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Diseases of Nail Plate


Psoriasis, alopecia areata, hand dermatitis, nail biting, lichen planus, idiopathic

Horizontal ridges

Beau's lines, any inflammation affecting soft tissues around nails

Longitudinal ridges:

a. Single   b. Multiple

Pressure effect e.g. tumour in nail fold
Psoriasis, lichen planus, alopecia areata, Darier's disease


Psoriasis, onychomycosis, pachyonychia congenita

Onycholysis separation of nail plate from nail bed distally)

Idiopathic, psoriasis, onychomycosis, trauma, thyroid acropachy, drug induced photo-onycholysis e.g. tetracyclines

Subungual hyperkeratosis

Psoriasis, onychomycosis, trauma, ischaemia


Iron deficiency, lichen planus, idiopathic

Colour changes

Infection: Pseudomonas (green) 
Drugs: Tetracycline (yellow)  
          Antimalarial (blue)     
        Chlorpromazine (brown)  
Topical agents:  Potassium permanganate  
Systemic diseases:  Cirrhosis  hypoproteinaemia

Others:  Cigarette smoking (brown)   
             Subungual haematoma (reddish blue)  
           Melanoma (black)         

(whiteness of nail):
True (affect nail plate)
Apparent (affect
subungual tissues)

Onychomycosis, trauma, congenital
Anaemia, hypoproteinaemia

Pigmented streaks

Normal in pigmented skin, malignant melanoma, benign melanocytic naevi, Addison's disease

  1. Diseases of Nail Fold

Paronychia (inflammation of nail fold): 




Trauma, wet work, drugs e.g. etretinate

Pterygium formation (cuticle appears to grow out over the nail with loss of proximal nail fold)

Lichen planus, circulatory disorders, pemphigus

Palisading of dilated nail fold capillaries

Dermatomyositis, lupus erythematosus, scleroderma

Infarcts at posterior or lateral folds

Vasculitis, e.g. rheumatoid diseases

Nail fold masses

Viral warts, myxoid cyst, periungual, fibromata, malignant melanoma

  1. Diseases of Nail Bed and Matrix


Subungual exostosis

Glomus tumour


Malignant melanoma


Subungual wart

Causes of Nail pitting
  1. Skin disorders: 
    • Psoriasis
    • Lichen planus
    • Alopecia areata  
    • Reiter's syndrome
    • Eczema
    • Incontinentia pigmenti
  2. Infections
    • Onychomycosis
    • Tinea unguiumo Paronychia
  3. Congenital/Hereditary
    • Ectodermal dysplasia
    • Nail patella syndrome
  4. Endocrine
    • Hypothyroidism
    • Hyperthyroidism
    • Hypoparathyroidism

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