Scar Tissue And Im Nail

Figure 2.16

Congenital koilonychia associated with total leukonychia.

Table 2.2 Common causes of koilonychia Physiological

Early childhood (Figures 2.12-2.13) Idiopathic Congenital

LEOPARD syndrome Ectodermal dysplasias (Figure 2.15) Trichothiodystrophy Nail-patella syndrome Acquired Metabolic/endocrine iron deficiency acromegaly haemochromatosis porphyria renal dialysis/transplant thyroid disease Dermatoses alopecia areata Darier's disease lichen planus psoriasis

Raynaud's disease Occupational contact with oils, e.g. engineering industry

Infections onychomycosis syphilis

Traumatic toes of rickshaw pullers Carpal tunnel syndrome

Trumpet Nail

Figure 2.17

Transverse overcurvature showing the three subtypes: (a) pincer or trumpet nail; (b) tile-shaped nail; and (c) plicatured nail with sharply angled lateral margins.

Figure 2.17

Transverse overcurvature showing the three subtypes: (a) pincer or trumpet nail; (b) tile-shaped nail; and (c) plicatured nail with sharply angled lateral margins.

Table 2.3 Common causes of transverse overcurvature_

Congenital

Hidrotic ectodermal dysplasia Hypohidrotic ectodermal dysplasia Congenital onychodysplasia of index finger nails

Yellow nail syndrome (Figure 2.22) pseudo yellow nail syndrome (insecticides and weed killers) (Figure 2.21) Developmental

Pincer nails (Figures 2.18, 2.19) Acquired

Osteoarthritis (Figure 2.18b, d)

Neglect e.g. of toe nails in old age_

TRANSVERSE OVERCURVATURE

There are three main types of transverse overcurvature: the arched, pincer or trumpet nail; the tile-shaped nail; and a third less common variety, the 'plicatured' nail (Figure 2.17). Table 2.3 lists some of the causes of transverse overcurvature, as seen in Figures 2.182.23.

Transverse overcurvature may cause ingrowing nail of the hand

Plicatured Nails

Figure 2.18

(a-d) Varying degrees of pincer nail deformity.

Figure 2.18

(a-d) Varying degrees of pincer nail deformity.

Pincer nail

Pincer nail is characterized by transverse overcurvature that increased along the longitudinal axis of the nail and reaches its greatest proportion towards the tip (Figure 2.18, 2.19). At this point the lateral borders tighten around the soft tissues, which are pinched without necessarily disrupting the epiderms. Eventually the soft tissue may actually disappear, sometimes accompanied by resorption of the underlying bone. Subungual exostosis may present in this way: the dorsal extension of bone producing the pincer nail (the exostosis) must be excised. The lateral borders of the nail exert a constant pressure, permanently constricting the deformed nail plate (unguis constringens). In extreme cases they may join together, forming a tunnel, or they may become rolled, taking the form of a cone. In certain varieties, the nails are shaped like claws, resembling pachyonychia congenita.

Traumatic Pachyonychia Foot

Figure 2.19

(a, b) Progressive worsening of the pincer nail deformity in 5 years.

Figure 2.19

(a, b) Progressive worsening of the pincer nail deformity in 5 years.

This morphological abnormality would be no more than a curiosity if the constriction were not occasionally accompanied by pain which can be provoked by the lightest of touch, such as the weight of a bedsheet. There are a number of subtypes of this condition:

1 The inherited form usually shows symmetrical involvement of both the great toe nails and of the lesser toe nails. The great toe nails typically have lateral deviation of their longitudinal axis, the lesser toe nails being deviated medially. This dystrophy

Dystrophic Toenails

Figure 2.20

(a) Transverse curvature of nail; (b) transverse curvature of nail in yellow nail syndrome (before colour change).

Figure 2.20

(a) Transverse curvature of nail; (b) transverse curvature of nail in yellow nail syndrome (before colour change).

Pseudo Pseudo Hypoparathyroidism Photos

Figure 2.21

Transverse overcurvature in the pseudo yellow nail syndrome due to insecticide and weed killer.

Figure 2.21

Transverse overcurvature in the pseudo yellow nail syndrome due to insecticide and weed killer.

Pseudo Hypoparathyroid

Figure 2.22

Transverse overcurvature in the yellow nail syndrome.

