades with MD and Nazaninchemotherapy Saedi, MD Apparent Nail bed White discoloration that fades Nephrotic pressuresyndrome, Nazanin Saedi, MD, pressure leukonychia with pressure Apparent Hypoalbuminemia,Nail bed White discoloration Hypoalbuminemia, is the chief resident leukonychia that fades with chemotherapy in at pressure

the University of True leukonychiaTrue leukonychia Distal Distal Punctate:Punctate: small small Trauma,Trauma, hereditary, hereditary, , infection, True leukonychia Distal matrix Punctate: small opaque white Trauma,matrix matrix hereditary, opaqueopaque white spotswhite infection, spots ,anemia, anemia, low lowcalcium, calcium, low California, Irvine. Striate:Striate: multiple multiple heart/renalheart/renal disease, disease, drugs spots True leukonychiacalcium, Distal heart/renalPunctate:transverse small disease,white Trauma, drugs hereditary, infection, transverseparallel white lines Striate: multiple transverse matrix parallelopaque lines white spots anemia, low calcium, Striate:Diffuse: multiple completely or heart/renal disease, drugs Diffuse: completely or white parallel lines transversealmost completely white Diffuse: completely or almost almostparallel whitecompletely lines Linday’s nails Nail bedwhite Diffuse: Distal completelynail is normal, or Chronic renal failure completely white Linday’s nails(half and half)Nail bed Distalalmost nailproximal is completely normal, nail is white Chronic renal failure (half and half) proximalwhite nail is white Lindsay’s nails Nail bed Distal 1/2 of nail normal, Linday’s nailsChronic Nail bed renal Distal failure nail is normal, Chronic renal failure (halfLongitudinal and half) Proximal or proximalLongitudinal nail is white Nevus/melanoma of matrix, (half and half) proximal 1/2 of nail is white distal pigmented bands Laugier-Hunziker, Peutz- Longitudinal(melanonychia Proximal matrix or Longitudinalextending from the Nevus/melanomaJegher, AZT, AIDS, of matrix,normal melanonychia distal pigmented bands Laugier-Hunziker, Peutz- Longitudinalstriata) Proximal or Longitudinalproximal nail fold to Nevus/melanomavariant in dark skinned of matrix, (melanonychiamelanonychia matrix distal extendingpigmentedthe fromdistal bands margin.the Jegher,Laugierindividuals, AZT,-Hunziker, AIDS, trauma Peutznormal - Longitudinal Proximal or Longitudinal pigmentedstriata) bands (melanonychiaMacronychia Nevus/melanoma matrixNail plateproximal extending nail offold from matrix, to the variant Jegher,Laugier-Neurofibromatosis in AZT, dark AIDS, skinned normal 1, melanonychia distal matrix extending from the proximal striata)nail Hunziker, thePeutz-Jegher, distalproximal margin. nail fold to AZT,individuals,variantTuberous AIDS, in dark trauma sclerosis, skinnednormal Proteus Macronychia Nail plate the distal margin. Neurofibromatosisindividuals,syndrome trauma 1, (melanonychia fold to the distal margin. MacronychiaMee’s linesvariant NailProximal inplate dark Transverseskinned white individuals, linesTuberous NeurofibromatosisArsenic sclerosis, poisoning, trauma 1,Proteus rheumatic matrix that affect all nails syndromeTuberousfever, congenital sclerosis, Proteusheart failure, striata) leprosy Mee’s lines Proximal Transverse white lines Arsenicsyndrome poisoning, rheumatic Muehrcke’s lines Nail bed Double white Nephritic syndrome, low Mee’s lines matrixProximal that affectTransverse all nails white lines ,Arsenic congenital poisoning, heart rheumatic failure, Macronychia Nail plate Neurofibromatosismatrix thattransverse affect 1,all linesnails Tuberous from fever,albumin, congenitalsclerosis, liver disease, heart failure, Amy Reinstadler, abnormal vascular leprosymalnutrition Proteus syndrome leprosy Muehrcke’sMuehrcke’s lines linesNail bedNail bed DoubleDoublebed. white Disappearwhite with NephriticNephritic syndrome syndrome,, low MD, is a dermatology transversetransversesqueezing lines lines fromof thefrom nail albumin,albumin, liver liver disease, disease, Oil spots Nail bedabnormal abnormalBrownish vascular vascular macules malnutritionmalnutritionPsoriasis resident at the Mee’s lines Proximal matrix Transverse white lines that ,bed. bed.Disappearbeneath Disappear rheumatic thewith nailwith plate fever, University of affect all nails congenitalsqueezing heartsqueezing offailure, the of thenail nail leprosy Oil spotsOil spots Nail bedNail bed BrownishBrownish macules macules PsoriasisPsoriasis California, Irvine. beneathbeneath the thenail nail plate plate

Muehrcke’s lines Nail bed Double white transverse lines OnychogryphosisNephritic Nail plate syndrome, Ram’s nail; lowlong, albumin,Neglect, trauma from abnormal vascular bed liver disease, malnutritioncurving

