Overview
Examination of the nails may reveal pathognomonic signs suggestive of rheumatologic disease.
Onycholysis
Look For
- Separation of the nail from the nail bed, either distally or laterally.
Causes of Onycholysis
- Skin disease - psoriasis, dermatitis, lichen planus
- Nail infection
- Trauma
- Systemic disease - chronic kidney disease, bronchial carcinoma, anaemia, diabetes mellitus, porphyrias, peripheral vascular disease, thyrotoxicosis
Nail Pitting
Look For
- Pin-point depressions in the nail plate.
Causes of Nail Pitting
- Eczema
- Psoriasis
- Reactive arthritis
- Alopecia areata
- Sarcoidosis
Splinter Haemorrhages
Look For
- Painless longitudinal red / brown lines between 1-3mm on the nail bed.
Causes of Splinter Haemorrhages
- Trauma
- Infective endocarditis
- Vasculitis - rheumatoid arthritis, antiphospholipid syndrome, systemic lupus erythematosus, Behcet disease
- Skin conditions - psoriasis, lichen planus
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