Figure 2.22

Transverse overcurvature in the yellow nail syndrome.

is a developmental abnormality which may be an autosomal dominant trait. The pathogenesis of the nail plate deformation has recently been clarified: the great toe nail, which is normally curved transversely, spreads around almost 40% of the dorsal aspect of the base of the terminal phalanx. Radiographs demonstrate that in people with pincer nails the base of the terminal phalanx is widened by lateral osteophytes that are even more pronounced on the medial aspect of the phalanx. By widening the transverse curvature of the nail at its proximal end it becomes more curved distally. This can easily be shown by trying to flatten a curved elastic sheet at one end: the other end will increase its curve. The asymmetry of the lateral osteophytes explains why the lateral deviation of the nail is even more pronounced than that of the distal phalanx.

2 Acquired pincer nails can be attributed to wearing ill-fitting shoes. These nails are not usually symmetrical and the lesser toe nails are not generally affected.

Plicatured

Figure 2.23

(a) Transverse overcurvature of nail: unilateral plicature; (b) transverse overcurvature of nail: bilateral plicatured variety (see Figure 2.17).

Figure 2.23

(a) Transverse overcurvature of nail: unilateral plicature; (b) transverse overcurvature of nail: bilateral plicatured variety (see Figure 2.17).

3 Underlying disease, such as subungual exostosis of the toes and inflammatory osteoarthritis, should always be looked for, especially if the fingers are involved.

4 Some dermatological disorders, especially psoriasis, may also cause transverse overcurvature of the nails.

5 Localized overcurvature is observed in onychomatricoma.

Tile-shaped nail

The tile-shaped nail presents with an increase in the transverse curvature; the lateral edges of the nail remain parallel.

Plicatured nail

In the plicatured nail the surface of the nail plate is almost flat, with one margins being sharply angled forming vertical sides which are parallel Although these deformities may be associated with ingrowing nails, oedema due to the constriction of the enclosed soft tissues is unusual.

DOLICHONYCHIA (LONG NAILS)

In dolichonychia the length of the nail is much greater than the width (Figure 2.24). It has been described in:

1 Ehlers-Danlos syndrome or both lateral (Figure 2.23). inflammatory

2 Marfan's syndrome (Figure 2.25)

3 Eunuchoidism

4 Hypopituitarism

5 Hypohidrotic ectodermal dysplasia.

Figure 2.24

Dolichonychia (long nails).

Dolichonychia

Figure 2.25

Dolichonychia in Marfan's syndrome.

Figure 2.25

Dolichonychia in Marfan's syndrome.

BRACHYONYCHIA (SHORT NAILS)

In brachy onychia (Figures 2.26-2.34) the width of the nail plate (and the nail bed) is greater than the length. It may occur in isolation or in association with shortening of the terminal phalanx. This 'racquet thumb' is usually inherited as an autosomal dominant trait. All the fingers may rarely be involved. The epiphyses of the terminal phalanx of the thumb usually undergo closure between 13 and 14 years of age in girls, slightly later in boys. In individuals with this hereditary defect the epiphyseal line is obliterated on the affected side by 7-10 years of age, only occurring at the usual later age in the normal thumb. Since periosteal growth continues, the result is a deformed, racquet-like thumb.

Artificial Cranial Deformation

Figure 2.26

Brachyonychia: Rubinstein-Taybi type, broad thumb. (Courtesy of P.Souteyrand.)

Figure 2.26

Brachyonychia: Rubinstein-Taybi type, broad thumb. (Courtesy of P.Souteyrand.)

Brachyonychia

Figure 2.27

Brachyonychia (short nails).

Brachyonychia

Figure 2.28

Brachyonychia of the thumb and middle finger.

Figure 2.28

Brachyonychia of the thumb and middle finger.

Finger Nail Disease Loose Nails

Figure 2.29

Brachyonychia—racquet nail of one thumb.

Figure 2.29

Brachyonychia—racquet nail of one thumb.

Figure 2.30

Bilateral brachyonychia—racquet nail associated with clubbing. (Courtesy of F.Daniel, Paris.)

Figure 2.30

Bilateral brachyonychia—racquet nail associated with clubbing. (Courtesy of F.Daniel, Paris.)