(not grooved like Beau’s lines); Nail plate Ram’s nail; long, Neglect, trauma Onychogryphosis Nail plate Ram’scurving nail; long, Neglect, trauma Disappear with squeezing of curving

the nail irinections D­Residency p. 1 • Winter 2010

Boards Fodder: Nail Disease Amy Reinstadler, MD and Nazanin Saedi, MD

Apparent Nail bed White discoloration Hypoalbuminemia, leukonychia that fades with chemotherapy pressure

True leukonychia Distal Punctate: small Trauma, hereditary, infection, matrix opaque white spots anemia, low calcium, Striate: multiple heart/renal disease, drugs transverse white parallel lines Diffuse: completely or almost completely white Linday’s nails Nail bed Distal nail is normal, Chronic renal failure (half and half) proximal nail is white

Longitudinal Proximal or Longitudinal Nevus/melanoma of matrix, melanonychia distal pigmented bands Laugier-Hunziker, Peutz- (melanonychia matrix extending from the Jegher, AZT, AIDS, normal boards’ fodder striata) proximal nail fold to variant in dark skinned the distal margin. individuals, trauma Macronychia Nail plate Neurofibromatosis 1, Tuberous sclerosis, Proteus syndrome Nail Disease Mee’s lines Proximal Transverse white lines Arsenic poisoning, rheumatic matrix that affect all nails fever, congenital heart failure, Amy Reinstadler, MD and Nazanin Saedi, MD. (Updated July 2015*) leprosy Muehrcke’s lines Nail bed Double white Nephritic syndrome, low transverse lines from albumin, liver disease, abnormal vascular malnutrition Location of bed. Disappear with squeezing of the nail Disorder Defect Definition Oil spots AssociatedNail bed ConditionsBrownish macules Psoriasis Image beneath the nail plate Oil spots Nail bed Brownish macules beneath the Psoriasis nail plate

Onychogryphosis Nail plateBoards BoardsRam’s Fodder: nail; Fodder: long, Nail Nail Neglect,Disease Disease trauma Boardscurving Fodder: Nail Disease Onychogryphosis Nail plate Ram’s nail; long, curving Neglect,Amy Reinstadler, traumaBoards MD Fodder: and Nazanin Nail Disease Saedi, MD Amy Reinstadler,Boards MD Fodder: and NailNazanin Disease Saedi, MD Amy Reinstadler, MD and Nazanin Saedi, MD Nail bed Distal separation. Psoriasis, trauma, drugs, Onycholysis Nail bed Distal separation. Psoriasis, trauma, drugs, OnycholysisOnycholysis Nail Nailbed bedAppears DistalDistal white separation. separation. contactPsoriasis,Psoriasis, dermatitis trauma, trauma, drugs, drugs, Onycholysis Nail bed Distal separation; appears whiteOnycholysis Psoriasis,Nail bed trauma,AppearsDistal white separation. drugs, contactcontactPsoriasis, dermatitis dermatrauma, drugs,- becauseAppearsAppears of the whiteBoards white Fodder:contactcontact Nail dermatitis dermatitisDisease becauseAppears of the white contact dermatitis because of the presence of air titis becausebecause of the of the presenceAmypresencebecause Reinstadler,of Boards airof ofairin the thein theFodder: MD and Nail Nazanin Disease Saedi, MD presencepresence of airof airin thein the subungualAmysubungualpresence Reinstadler, space space of air in MDthe and Nazanin Saedi, MD in the subungual space subungualsubungual space space Onycholysis Nail bed subungualDistal separation. space Psoriasis, trauma, drugs,

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Triangularlunulae Distal matrix Nail-patella syndrome Triangular lunulae Distal matrix Nail-patellaReferences: syndrome lunulae TriangularYellow nail matrix Distal Slow growth, absent NailPulmonary-patella disorders;syndrome Bolognia J, Jorizzo j, Rapini R. Dermatology, 2nd Edition. Mosby Publishing, 2007. Yellow naillunulaesyndrome matrix Slow cuticle/lunulae,growth, absent PulmonaryMedications: disorders; D-penicillamine, transverse ridging bucillamine syndromeYellow nail cuticle/lunulae,Slow growth, absent Medications:Pulmonary disorders; D-penicillamine, Yellow nail syn- Slow growth, absent cuticle/ Pulmonarysyndrome disorders;cuticle/lunulae, Medications: D-penicillamine, transverse ridging bucillamine drome lunulae, transverse ridging Medications: PHOTO CREDITS: D-penicillamine,transverse ridging bucillaminebucillamine Nazanin Saedi, M.D., is the chief resident in dermatology at the University of California, Irvine. References:Amy Reinstadler, M.D., is a dermatology resident at the University of California, Irvine. Bolognia J, Jorizzo j, Rapini R. Dermatology, 2nd Edition. Mosby Publishing, 2007. References: References:References: In a box: nd BologniaBolognia J, Jorizzo J, Jj,orizzo Rapini j, Rapini R. Dermatology, R. Dermatology, 2nd 2 Edition Edition. Mosby. Mosby Publishing,Publishing, 2007. 2007. 1. Bolognia J, Jorizzo j, Rapini R. Dermatology, 2nd Edition. Mosby Publishing, PHOTO CREDITS: 2007.

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