This document discusses various nail abnormalities and their potential systemic disease associations. Clubbing, koilonychia, Muehrcke's lines, blue lunulae, Beau's lines, splinter hemorrhages, trachyonychia, nail separation, pale nails, white nails, yellow nails, bluish nails, rippled/pitted nails, cracked/split nails, puffy nail folds, dark lines beneath nails, gnawed nails, Terry's nails, and brown nails are each described along with one or more conditions they may indicate such as iron deficiency, liver disease, glomerulonephritis, diabetes, zinc toxicity, or chemotherapy side effects.

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April 12, 2023
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Nails in systemic
diseases
DR. HIWA OMER AHMED
PROFESSOR IN GENERAL AND BARIATRIC SURGERY
UNIVERSITY OF SULAIMANI
COLLEGE OF MEDICINE – SULAIMANI CITY-
KURDISTAN

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April 12, 2023
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April 12, 2023
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Abnormalities
1. Clubbing

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April 12, 2023
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koilonychia
“spooning” of the
nails due to
deficiency of
1. Iron
2. B12
3. Folate

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April 12, 2023
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Muehrcke’s lines
 transverse white lines
 not grooved
 dont move with nail growth
 disappear with pressure.
1. Nephrotic syndrome
2. Glomerulonephritis
3. Liver diseases,
4. Malnutrition,
5. High metabolic stress (e.g.,
systemic inflections, AIDS).
6. Trauma
7. Chemotherapy

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April 12, 2023
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Blue lunulae
1. bluish discolouration
seen in Wilson’s
disease
2. Cyclophosphamide
3. Zinc toxicity

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April 12, 2023
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Beaus's line
 transerse white lines
 grooved
 usually single line
per fingernail
1. Uncontrolled diabetes
2. Peripheral vascular disease
3. High fever
4. Zinc deficiency.

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April 12, 2023
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splinter hemorrhage
 Infective
endocarditis
 They may be caused by
1. Vasculitis
2. Microemboli

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April 12, 2023
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Trachyonychia
 Rough nail
 Longitudinal ridged lines
 Caused by
1. Lichen planus
2. Psoriasis
3. Alopecia areata,
immunoglobulin A deficiency
4. Atopic dermatitis

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April 12, 2023
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nail separation
1. trauma
2. Thyroid disease
3. Psoriasis

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April 12, 2023
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Pale nails
 Leukonychia, describes fingernails that are partially or completely white in
color.
 The white color could be the result of several things such as
1. Trauma
2. Anemia
3. Dietary deficiencies
4. Heart or kidney disease
5. Poisoning.

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White Nails
If the nails are mostly white
with darker rims, this can
indicate liver problems,
such as hepatitis.

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April 12, 2023
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Yellow Nails
One of the most common causes of
yellow nails is
1. A fungal infection. As the infection
worsens, the nail bed may retract, and
nails may thicken and crumble.
2. In rare cases, yellow nails can indicate
a more serious condition such as
 Severe thyroid disease
 Lung disease
 Diabetes
 Psoriasis.

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April 12, 2023
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Bluish Nails
 Nails with a bluish tint
can mean the body isn't
getting enough oxygen.
 This could indicate a lung
problem, such as
1. Emphysema
2. Some heart problems

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April 12, 2023
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Rippled or pitted
 The nail surface is rippled
or pitted, this may be an
early sign of
1. Psoriasis
2. Inflammatory arthritis.
 Discoloration of the nail is
common; the skin under
the nail can seem
reddish-brown.

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April 12, 2023
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Cracked or Split Nails
Dry, brittle nails that
frequently crack or split
have been linked to
1. thyroid disease.
2. Cracking or splitting
combined with a
yellowish hue is more
likely due to a fungal
infection.

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April 12, 2023
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Puffy Nail Fold
 Chronic paronychia
 It is usually the result of
1. Irritants
2. allergens
3. fungus Candida
albicans,
4. psoriasis.

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April 12, 2023
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Dark Lines Beneath the Nail
 This nail discoloration
is called a
melanonychia
1. Skin cancer.
2. Infection.
3. Injury.

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April 12, 2023
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Gnawed Nails
 Biting the nails may be
nothing more than an
1. Old habit
2. Persistent anxiety
3. Obsessive-compulsive
disorder.

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April 12, 2023
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Terry's nails
 The nailbeds look
“washed out,” except for
a thin reddish-brown strip
near the tip. Often,
1. Aging
2. Liver disease
3. Congestive heart
failure
4. Kidney failure
5. Diabetes.

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April 12, 2023
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Brawn nail
 Adrimycin chemotherapy
 Cyclophosphamide