What Does Mean Have Nail Clubbing

Figure 2.31

Brachyonychia—severe variant.

Racquet nails have been reported in association with brachydactyly and multiple malignant Spiegler tumours. A syndrome of broad thumbs, broad great toes, facial abnormalities and mental retardation has also been described. Table 2.4 lists many well-recognized causes of short nails, while Table 2.5 gives details of the rarer hereditary and congenital conditions in which it can occur.

Table 2.4 Causes of brachyonychia_

Congenital Acquired

Rubenstein-Taybi: 'broad thumbs' Isolated defect: racquet thumb (Figures syndrome (Figure 2.26) 2.27, 2.30, 2.31) (hereditary) Micronychia with trisomy 21 Nail biters (Figure 2.32) Congenital malalignment—great toe Associated with bone resorption in nails hyperparathyroidism (Figure 2.33) _Psoriatic arthropathy (Figure 2.34)

Extreme Nail Biting Boy

Figure 2.32

Brachyonychia—nail biting.

Figure 2.32

Brachyonychia—nail biting.

Brachyonychia

Figure 2.33

(a) Brachyonychia associated with bone resorption in hyperparathyroidism; (b) radiograph of (a). (Courtesy of B. Schubert.)

Figure 2.33

(a) Brachyonychia associated with bone resorption in hyperparathyroidism; (b) radiograph of (a). (Courtesy of B. Schubert.)

Table 2.5 Hereditary forms of broad nails (some also with pseudoclubbing)

Disease_InheritanceClinical features_

Acrocephalosyndactyly AD Craniosynostosis, syndactyly, ankylosis and other skeletal deformities Acrodysostosis AD Finger nails short, broad and oval in shape; short fingers; nasal and midface

Berk-Tabatznik syndrome

Familial mandibuloacral dysplasia

Keipert syndrome

Larsen's syndrome

Nanocephalic dwarfism

Otopalatodigital syndrome

Pleonosteosis

Pseudohypoparathyroidism

Puretic syndrome

Rubinstein-Taybi syndrome AD

Spiegler tumours and racquet hypoplasia; mental retardation; growth failure; pigmented naevi Stub thumb, short terminal phalanges of all fingers except little finger; bilateral optic atrophy, cervical kyphosis

Club-shaped terminal phalanges; mandibular hypoplasia, delayed cranial closure; dysplastic clavicles; atrophy of skin over hands and feet; alopecia AR or XR Unusual facies with large nose;

protruding upper lip; short and broad distal phalanges of halluces and fingers, except little finger AR or AD Stub thumbs, cylindrical fingers;

flattened peculiar facies, wide-spaced eyes; multiple dislocations, short metacarpals

Low birthweight with adult head circumference; mental retardation; beak-like protrusion of nose; multiple osseous anomalies; clubbing of fingers XR or AR Broad, short nails, especially of thumbs and great toes; mental retardation; prominent occiput; hypoplasia of facial bones; cloven palate; conductive deafness

? Short stature; spade-like thumbs with thick palmar pads; massive, 'knobby' thumbs; short, flexed fingers; limited joint motion with contractures XD or AR Short stature; round face; depressed nasal bridge; short metacarpals; mental retardation; cataracts in 25%; enamel hypoplasia; calcifications in skin ? Osteolysis of peripheral phalanges;

stunted growth; contracture ofjoints; multiple subcutaneous nodules; atrophic sclerodermic skin Broad thumb with radial angulation and great toes; high palate; short stature; mental retardation; peculiar facies

Brachydactyly; Turban tumours nails

Stub thumb with racquet nail AD No other defects; appears at the age of

(Figures 2.27, 2.30) 7-10 years with early obliteration of

_the epiphyseal line_

AD, autosomal dominant; AR, autosomal recessive; XD, sex-linked dominant; XR, sex-linked recessive_

Asymmetric Oligo Arthropathy

Figure 2.34

Brachyonychia in psoriatic arthropathy. (Courtesy of P. Combemale, Lyon.)

Figure 2.34

Brachyonychia in psoriatic arthropathy. (Courtesy of P. Combemale, Lyon.)

