Colour changes

All the nails may be white (leukonychia) due to hypoalbuminaemia in conditions such as cirrhosis of the liver. Brown discoloration is seen in renal failure and the "yellow nail syndrome", may be associated with abnormalities of the lymphatic drainage. The nail may have a yellow colour in jaundice. Drugs may cause changes in colour, for example tetracycline may produce yellow nails, antimalarials a blue

Pitting of nail

Lichen planus

Pitting of nail

Lichen planus

Dystrophy due to lupus erythematosus

Pterygium formation due to lichen planus

Dystrophy due to lupus erythematosus

Pterygium formation due to lichen planus

Nail dystrophy

Beau's line

Nail dystrophy

Beau's line

Clubbing

Yellow nail syndrome

Leukonychia

Yellow nail syndrome

Leukonychia discolouration, and chlorpromazine a brown colour. Leuconychia or whiteness of the nails occurs in fungal infections. Small white spots on the nail are quite commonly seen and are thought to be due to trauma of the nail plate.

Longitudinal pigmented streaks result from increased melanin deposition in the nail plate.

Longitudinal brown streaks are frequently seen in individuals with racially pigmented skin, particularly after trauma. This is rare in caucasians but occurs as a result of a benign pigmented naevus at the base of the nail and in associated lentigo. The most important cause to remember is subungual melanoma, which may present with a longitudinal deep brown or black streak. Hutchinson's sign with pigmentation extends into the surrounding tissues, particularly the cuticle. Adrenal disease may rarely be associated with longitudinal streaks.

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