Nail Abnormalities

CLINICAL DIAGNOSIS MANUAL

Nail alterations can be indicators of systemic or local diseases. Here is a brief description of each mentioned clinical sign, the suggested complementary tests, and a list of associated pathologies:

Alteration	Suspected Diagnosis	Confirmation Diagnosis
Clubbing	Clinical observation of drumstick-shaped fingers	Confirmation through specific tests depending on the underlying cause
Terry's lines	Visual observation of transverse white lines	Liver and kidney function tests to identify underlying causes
Nail fold infarcts	Local pain, redness, and visible necrosis	Biopsy and vascular analysis to confirm vasculitis or embolism
Koilonychia	Concave nails observed during physical examination	Confirmation through iron deficiency analysis
Onycholysis	Visible separation of the nail from the nail bed	Microscopic examination and culture to rule out infections
Beau's lines	Transverse depressions observed in the nails	Evaluation of clinical history to correlate with systemic events
Longitudinal nail lines	Visible lines running along the nails	Detailed dermatological examination
Onychomadesis	Initial detachment of the nail observed	Review of history of drug exposures or serious illnesses
Muehrcke's lines	Parallel white lines observed	Measurement of albumin levels to confirm hypoalbuminemia
Nail pitting	Small depressions in the nail surface	Clinical diagnosis and correlation with psoriasis or atopic dermatitis
Splinter haemorrhages	Red or brown lines under the nail surface	Evaluation of cardiovascular or coagulation disorders
Chronic paronychia	Chronic inflammation and pain in the nail fold	Bacterial or fungal culture to identify the causal agent
Mee's lines	Transverse white lines on the nails	Toxicology tests for heavy metals, kidney function evaluated
Yellow nails	Observed yellow discolouration of the nails	Specific tests for yellow nail syndrome or pulmonary issues