Horizontal ridging

• Beau's lines may be seen after systemic illness and acute episodes of hand dermatitis.

Pigmented streaks

Malignant melanoma Normal in pigmented skin

• Melanocytic naevi

• Addison's disease

Melanocystic naevus

Psoriasis

Onycholysis due to psoriasis

Onycholysis due to psoriasis

Psoriasis

Onycholysis due to psoriasis

Onycholysis due to psoriasis

Longitudinal ridging

• Single due to pressure from nail fold tumours

• Multiple due to lichen planus

• Alopecia areata

Ridging represents a disturbance of nail growth. Inflammation as seen in acute paronychia or trauma can result in a single nail developing a horizontal ridge. After an acute illness there may be horizontal lines on all the nails. The lines may also occur with eczema.

A single longitudinal ridge can result from pressure due to benign or malignant tumours in the nail fold. A mucoid cyst can produce a longitudinal ridge. Multiple longitudinal lines are characteristic of lichen planus, psoriasis, alopecia areata, and Darier's disease.

Koilonychia is a concave deformity of the nail plate, generally occurring in the finger nails. It may be idiopathic or occur as a result of iron deficiency anaemia.

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