Overview
Nail signs such as leukonychia and koilonychia are useful external signs of gastrointestinal or hepatobiliary pathology.
Leukonychia
Look For
- Whiteness of the nail beds.
Interpretation
True Leukonychia
- Total leukonychia: generalised whitening of the nails.Inherited - rare
- Transverse leukonychia (Mee's lines): single white bands running parallel to the nail base, that do not disappear when depressed.Intermittent insult during nail growth - arsenic, chemotherapy, trauma, infection
Apparent Leukonychia
- Muehrcke's lines: double white bands that disappear when the nail is depressed.Chronic hypoalbuminaemia
- Half and half nails (Lindsay's nails): proximal white nail bed and distal brown nail, separated by a transverse ridge.Uraemia
- Terry's nails: white proximal nail bed with loss of the lunula (proximal white crescent-shaped area).Cirrhosis, heart failure, diabetes, malnutrition, renal transplant
Koilonychia
Look For
- Spoon-shaped nails.
Causes of Koilonychia
- Chronic iron deficiency
- Upper GI carcinoma
- High altitude
- Trauma
- Hypothyroidism
- Systemic lupus erythematosus
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