Common

High fever Postnatal

Menstrual cycle (multiple grooves), dysmenorrhoea

Measles

Trauma

Chronic paronychia Local inflammation Chronic eczema Uncommon Kawasaki syndrome

Stevens-Johnson syndrome Cytotoxic drugs

Acrodermatitis enteropathica and zinc deficiency

Hypoparathyroidism

Syphilis

Mouth, hand and foot disease Radiation

Carpal tunnel syndrome_

When a series of transverse grooves parallels the proximal nail fold the cause is likely to be repeated trauma from overzealous manicuring. 'Rhythmic' parallel transverse grooves may be an isolated sign of psoriasis, equivalent to patterned pitting.

The nervous habit of pushing back the cuticle usually affects the thumbs which are damaged by either the thumb nail of the opposite hand or the index finger nail of the corresponding hand: symmetrical involvement of the thumbs is the rule and damage is most commonly effected by the thumb nail of the other hand (see Figures 3.14, 3.16). Occasionally only one thumb is affected; rarely, other digits may be involved, the thumb reversing roles and creating the damage. This produces:

1 Swelling, redness and scaling of the proximal nail fold from the mechanical injury.

2 Multiple horizontal grooves that do not extend to the lateral margin of the nail; often filled with debris, they are interspersed between the ridges.

3 A large central longitudinal or slightly lateral depression along the nail mimicking median canaliform dystrophy, with an enlarged lunula.

Table 3.2 lists causes of transverse groove formation.

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