Nail changes: Difference between revisions

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{{DiseaseDisorder infobox |
'''For patient information, click [[Nail changes (patient information)|here]]'''
  Name          = Nail disease |
  ICD10          = {{ICD10|L|60||l|60}} |
  ICD9          = {{ICD9|703}} |
  ICDO          = |
  Image          = ONYCHIA1.JPG |
  Caption        = Onychia without [[granuloma]] |
  OMIM          = |
  MedlinePlus    = 003247 |
  eMedicineSubj  = |
  eMedicineTopic = |
  DiseasesDB    = 23092 |
}}
{{SI}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}


{{SK}} nail abnormality, nail disorders, nail signs
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}; {{MJM}}
 
{{SK}} Nail abnormality; nail disorders; nail signs


==Overview==
==Overview==
'''Nail diseases''' are distinct from diseases of the skin. Although [[nail (anatomy)|nail]]s are a skin appendage, they have their own signs and symptoms which may relate to other medical conditions. Nail conditions that show signs of [[infection]] or [[inflammation]] require medical assistance and cannot be treated at a beauty parlor. [[Deformity]] or [[disease]] of the nails may be referred to as '''onychosis'''.
'''Nail diseases''' are distinct from diseases of the skin. Although [[nail (anatomy)|nail]]s are a skin appendage, they have their own signs and symptoms which may relate to other medical conditions. Nail conditions that show signs of [[infection]] or [[inflammation]] require medical assistance and cannot be treated at a beauty parlor. [[Deformity]] or [[disease]] of the nails may be referred to as '''onychosis'''.
There are many examples of how nail changes can play a role in helping to diagnose certain conditions. For example, short, small nail beds, and redness are associated with various [[heart disease|heart conditions]].


==Classification Scheme==
==Classification Scheme==
[http://www.peir.net Some images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]