PARROT-BEAK NAILS

In this symmetrical overcurvature of the free edge, some finger nails mimic the beak of a parrot (Figures 2.35, 2.36); this shape disappears temporarily if the nails are soaked in lukewarm water for about 30 minutes. This condition is often not seen in clinical practice because such patients usually trim their nails close to the line of separation from the nail bed. Parrot-beak nails are a typical sign of severe acrosclerosis with distal phalangeal resorption. The nail plate bends around the shortened fingertip.

ROUND FINGERPAD

The round fingerpad sign describes a modification in the contour of the fingerpad, which changes from peaked to hemispheric. The sign is more common on the ring finger of patients with scleroderma or Raynaud's phenomenon (Figure 2.37).

Scleroderma Face

Figure 2.35

Parrot-beak nails.

Figure 2.35

Parrot-beak nails.

Parrot Beak Nails

Figure 2.37

Nail configuration abnormalities 37 Fingerpad sign in scleroderma.

Graft Scleroderma

Figure 2.38

Claw-like nail.

Figure 2.38

Claw-like nail.

Pictures Nail Disorders Trumpet Nail

Figure 2.39

(a, b) Claw-like nail—frontal and lateral views.

Figure 2.40

Hook nail.

Claw Like Toe Nails

HOOK AND CLAW-LIKE NAILS

One or both little toe nails are often rounded like a claw. This condition predominates in women wearing high heels and narrow shoes and is often associated with the development of hyperkeratosis such as calluses on the feet. Congenital claw-like fingers and toe nails have been reported (Figures 2.38, 2.39) Claw nails may be curved dorsally showing a concave upper surface, resembling onychogryphosis or post-traumatic hook nail. In the nail-patella syndrome when the pointed lunula sign occurs, if the nail is not manicured it will tend to grow with a pointed tip, resembling a claw. Hook nails (Figure 2.40) may be an isolated defect, congenital or acquired (e.g. traumatic).

MICRONYCHIA, MACRONYCHIA AND POLYDACTYLY

In Iso-Kikuchi syndrome (congenital onychodysplasia of index finger nails, COIF) there are two types of micronychia. The most frequent is medially sited; in 'rolled' micronychia the nail is centrally located (Figures 2.41-2.45). Figures 2.46-2.48 illustrate other examples of congenital micronychia. Overlapping of the nail surface by an enlarged lateral nail fold may result in apparent micronychia (Turner's syndrome).

Turners Syndrome Nails

Figure 2.41

Micronychia involving one finger.

Figure 2.41

Micronychia involving one finger.

Micronychia

Figure 2.42

Micronychia—congenital onychodysplasia of index finger nails (COIF) syndrome.

Figure 2.42

Micronychia—congenital onychodysplasia of index finger nails (COIF) syndrome.

Deformed Pointer Finger Nail

Figure 2.43

Micronychia in COIF syndrome.

Syndrome Turner Ongles

Figure 2.44

Rolled micronychia in COIF syndrome.

Figure 2.44

Rolled micronychia in COIF syndrome.

Figure 2.45

Rolled micronychia.

Ectodermal Dysplasia Nails

Figure 2.46

Micronychia in congenital ectodermal dysplasia.

Figure 2.46

Micronychia in congenital ectodermal dysplasia.

Micronychia

Figure 2.47

Micronychia—'small nail field' defect in hidrotic ectodermal dysplasia. (Courtesy of L.Norton.)

Figure 2.47

Micronychia—'small nail field' defect in hidrotic ectodermal dysplasia. (Courtesy of L.Norton.)

Dermatitis Hidrotica

Figure 2.48

Micronychia in a child affected by AEC syndrome (ankyloblepharon, ectodermal dysplasia and cleft palate).

Figure 2.48

Micronychia in a child affected by AEC syndrome (ankyloblepharon, ectodermal dysplasia and cleft palate).

Macronychia

Figure 2.49

Macronychia of the middle finger.

Figure 2.49

Macronychia of the middle finger.

Macrodactyly Treatment

Figure 2.50

Macronychia with macrodactyly in Proteus syndrome.

