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Nail changes in systemic diseases and drug reactions
Published in Eckart Haneke, Histopathology of the NailOnychopathology, 2017
Several renal disorders may be associated with nail changes. Nail alterations are even seen in 98% of patients under chronic hemodialyis; the nail changes included absence of the lunula (55%), half-and-half (51%), splinter hemorrhages (36%), subungual hyperkeratosis (34%), onychomycosis (31%), koilonychia (19%), and onycholysis (9%).111 Muehrke's lines are two pale bands in the nail beds of patients with hypalbuminemia under 2.2 g/100 mL. Pressure makes the bands that run parallel to the lunula disappear. No specific pathology can be attributed to them. Calciphylaxis may cause acral necrosis,112 but is rare in the tip of the digit. Half-and-half nails are said to be characteristic for chronic renal failure and azotemia. The proximal nail half is opaque and ground-glass-like whereas the distal half is red, pink, or brown.
History and physical examination
Published in Alistair Burns, Michael A Horan, John E Clague, Gillian McLean, Geriatric Medicine for Old-Age Psychiatrists, 2005
Alistair Burns, Michael A Horan, John E Clague, Gillian McLean
Inspect the fingers. Tar stains ind�cate tobacco smoking. Evidence of osteoarthritis, rheumatoid disease or gout should be readily apparent. Test muscle strength (finger spreading). Are the palmar creases pal� (anaemia)? Is there a tremor (most likely Parkinson's disease, anxiety, essential tremor or thyrotoxicosis)? Look at the nails for clubbing. Nail colour may point to diagnoses: blue suggests cyanosis, red suggests polycythaemia, white sug- gests hypoalbuminaemia and half-and-half nails suggest uraemia, liver disease or osteoporosis. Faecal contamination of the hands and nails in cogni- tively impaired patients is highly suggestive of faecal loading, with repeated attempts at auto-evacuation with the fingers.
Development of Terry’s nails after a gastrointestinal bleed
Published in Baylor University Medical Center Proceedings, 2021
Christine P. Lin, Mahmud Alkul, Jay M. Truitt, Cloyce L. Stetson
The differential diagnoses for Terry’s nails include Lindsay’s (half and half) nails, Muehrcke’s nails, and true leukonchyia.1 Although both Terry’s nails and Lindsay’s nails are associated with chronic kidney disease and characterized by ground-glass opacities, the proximal nail bed whiteness in Terry’s nails occupies approximately 80% of nail while only about half of the proximal nail bed is opacified in Lindsay’s nails.1,4 In Muehrcke’s nails, transverse white lines run parallel to the lunula and are separated by areas of normal pink nail bed color. They are often seen in association with hypoalbuminemia (e.g., from nephrotic syndrome, liver diseases, malnutrition) and chemotherapy.5 True leukonychia may mimic Terry’s nails, but true leukonychia involves the nail plate instead of the nail bed. Thus, a true leukonychia will grow out with the nail while Terry’s nails retain the proximal nail discoloration as the nail grows out.1