| 🧩 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 |