Table 2.6 Causes of micronychia and macronychia

Congenital

Ectodermal dysplasias (Figures 2.46, 2.47)

Congenital onchodysplasia of index finger nails (Figures 2.422.44)

Bifid toe (Figure 2.51) Dyskeratosis congenita

Chromosomal abnormalities

Nail-patella syndrome_

Acquired

Fetal teratogens hydantoinates alcohol warfarin

Amniotic bands

In macronychia the nails of one or more digits are wider than normal, with nail bed and matrix similarly affected (Figure 2.49). This may occur as an isolated defect or in association with megadactyly, as in von Recklinghausen's disease, epiloia and Proteus syndrome (Figure 2.50). Table 2.6 lists the known associations of micronychia and macronychia.

Figure 2.52 Bifid thumb.

Thumb Toe Transplant

Figure 2.51 Bifid toe.

Duplication of the thumb is a sign of congenital polydactyly, one of the most common anomalies of the hand. The frequency of polydactyly of the hands has been estimated to be 0.37%; it is more common than polydactyly of the feet (Figure 2.51). Seven types of thumb polydactyly can be distinguished according to the level of bone bifurcation. Patients with types 1 and 2 thumb polydactyly have two distinct nails separated by a longitudinal incision or a unique nail with a central indentation of the distal margin (Figures 2.52, 2.53). Symphalangism is commonly observed. Thumb polydactyly may be sporadic, usually transmitted as an autosomal dominant trait with variable expressivity. A similar clinical picture can be seen in the great toe with bifurcation of the terminal phalanx and duplication of the nail. Early treatment is important to maximize functional restoration and aesthetic results.

What Causes Shiny Fingernails

A bifid lunula can also be a sign of polydactyly

WORN-DOWN, SHINY NAILS

Patients with atopic dermatitis or chronic erythroderma may be 'chronic scratchers and rubbers'. The surface of the nail plate becomes glossy and shiny and the free edge is worn away (Figures 2.54, 2.55). This condition, also called usure des ongles, may also occur in many different manual occupations. It has recently been described as a particular hazard of individuals handling heavy plastic bags.

The term 'bidet nails' describes an unusual nail configuration abnormality characterized by thinning and excavation of the central portion of the distal nail plate in a triangular pattern

What Causes Shiny Fingernails

Figure 2.54

Worn-down, shiny nails (usure des angles), due to chronic rubbing and scratching.

Figure 2.54

Worn-down, shiny nails (usure des angles), due to chronic rubbing and scratching.

Wide White Line Nails

Figure 2.55

Darier's disease—worn-down tips due to intrinsic keratinization defect;

note associated white lines.

Figure 2.56

Bidet nails.

Shiny finger nails usually imply severe scratching or rubbing of the skin with distal base (Figure 2.56). The distal margin shows a V-shaped incisure. 'Bidet nails' result from chronic rubbing of the nails against a hard surface and typically affect the middle three fingers of the dominant hand. The following conditions may be responsible:

• worn-down nails: occupational causes

• smooth, shiny nails: atopic eczema; pruritic lymphoma; chronic pruritus

• distal fraying: trauma; Darier's disease (Figure 2.55); old age; nail scratching.

ANONYCHIA AND ONYCHATROPHY

It is impossible to differentiate completely between anonychia and onychatrophy in the light of current knowledge. In principle the term 'anonychia' (total or partial) is probably best reserved for conditions in which the nail has failed to develop; 'onychatrophy' should be used to describe processes in which the nail has initially formed satisfactorily and then shown total or partial regression. Table 2.7 lists the causes of anonychia and onychatrophy.

In aplastic anonychia, a rare congenital disorder occasionally associated with other defects such as ectrodactyly, the nail never forms. Loose, horny masses are produced by the metaplastic squamous epithelium of the matrix and the nail bed in anonychia keratodes. Hypoplasia of the nail plates is a hallmark of the nail-patella syndrome; in the least affected cases only the ulnar half of each thumb nail is missing.

