Makindo Medical Notes"One small step for man, one large step for Makindo" |
|
|---|---|
| Download all this content in the Apps now Android App and Apple iPhone/Pad App | |
| MEDICAL DISCLAIMER: The contents are under continuing development and improvements and despite all efforts may contain errors of omission or fact. This is not to be used for the assessment, diagnosis, or management of patients. It should not be regarded as medical advice by healthcare workers or laypeople. It is for educational purposes only. Please adhere to your local protocols. Use the BNF for drug information. If you are unwell please seek urgent healthcare advice. If you do not accept this then please do not use the website. Makindo Ltd. |
| Disorder | Key nail findings | Clues / Associations | First steps (primary care) |
|---|---|---|---|
| 🧩 Psoriasis | Pitting, onycholysis, “oil-drop/salmon patch”, subungual hyperkeratosis | Cutaneous plaques, scalp disease, PsA symptoms | Emollients; potent topical steroid or calcipotriol to periungual skin; refer if severe/functional impact |
| 🌀 Alopecia areata | Regular geometric pitting, trachyonychia (rough nails), longitudinal ridging | Patchy non-scarring hair loss, atopy | Reassure; consider derm referral; treat AA per guideline (topical/intralesional steroids) |
| 📏 Lichen planus | Longitudinal ridging, thinning, dorsal pterygium, fissuring | Violaceous pruritic papules, oral lacy lesions | Derm referral (risk of scarring nail loss); potent topical/intralesional steroids |
| 🍄 Onychomycosis | Yellow-brown discoloration, distal-lateral onycholysis, subungual debris | Tinea pedis, occlusive footwear, diabetes | Confirm mycology (clippings/scrapings) before Rx; oral terbinafine 6–12 wks if dermatophyte; liver tests if indicated |
| 🫁 Clubbing | Spongy nail bed, loss of Schamroth window, Lovibond angle >180° | Lung Ca, bronchiectasis, IPF; IBD; cyanotic heart disease; cirrhosis | History/exam → CXR ± CT, coeliac/IBD/liver tests guided by symptoms; urgent cancer pathway if red flags |
| 🥄 Koilonychia | “Spoon” nails (concave) | Iron deficiency anaemia; congenital forms | FBC, ferritin; treat iron deficiency and search for source (e.g., GI blood loss) |
| 📉 Beau’s lines | Transverse depressions | Systemic illness, chemo, severe infection; temporal relation ~growth rate | Reassure; address precipitant; nails normalise as they grow |
| 🩸 Splinter haemorrhages | Longitudinal reddish-brown streaks (distal > proximal) | Trauma most common; consider IE if fever, murmur, emboli | If trauma likely → reassure. If IE suspected → blood cultures, echo, urgent review |
| 🤍 Terry’s nails | Proximal 80% white, distal rim pink | Cirrhosis, HF, diabetes, age | Assess for liver/cardiac disease; manage underlying condition |
| 🌓 Lindsay’s (half-and-half) | Proximal white, distal brown ~20–60% | Chronic kidney disease | Review renal function; CKD optimisation |
| 📐 Onycholysis | Distal nail plate separation | Psoriasis, thyrotoxicosis (Plummer nails), trauma, tetracyclines | Treat cause; keep nail short/dry; avoid trauma; check TSH if systemic features |
| 🦠 Paronychia (acute) | Periungual erythema, pain, pus | S. aureus; nail biting, trauma | Warm soaks; flucloxacillin (UK) if cellulitis; I&D if abscess |
| 🦠 Paronychia (chronic) | Swollen, boggy nail folds; ridging | Irritant wet work; Candida colonisation | Avoid wet work; topical steroid + antifungal; treat secondary infection |
| 💛 Yellow nail syndrome | Yellow, thick, slow-growing, onycholysis | Lymphoedema, pleural effusions, bronchiectasis | Manage respiratory/lymphatic disease; vitamin E sometimes tried (limited evidence) |
| 🎯 Subungual melanoma | New/widening pigmented band, irregular; Hutchinson sign (periungual spread) | Thumb/great toe common; darker phototypes at risk | 2WW dermatology urgent; avoid nail avulsion in primary care |
| 🧠 Habit-tic / median canaliform dystrophy | Central longitudinal split/“fir-tree” ridging (thumbs) | Repeated picking/pressure | Behavioural advice, emollients, tape barrier; consider dermatology if severe |
| 🧴 Leukonychia | White patches/lines in nail plate | Trauma most common; true vs apparent leukonychia | Reassure; grows out with the nail; check for systemic causes if diffuse |
🧑🏫 Teaching tip: “pitting” favours psoriasis or alopecia areata (regular geometric in AA); onycholysis with thyrotoxicosis is “Plummer nails”. Always examine skin, scalp, and mucosa.