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Nail terminology
This page outlines the terms used by dermatologists to describe diseases of the fingernails and toenails.
- Abnormalities of the nail plate surface
- Nail discolouration
- Abnormalities of the cuticle and nail fold
- Abnormalities of nail shape
- Loss of nails
- Lesions around nails
Abnormalities of the nail plate surface
Nail plate abnormalities are often due to inflammatory conditions affecting the matrix or nail bed. Specific diagnoses may be made from characteristic appearances.
Pitting
Nail pitting may be a sign of eczema, psoriasis and alopecia areata.
Transverse ridging
Transverse ridging of a nail may be a sign of eczema, paronychia, psoriasis and parakeratosis pustulosa.
Beau line
A Beau line is a transverse depression affecting all nails, due to acute systemic illness stopping nail growth.
Onychorrhexis
Onychorrhexis is longitudinal ridging of the nail plate. Consider ageing, lichen planus, psoriasis, fungal nail infection and Darier disease or a habit of picking.
Transverse groove
Nail trauma 4 months earlier
A horizontal groove can be the result of earlier nail trauma or subungual haematoma.
Longitudinal groove
A longitudinal groove in the nail plate is due to myxoid cyst or wart overlying the proximal nail matrix.
Median canaliform nail dystrophy
Median canaliform nail dystrophy presents as a feathered, central, longitudinal ridge with a fir-tree pattern usually involving both thumbnails. It is similar to the deformity caused by repetitively pushing back the cuticle (habit-tic deformity). Macrolunulae (large half-moons) may expose the nail matrix to trauma, as they are frequently present.
Onychogryphosis
Onychogryphosis is a thick hard curved nail plate in the shape of a ram's horn usually due to ageing, psoriasis or trauma.
Onychauxis
Onychauxis is a thick nail due to psoriasis, trauma or fungal nail infection.
Angel-wing deformity
Angel-wing deformity describes nail plate thinning due to lichen planus.
Nail plate crumbling
Nail plate crumbling is typical of psoriasis and fungal nail infection.
Onychoschizia
Onychoschizia is distal lamellar or splitting/brittle nails due to water/detergent damage.
Longitudinal splitting
Longitudinal nail splitting is an extension of ridging seen in psoriasis, a fungal nail infection or lichen planus. Distal splitting in association with a pigmented or red linear band can be a sign of onychopapilloma.
Distal notching
Distal notching of the nail occurs from trauma, Darier disease, and lichen planus.
Trachyonychia
Trachyonychia means rough nails. Trachyonychia is characteristic of lichen planus. Twenty nail dystrophy is trachyonychia of all nails.
Erosion
Nail erosion is due to trauma or malignant tumours, such as squamous cell carcinoma or melanoma.
Acrylic nails
These images show acrylic nails used as decorative cosmetics.
Nail discolouration
Distinguish a discoloured nail bed from a discoloured nail plate.
Yellow nail syndrome
Yellow nail syndrome refers to multiple yellow nails due to lymphatic obstruction in cardiopulmonary disease.
Green nails
Green nails are associated with Pseudomonas or Candida infection.
Yellow nails due to fungal nail infection
Lateral yellow streak
See onychomycosis.
Yellow nails due to psoriasis
Oil drop or salmon patch
Yellow nails in psoriasis is due to onycholysis, lifting of the nail plate from the nail bed (see below).
Brown nails
If nails are brown coloured, consider staining (nicotine, potassium permanganate, nail varnish) and chemotherapy. Illustrated are staining from podophyllin and streaks due to oral hydroxyurea. Brown nails may also be due to onychomycosis and in dark-skinned individuals, inflammatory conditions like lichen planus. See also melanonychia and multiple brown linear streaks below.
Vitiligo
Leukonychia
White nails. Consider hypoalbuminaemia or chronic renal failure. May also be familial. Transverse leukonychia, in which there are multiple parallel white lines, is thought to be due to manicuring. It may also arise in association with Beau lines.
White streaks
These images show white streaks due to trauma, such as manicuring.
Onycholysis
These images show the lifting of the distal nail plate, which appears white or yellow. Consider idiopathic causes, trauma, psoriasis, thyrotoxicosis, irritant and allergic contact dermatitis, fungal nail infection (candida), drug photosensitivity (especially tetracycline and psoralens)
White spotting
Superficial white onychomycosis
Half-and-half nails
Half-and-half nails occur in renal failure as a white proximal nail, with a brown distal nail.
Terry nail
Terry nail occurring with liver cirrhosis presents as a white proximal nail, and reddened distal nail.