Table 2.7 Causes of anonychia and onychatrophy_

Permanent hypo- or anonychia (Figures 2.57-2.60) +/- ectrodactyly +/- dental malformations Nail-patella syndrome (Figure 2.60) Congenital onychodysplasia of index finger Coffin-Siris syndrome with many congenital defects DOOR syndrome (deafness, onychodystrophy, osteodystrophy, mental retardation) (Figure 2.58) Onychatrophy (Figures 2.61-2.78) With pterygium (Figure 2.71) lichen planus (Figures 2.71, 2.72) acrosclerosis (Figure 2.63) onychotillomania (Figures 2.76, 2.77) Lesch-Nyhan syndrome chronic graft-versus-host disease Stevens-Johnson or Lyell's syndrome (Figure 2.66) cicatricial pemphigoid (Figure 2.64) Without pterygium severe paronychia with nail dystrophy Stevens-Johnson or Lyell's syndrome (Figure 2.66) epidermolysis bullosa (Figures 2.67-2.69) amyloidosis etretinate nail dystrophy (Figure 2.62)

idiopathic atrophy of childhood (Figure 2.75)

severe psoriatic nail dystrophy (Figure 2.70)_

Onychatrophy presents as a reduction in size and thickness of the nail plate, often accompanied by fragmentation and splitting, for example in lichen planus. It may progressively worsen, scar tissue eventually replacing the atrophic nail plate.

Congenital Absence The Nasal Bones

Figure 2.57

Congenital absence of nails.

Figure 2.57

Congenital absence of nails.

Absence Nail

Figure 2.58

Congenital absence of nails in the DOOR syndrome. (Courtesy of Professor Nevin, Belfast.)

Figure 2.58

Congenital absence of nails in the DOOR syndrome. (Courtesy of Professor Nevin, Belfast.)

Door Syndrome

Figure 2.59

Micronychia in congenital ectodermal dysplasia.

Figure 2.59

Micronychia in congenital ectodermal dysplasia.

Nail Patella Syndrome

Figure 2.60

Partial anonychia in the nail-patella syndrome.

Figure 2.60

Partial anonychia in the nail-patella syndrome.

Permanent Anonychia

Figure 2.61

Onychatrophy—ectodermal dysplasia.

Nail Patella Syndrome

Figure 2.62

Onychatrophy due to oral etretinate therapy. (Courtesy of B.Kalis, Reims)

Figure 2.62

Onychatrophy due to oral etretinate therapy. (Courtesy of B.Kalis, Reims)

Nail Scars

Figure 2.63

Onychatrophy—acrosclerosis.

Figure 2.63

Onychatrophy—acrosclerosis.

Koilonychia Images

Figure 2.64

Onychatrophy and koilonychia in cicatricial pemphigoid.

Figure 2.64

Onychatrophy and koilonychia in cicatricial pemphigoid.

Sarcoidosis Fingers

Figure 2.65

Onychatrophy due to sarcoidosis with bone involvement.

Figure 2.65

Onychatrophy due to sarcoidosis with bone involvement.

Sarcoidosis And Low Bone Density VvvvvvEpidermolysis Bullosa Dystrophica Nails

Figure 2.68

Onychatrophy in a child with epidermolysis bullosa dystrophica.

Figure 2.68

Onychatrophy in a child with epidermolysis bullosa dystrophica.

Nail Dystrophy Epidermolysis Bullosa

Figure 2.69

Onychatrophy—epidermolysis bullosa dystrophies.

Figure 2.69

Onychatrophy—epidermolysis bullosa dystrophies.

Onychatrophia

Figure 2.70

Onychatrophy—pustular psoriasis.

Figure 2.70

Onychatrophy—pustular psoriasis.

Lichen Nail

Figure 2.72

Onychatrophy—lichen planus with total nail loss.

Figure 2.72

Onychatrophy—lichen planus with total nail loss.

Raynauds Nail Loss

Figure 2.71

Onychatrophy—lichen planus.

Figure 2.71

Onychatrophy—lichen planus.

Onychatrophia The Feet

Figure 2.73

Severe onychatrophy.

Figure 2.73

Severe onychatrophy.

Extreme Cases Nail Biting

Figure 2.74

Onychatrophy—severe nail biting.

Figure 2.74

Onychatrophy—severe nail biting.

Diseases From Biting Nails

Figure 2.75

(a, b) Idiopathic atrophy of the nails: onychatrophy and anonychia.

Figure 2.75

(a, b) Idiopathic atrophy of the nails: onychatrophy and anonychia.

Atrophic Onychodystrophia

Figure 2.76

Onychatrophy—onychotillomania.

Figure 2.76

Onychatrophy—onychotillomania.