===[[Beau lines]]===
[[Image:Subungual_melanoma.jpg|left|150x200px]][[Acral lentiginous melanoma]]<br>'''Doctor definition:''' Acral lentiginous melanoma is a kind of skin [[melanoma]], and it is also known as subungual melanoma.<br>'''Patient definition:''' Acral lentiginous melanoma is a kind of skin cancer, and it is also know as a skin cancer that manifests under the nail.{{clr}}
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===[[Digital clubbing]]===
[[Image:acrocyanosis.jpg|left|150x200px]][[Acrocyanosis]]<br>'''Doctor definition:''' Acrocyanosis is a persistent blue or cyanotic discoloration of the digits. <br>'''Patient definition:''' Acrocyanosis is a blue discoloration ([[cyanosis]]) of the fingers and the fingernails. {{clr}}
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===[[Koilonychia]]===
[[Image:Secondary_aterosclerotic_changes.Nail.jpg‎|left|150x200px]][[Atherosclerosis]]<br>'''Doctor definition:''' Atherosclerosis is a [[disease]] affecting [[arterial]] [[blood vessels]] and it can cause changes to the nail beds.<br> '''Patient definition:''' Atherosclerosis is a disease affecting arterial blood vessels and it can cause changes to the nail beds.{{clr}}
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===[[Nail discoloration]]===
[[Image:Beaus_groove.Nail.jpg‎|left|150x200px]][[Beau's lines]]<br>'''Doctor definition:''' Beau's lines are deep grooved lines that run from side to side on the [[fingernail]].<br>'''Patient definition:''' Beau's lines are deep grooved lines that run from side to side on the fingernail.{{clr}}
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===[[Nail pitting]]===
[[Image:Bowens_carcinoma.jpg|left|150x200px]][[Bowen's disease]]<br>'''Doctor definition:''' Bowen's disease is a sunlight induced skin disease considered either as an early stage or intraepidermal form of [[squamous cell carcinoma]].<br>'''Patient definition:''' Bowen's disease is a sunlight induced skin disease considered an early stage for of skin cancer.{{clr}}
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===[[Onycholysis]]===
[[Image:Brittle nails.jpg|left|150x200px]][[Brittle nails]]<br>'''Doctor definition:''' Brittle nails is a condition where the nails are fragile and break frequently.<br>'''Patient definition:''' Brittle nails is a condition where the nails are fragile and break frequently.{{clr}}
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===[[Onychorrhexis]]===
[[Image:ClubbingFingers1.jpg‎|left|150x200px]][[Digital clubbing]]<br>'''Doctor definition:''' Digital clubbing is a deformity of the fingers and fingernails that is associated with a number of diseases, mostly of the heart and lungs.<br>'''Patient definition:''' Digital clubbing is a deformity of the fingers and fingernails that is associated with a number of diseases, mostly of the heart and lungs.{{clr}}
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===[[Pachyonychia]]===
[[Image:Half and half.jpg|left|150x200px]][[Half and half nails]]<br>'''Doctor definition:''' Half and half nails refer to a change in the appearance of the nails due to internal diseases and nutritional deficits.<br>'''Patient definition''' Half and half nails refer to a change in the appearance of the nails due to internal diseases and nutritional deficits.{{clr}}
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===[[Paronychia]]===
[[Image:Whitlow.Herpetic disease.Nail.jpg|left|150x200px]][[Herpes simplex]]<br>'''Doctor definition:''' Herpes simplex is a [[viral disease]] caused by [[Herpes simplex viruses]].<br>'''Patient definition:''' Herpes simplex is a [[viral disease]] caused by [[Herpes simplex viruses]].{{clr}}
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===[[Platonychia]]===
[[Image:Trophic changes.jpg|left|150x200px]][[Ischemia]]<br>'''Doctor definition:''' Ischemia is a restriction in blood supply, generally due to factors in the [[blood vessels]], which result in damage or dysfunction of tissue.<br>'''Patient definition:''' Ischemia is a restriction in blood supply, generally due to factors in the blood vessels, which result in damage or dysfunction of tissue.{{clr}}
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===[[Ridged nails]]===
[[Image:Koilonychia.jpg|left|150x200px]][[Koilonychia]]<br>'''Doctor definition:''' Koilonychia refers to nails (usually of the hand) which have lost their convexity, becoming flat or even concave in shape.<br>'''Patient defintion:''' Koilonychia literally means spoon nails. It is when your nails become flat or sunken in. {{clr}}
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===[[Splinter hemorrhages]]===
[[Image:Leukonychia.jpg|left|150x200px]][[Leukonychia]]<br>'''Doctor definition:''' Leukonychia  is a medical term for white discoloration appearing on nails.<br> '''Patient defintion:''' Leukonychia is a medical term for white discoloration appearing on nails.{{clr}}
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===[[Subungual hyperkeratosis]]===
[[Image:Lichen planus.Nail.jpg|left|150x200px]][[Lichen planus]] nail changes<br> '''Doctor definition:''' Lichen planus is an [[inflammatory disease]] that affects the [[skin]] and the [[oral mucosa]].<br>'''Patient definition:''' Lichen planus is an inflammatory disease that affects the skin and the mouth.{{clr}}
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<div align="left">
[[Image:Mees line.JPG|left|150x200px]][[Mee's lines]]<br>'''Doctor definition:''' Mees' lines are lines of discoloration across the nails of the fingers and toes after an episode of [[poisoning]] with [[arsenic]] or [[thallium]] or other [[heavy metal]]s.<br> '''Patient definition:''' Mees' lines are lines of discoloration across the nails of the fingers and toes after an episode of [[poisoning]] with [[arsenic]] or [[thallium]] or other [[heavy metal]]s.{{clr}}
<gallery heights="175" widths="175">
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Image:Fingernail label.jpg|A normal nail
Image:Fingernails1.JPG|Normal fingernails
</gallery>
</div>


[[Image:Brown banding.jpg|left|150x200px]][[Melanonychia]]<br>'''Doctor definition:''' Melanonychia is a black or brown pigmentation of the normal nail plate that can present as horizontal or longitudinal bands.<br>'''Patient definition:''' Melanonychia is a black or brown pigmentation of the normal nail plate that can present as horizontal or longitudinal bands.{{clr}}
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<div align="left">
[[Image:Muehrcke's lines.JPG|left|150x200px]][[Muehrcke's lines]]<br>'''Doctor definition:''' Muehrcke's lines are white lines across the nail associated with [[hypoalbuminemia]].<br>'''Patient definition:''' Muehrcke's lines are white lines across the nail associated with low levels of the most abundant blood protein ([[albumin]]).{{clr}}
<gallery heights="175" widths="175">
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Image:Toes.jpg|Normal toenails
Image:HEMORRHAGESUBUNG1.JPG|Subungual hematoma (mild)
</gallery>
</div>