Mee lines
Mee lines are partial leukonychia due to arsenic intoxication or systemic disease.
Muehrcke lines
Muehrcke lines are a double band of leukonychia in renal disease.
Red lunula
Red longitudinal streaks
A red longitudinal streak or erythronychia is often due to onychopapilloma.
Red and white streaks
See Darier disease.
Red, tender area
If a red spot is tender, consider glomus tumour.
Blue nail
If nails are discoloured blue, consider drugs if all nails are affected, in this case, due to minocycline.
Red/purple streak
A red or purple streak is known as a splinter haemorrhage.
Purple/black nail
Subungual haemorrhage or haematoma (blood clot) causes a purple or black discolouration.
Black nail
A black nail may be due to a pseudomonas infection
Melanonychia
Melanonychia is a brown/black longitudinal band due to benign melanocytic naevus.
Multiple brown linear streaks
Longitudinal melanonychia may be of racial origin, Laugier-Hunziker syndrome. Rarely due to drug (azidothymidine, tetracycline), endocrine disorders or Peutz-Jeghers syndrome.
Expanding variable colour/shaped streak
Consider melanoma.
Abnormalities of the cuticle and nail fold
The cuticle is a sheet of keratin joining the skin of the proximal nail fold to the nail plate, protecting the space under the proximal nail fold. Loss of cuticle results in paronychia.
Ragged cuticles
Ragged cuticles are characteristic of connective tissue disease, and also occur in parakeratosis pustulosa.
Hangnail
Hangnail can be due to trauma (eg, nail biting).
Nail fold telangiectases
Nail fold telangiectases are characteristic of connective tissue disease, for example, lupus erythematosus.
Occlusive vasculopathy
Subungual hyperkeratosis
Subungual hyperkeratosis is scaling under the hyponychium. Typical of psoriasis and onychomycosis, it is also seen in crusted scabies.
Pterygium
A pterygium is a wing of extra tissue. In a nail, it is due to scarring in the matrix. Characteristic of lichen planus, but may also occur in Stevens-Johnson syndrome and after trauma.
Acute paronychia
Staphylococcus aureus is the main cause of acute paronychia.
Herpes simplex is another common cause of acute paronychia.
Chronic paronychia
Chronic paronychia is associated with dermatitis, and infection with Candida albicans and Pseudomonas.
Acrodermatitis continua of Hallopeau
Acrodermatitis continua of Hallopeau is a form of severe psoriasis
Retronychia
Retronychia refers to the embedding of the proximal nail plate into the proximal nail fold with subsequent painful nail fold inflammation and thickening, and granulation tissue, usually seen in the great toes. It typically results from trauma pushing the nail plate up with a new plate growing out underneath. Treatment is the removal of the nail.
Abnormalities of nail shape
Enlarged nail
Long nail
Brachyonychia
Short nail
Over-curvature
Clubbing is due to hypertrophic osteoarthropathy or thyroid disease (acropachy); see hypertrophic osteoarthropathy.
Koilonychia
Koilonychia is a thin, spoon-shaped nail, and can occur in normal children and adults. It is also associated with iron deficiency anaemia, diabetes, protein deficiency, connective tissue disease, nail exposure to solvents and acitretin treatment.
Pachyonychia
Pincer nail is sometimes familial or associated with psoriasis.
Onychocryptosis
Onychocryptosis is commonly known as an in-grown nail, and involves the lateral nail folds with granuloma formation. Often aggravated by oral retinoids, isotretinoin and acitretin.
Loss of nails
Without scarring
Usually, traumatic, such as nail-biting; in children parakeratosis pustulosa
Scarring
Onychomadesis
Nail-patella-syndrome
Lesions around nails
Common skin lesions around nails include:
Viral warts
Melanocytic naevus
Subungual melanoma
Squamous cell carcinoma or keratoacanthoma
Corn
Subungual fibroma
Inclusion cyst
Onychomatricoma
Subungual exostosis
Giant cell tumour of tendon sheath
Myxoid cyst
Pyogenic granuloma
See smartphone apps to check your skin.
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Related information
References
- Diseases of the Nails and Their Management 3rd Edition. Eds Baran, Dawber, Deberker, Haneke, Tosti. Publ Blackwell, 2001.
On DermNet NZ
Other websites
- Nail Diseases — Medline Plus
- Psoriasis, nails — Medscape Reference
- Clubbing — Medscape Reference
- Atlas of Nail Disorders — PDF download
Books about skin diseases