Onychotillomania

Figure 2.77

Onychatrophy—onychotillomania.

Figure 2.77

Onychatrophy—onychotillomania.

Onychotillomania

Figure 2.78

Onychotillomania—onychatrophy and pigmentation.

Figure 2.78

Onychotillomania—onychatrophy and pigmentation.

FURTHER READING Clubbing

Dickinson CJ, Martin JF (1987) Megakaryocytes and platelet clumps as the cause of finger clubbing, Lancet ii: 1434-1435.

Fischer DS, Singer DH, Feldman SM (1964) Clubbing, a review, with emphasis on hereditary acropachy, Medicine 43:459-479. Myers KA, Farquhar DRE (2001). Does this patient have clubbing? JAMA 286:341347.

Koilonychia

Hogan GR, Jones B (1970) The relationship between koilonychia and iron deficiency in infants, JPediatr 77:1054-1057.

Stone OJ (1985) Clubbing and koilonychia, Dermatol Clin 3:485-490.

Transverse overcurvature

Cohen P, Milewicz DM (1993) Dolichonychia in a patient with the Marfan syndrome, J Dermatol 20:779-782.

Cornelius CE, Shelley WB (1968) Pincer nail syndrome, Arch Surg 96:321-322. Haneke E (1992) Etiopathogénie et traitement de I'hypercourbure transversale de l'ongle du gros orteil, JMédEsth Chir Dermatol 19: 123-127.

Brachyonychia

Rubinstein JH (1969) The broad thumbs syndrome progress report 1968, Birth Defects: Original Article Series V(2): 25-41.

Round fingerpad sign

Mizutani H, Mizutani T, Okada H et al (1991) Round fingerpad sign: an early sign of scleroderma, J Am Acad Dermatol 24: 67-69.

Micro- and macronychia

Kikuchi I (1985) Congenital polyonychias: reduction versus duplication digit malformations, Int J Dermatol 24:211-215.

Telfer NR, Barth JH, Dawber RPR (1988) Congenital and hereditary nail dystrophies: an embryological approach to classification, Clin Exp Dermatol 13:160-163.

Worn-down and shiny nails

Baran R, Moulin G (1999). The bidet nail: a French variant of the worn-down nail syndrome, Br J Dermatol 140:377.

Anonychia and nail atrophy Zaias N (1970) The nail in lichen planus, Arch Dermatol 101:264-271.

Polydactyly

Tosti A, Paoluzzi P, Baran R (1992) Doubled nail of the thumb: a rare form of polydactyly, Dermatology 184:216-218.

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Responses

  • dinodas
    What causes shiny fingernails?
    7 years ago
  • Sabrina
    What causes pincer toenails?
    7 years ago
  • robert
    What is kikuchi syndrome?
    7 years ago
  • tiia
    What does it mean to have nail clubbing?
    7 years ago
  • aman
    Are nasal bones symmetrical?
    7 years ago
  • SIIRI
    What cause tile shaped nails?
    7 years ago
  • Achille
    What causes convex toenails?
    7 years ago
  • lelio marcelo
    What Are Trumpet Nails?
    7 years ago
  • tom
    Can foetal alcohol syndrome cause nail dystrophy?
    7 years ago
  • Tolman
    What causes Plicatured Nails?
    7 years ago
  • Priamus
    Is plicatured nails a disorder?
    7 years ago
  • Dina
    What Causes Nailbiting?
    6 years ago
  • diego
    What is picatured nails?
    6 years ago
  • BALDASSARRE SAGESE
    What causes concave nails?
    6 years ago
  • TOMBA
    What causes clawlike fingernails?
    6 years ago
  • ami
    What does pachyonychia look like?
    5 years ago
  • outi
    What causes pilcatured nail disorder?
    5 years ago
  • Kelsie Shaw
    How to flatten curved nails?
    5 years ago
  • zach
    How to flatten bent toenails before and afters?
    5 years ago
  • Racquel
    What does clubbing of the fingers indicate?
    5 years ago
  • Nora
    What causes claw shaped nails?
    5 years ago
  • virpi
    Can i get a fingernail transplant?
    3 years ago
  • Rebekah
    What causes placitured nail?
    2 years ago
  • Leanna Hunter
    How to cure plicatured nail?
    21 days ago

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