Fungal & Bacterial Nail Disorders with Features.

Racket nails:
- Congenital anomaly of thumbs in which the distal phalanx is shorter & wider than normal.
- Also seen in Tertiary hyperparathyroidism.

Congenital abnormalities:
- Anonychia (complete absence)
- Micro- or Macronychia
- Onychoheterotopia(abnormally situated nail)
- Racket nail
- Leuconychia totalis (completely white nail)

Beau's lines:
- Transverse ridges on nails
- Develop during attacks of severe illness
- Also in Raynaud's syndrome & carpal tunnel syndrome

Longitudinal ridges:


- Elderly
- Rheumatoid arthritis
- Alopecia areata
- Lichen planus
- Psoriasis
- Darier's disease (keratosis follicularis)

Trachyonychia:
- Means roughness of nails
- Seen in alopecia areata, lichen planus & psoriasis

Pachyonychia:
- Thickening of nail plate
- Seen most commonly in onychomycosis(tinea unguium)
- Also congenital
- Hyperparathyroidism
- Vitamin D therapy

Onychorrhexis:
- Nail separates at lunula & is shed partially or completely
- Seen in psoriasis
- Old age
- Systemic illness
- Eczema
- Paronychia

Onychomadesis:
- Complete shedding of nail
- Occurs in severe illness which results in sudden stopping of nail growth
- Also in lichen planus

Onycholysis:
- Detachment of nail from its nail- bed (differs from onychomadesis in that it begins distally or laterally)
- Hyperparathyroidism
- Psoriasis

Koilonyhchia:
- Spoon shaped nails
- Commonest in Iron deficiency anaemia
- Also in thyrotoxicosis
- Rheumatic fever
- Liver disease
- Occupationally in rickshaw pullers & oil workers

Clubbing:
- Respiratory causes: bronchogenic carcinoma, bronchiectasis, lung abscess, empyema, fibrosing alveolitis, asbestosis, pleural mesothelioma, cystic fibrosis.
- Cardiovascular causes: congenital cyanotic heart disease, infective endocarditis, atrial myxoma..
- Gastrointestinal causes: ulcerative colitis, Crohn's disease, primary biliary cirrhosis, sclerosing cholangitis, malabsorption syndrome.
- Endocrine cause: Grave's disease
- CNS cause: ataxia telengiectasia
- Familial in Taurine- Gole- Solente syndrome
- Idiopathic
- Unilateral clubbing: aneurysm of subclavian or brachial artery, Pancoast tumour, i.v. drug users.
- Unidigital clubbing: tophaceous gout, local trauma, sarcoidosis.

Changes in colour:

White nails:
- Patchy white discolouration of nail plates is seen after systemic illness such as MI, ulcerative colitis, etc.
- Mee's lines- transverse white bands are seen in arsenic poisoning, Hodgkin's disease, palmar keratosis.

Yellow nails:
- Yellow nail syndrome associated with lymphatic hypoplasia & lymphoedema, bronchiectasis & pleural effusion.
- Also after prolonged tetracycline therapy

Green nails:
- Seen in association with infection with pseudomonas spp.

Blue nails:
- chloroquine or mepacrine therapy
- Blue lunules in Wilson's disease

Red half moons:
- In congestive heart failure

Splinter haemorrhages:
- Infective endocarditis
- Rheumatic fever
- Disseminated malignancy
- Infectious mononucleosis
- Cryoglobulinaemia

Longitudinal brownish streaks:
- Addison's disease
- Subungual haematoma
- Melanocytic naevus
- Side effect of minocycline, zidovudine
- Lichen planus
- Laugier- Hunziker syndrome

Others:

Egg- shell nails:
- In avitaminosis A

Quincke's sign:
- Increased capillary pulsations
- Seen in aortic regurgitation & other conditions with hyperdynamic circulation

Brittle nails:
- Chronic peripheral circulation impairment
- Iron deficiency anemia