==Diseases==
[[Image:ONYCHIA1.JPG|left|150x200px]][[Onychia]]<br>'''Doctor definition:''' Onychia is an inflammation of the matrix of the nail with formation of [[pus]] and shedding of the nail.<br>'''Patient definition:''' Onychia is an inflammation of the surrounding tissue ([[matrix]]) of the nail with formation of [[pus]] and shedding of the nail.{{clr}}
*''Onychia'' is an inflammation of the matrix (surrounding tissue) of the nail with formation of [[pus]] and shedding of the nail. Onychia results from the introduction of microscopic [[pathogen]]s through small wounds.  
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*''[[Ingrown nail|Onychocryptosis]]'', commonly known as "ingrown nails" (''unguis incarnatus''), can affect either the fingers or the toes.  In this condition, the nail cuts into one or both sides of the nail bed, resulting in inflammation and possibly infection. The relative rarity of this condition in the fingers suggests that pressure from the ground or shoe against the toe is a prime factor. The movements involved in [[walking]] or other physical disturbances can contribute to the problem.  Mild onychocryptosis, particularly in the absence of infection, can be treated by trimming and rounding the nail.  More advanced cases, which usually include infection, are treated by surgically excising the ingrowing portion of the nail down to its bony origin and thermally or chemically [[cauterizing]] the matrix, or 'root', to prevent recurrence.  This surgery is called matrixectomy. The best results are achieved by cauterizing the matrix with [[phenol]]. Another, much less effective, treatment is [[excision]] of the matrix, sometimes called a 'cold steel procedure'.  
[[Image:Ingrown_nail_002.jpg|left|150x200px]][[Onychocryptosis]]<br>'''Doctor definition:''' Onychocryptosis is a painful condition in which the nail grows or cuts into one or both sides of the nail bed.<br>'''Patient defintion:''' Onychocryptosis is a painful condition in which the nail grows or cuts into one or both sides of the nail bed.{{clr}}
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*''Onychodystrophy'' is a deformation of the nails that can result from cancer chemotherapy which includes bleomycin, hydroxyurea, or 5-fluorouracil. It can include discoloration of the nail, or dyschromia.
[[Image:Onychodystrophy.jpg|left|150x200px]][[Onychodystrophy]]<br>'''Doctor definition:''' Onychodystrophy is a deformation of the nails that can result from cancer chemotherapy which includes [[bleomycin]], [[hydroxyurea]], or [[5-fluorouracil]].<br> '''Patient definition:''' Onychodystrophy is a deformation of the nails that can result from certain cancer drugs (bleomycin, hydroxyurea, or 5-fluorouracil).{{clr}}
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*''[[Onychogryposis]]'', also called "ram's-horn nail", is a thickening and increase in curvature of the nail. It is usually the result of injury to the matrix.  It may be partially [[hereditary]] and can also occur as a result of long-term neglect.  It is most commonly seen in the great toe but may be seen in other toes as well as the fingernails.  An affected nail has many grooves and ridges, is brownish in color, and grows more quickly on one side than on the other.  The thick curved nail is difficult to cut, and often remains untrimmed, exacerbating the problem.
[[Image:ONYCHOGRYPHOSIS1.JPG‎|left|150x200px]][[Onychogryphosis]]<br>'''Doctor definition:''' Onychogryposis, also called "ram's-horn nail", is a thickening and increase in curvature of the nail.<br>'''Patient definition:''' Onychogryposis, also called "ram's-horn nail", is a thickening and increase in curvature of the nail.{{clr}}
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*''Onycholysis'' is a loosening of the exposed portion of the nail from the nail bed, usually beginning at the free edge and continuing to the [[lunula (anatomy)|lunula]]. It is frequently associated with an internal disorder, trauma, infection, nail fungi, allergy to nail enhancement products, or side effects of drugs.
[[Image:Onycholysis.jpg|left|150x200px]][[Onycholysis]]<br>'''Doctor definition:''' Onycholysis is a loosening of the exposed portion of the nail from the nail bed, usually beginning at the free edge and continuing to the [[lunula]].<br> '''Patient definition:''' Onycholysis is a loosening of the exposed portion of the nail from the nail bed, usually beginning at the free edge and continuing to the crescent-shaped whitish area of the bed of a fingernail or toenail.{{clr}}
*''Onychomadesis'' is the separation and falling off of a nail from the nail bed.  Common causes include localized infection, minor injury to the matrix bed, or severe systemic illness. It is sometimes a side effect of [[chemotherapy]] or [[x-ray]] treatments for [[cancer]].  A new nail plate will form once the cause of the disease is removed.
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*''[[Onychomycosis]]'', also known as [[tinea|''tinea unguium'']], is a contagious infection of the nail caused by the same fungal organisms which cause [[ringworm]] of the skin (''Trichophyton rubrum'' or ''T. mentagrophytes'', rarely other trichophyton species or ''Epidermophyton floccosum'' <ref name="mycology">{{cite book |last= Hall |first= John C. |editor= John C. Hall |title= Sauer's Manual of Skin Diseases |edition= 9th edition |year= 2006 |publisher= Lippincott Williams & Wilkins |location= Philadelphia |isbn= 0-7817-2947-5|pages= 244=266 |chapter= 25. Dermatologic mycology.}}</ref>). It can result in discoloration, thickening, chalkiness, or crumbling of the nails and is often treated by powerful oral medications which, rarely, can cause severe side effects including liver failure. Mild onychomycosis sometimes responds to a combination of topical antifungal medication, sometimes applied as special medicinal nail lacquer, and periodic filing of the nail surface. For advanced onychomycosis, especially if more than one nail is infected, systemic medication (pills) is preferred. Home remedies are often used, although their effectiveness is disputed. In a study at the University of Rochester [[tea tree oil]] applied twice daily in conjunction with [[debridement]] was found to be an appropriate initial treatment strategy, equally effective to topical use of [[clotrimazole]]<ref name="scratch">[http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=8195735&dopt=AbstractPlus].</ref>.  Another procedure is to apply two drops of distilled white vinegar to the nail base, or, additionally, nail plate and under the nail, two or three times daily for approximately six months or until the fungus is gone. This treatment is very effective, due to the vinegar's acidity, if followed consistently.


*''Onychophosis'' is a growth of horny [[epithelium]] in the nail.
[[Image:copyleft_request.jpg|left|150x200px]][[Onychomadesis]]<br>'''Doctor definition:''' Onychomadesis is a periodic [[idiopathic]] shedding of the nails beginning at its [[proximal]] end.<br>'''Patient definition:''' Onychomadesis is a periodic, spontaneous shedding of the nails beginning at the end closer to the finger.{{clr}}
*''Onychoptosis'' is the periodic shedding of one or more nails, in whole or part. This condition may follow certain diseases such as [[syphilis]], or can result from [[fever]], [[Physical trauma|trauma]], systemic upsets or adverse reaction to drugs.
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*''[[Paronychia]]'' is a bacterial or fungal infection where the nail and skin meet. {{main|Paronychia}}
*''[[Koilonychia]]'' is when the nail curves upwards (becomes spoon-shaped) due to an [[iron deficiency]].  The normal process of change is: brittle nails, straight nails, spoon-shaped nails.


*''[[Subungual hematoma]]'' occurs when trauma to the nail results in a collection of blood, or [[hematoma]], under the nail. It may result from an acute injury or from repeated minor trauma such as running in undersized shoes.  Acute subungual hematomas are quite painful, and are usually treated by releasing the blood by creating a small hole in the nail.  Drilling and thermal cautery (melting) are common methods for creating the hole.  Thermal cautery is not used on acrylic nails because they are flammable.
[[Image:Toefungus.jpg|left|150x200px]][[Onychomycosis]]<br>'''Doctor definition:''' Onychomycosis is a fungal infection of the nails.<br> '''Patient definition:''' Onychomycosis is a fungal infection of the nails.{{clr}}
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==Associated Conditions with Nail Changes==
[[Image:Copyleft_request.jpg|left|150x200px]][[Onychophosis]]<br>'''Doctor definition:''' Onychophosis is a localized or diffuse hyperkeratotic tissue that develops on the lateral or proximal nailfolds, within the space between the nailfolds and the nail plate.<br>'''Patient definition:''' Onychophosis is a localized or diffuse excess of the nail proteins that develops on the side of the nail closer to the finger. This forms specifically in the space between the nail folds and nail plate.{{clr}}
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Nail inspection can give a great deal of information about the internal working of the body as well, and like tongue or [[Iris (anatomy)|iris]] inspection, has a long history of diagnostic use in traditional medical practices such as [[Chinese medicine]].  
[[Image:Copyleft_request.jpg|left|150x200px]][[Onychoptosis]]<br>'''Doctor definition:''' Onychoptosis is the periodic shedding of the nails.<br>'''Patient definition:''' Onychoptosis is the periodic shedding of the nails.{{clr}}
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===Pliability:===
[[Image:Copyleft_request.jpg|left|150x200px]][[Pachyonychia]]<br>'''Doctor definition:''' Pachyonychia is an autosomal dominant skin disorder.<br>'''Patient definition:''' Pachyonychia is a skin disorder that is expressed when the specific gene is present.{{clr}}
*Brittleness is associated with iron deficiency, thyroid problems,<ref>http://www.bhcs.com/healthinformation/baylorhealthmagazine/2005/nov/AS_thyroid.htm</ref> impaired kidney function, circulation problems, and biotin deficiency<ref name="scratch" />
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*Splitting and fraying are associated with psoriasis and deficiencies of folic acid, protein and Vitamin C.
*Unusual thickness is associated with circulation problems.
*Thinning nails and itchy skin are associated with [[lichen planus]]<ref name="jewel">Judith Cobb, [http://www.nspforum.com/faq/index.cgi?read=929 Fingernails, Jewels or Tools]? ''Nature's Field'' - Nail diagnosis]</ref>.


===Shape and texture:===
[[Image:Lower_paronychia2.jpg‎‎|left|150x200px]][[Paronychia]]<br> '''Doctor defintion:''' Paronychia is an often tender bacterial or fungal infection where the nail and skin meet at the side or the base of a finger or toenail.<br> '''Patient definition:''' Paronychia is an often tender infection where the nail and skin meet at the side or the base of a finger or toenail.<br>{{clr}}
*Clubbing, or nails that curve down around the fingertips with nailbeds that bulge is associated with oxygen deprivation and lung, heart, or liver disease.
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*Spooning, or nails that grow upwards is associated with iron or B12 deficiency.
*Flatness can indicate a B12 vitamin deficiency<ref name="jewel" /> or [[Raynaud's disease]]<ref name="tool">Mariann Cade, [http://www.nspforum.com/faq/bbs.cgi?read=1191 Fingernails - Diagnostic Tool]</ref>
*Pitting of the nails is associated with [[Psoriasis]].
*Ridges across the nail indicate stress.
*[[Beau's lines]] across the nail are associated with many serious conditions.
*Ridges along the nail are associated with arthritis<ref name="scratch" />.
*Grooves  along the nail are associated with kidney disorders, aging, and iron deficiency<ref name="scratch" />.
*Beading is associated with [[rheumatoid arthritis]]<ref name="scratch" />.
*Nails that resemble hammered brass are associated with (or portend) [[hair loss]]<ref name="jewel" />.
*Short small beds are associated with heart disease.


===Coloration of the nail bed:===
[[Image:Copyleft_request.jpg|left|150x200px]][[Pitted nails]]<br> '''Doctor definition:''' Pitted nails are pinpoint depressions in the nails.<br>'''Patient definition:''' Pitted nails are pinpoint depressions in the nails.{{clr}}
*[[Mee's lines]] are associated with [[arsenic]] or [[thallium]] [[poison]]ing, and renal failure.
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*White lines across the nail are associated with heart disease, liver disease, or a history of a recent high fever<ref name="jewel" />.
*[[Terry's nails|Opaque white nails with a dark band at the fingertip]] are associated with cancer, cirrhosis, congestive heart failure, diabetes and aging<ref name="jewel" />.
*Paleness or whitening is associated with liver or kidney disease and anemia<ref name="jewel" />.
*Yellowing of the nail bed is associated with chronic bronchitis, lymphatic problems, diabetes, and liver disorders.
*Brown or copper nail beds are associated with arsenic or copper poisoning, and [[Onychomycosis|local fungal infection]].
*Grey nail beds are associated with [[arthritis]], [[edema]], [[malnutrition]], post-[[Surgery|operative]] effects, [[glaucoma]] and [[cardio]]-[[pulmonary]] disease.
*Redness is associated with heart conditions.
*Dark nails are associated with B12 deficiency.
*Stains of the nail plate (not the nail bed) are associated with nail polish<ref name="scratch" />, smoking, and henna use.


===Markings:===
[[Image:Copyleft_request.jpg|left|150x200px]][[Platonychia]]<br> '''Doctor definition:''' Platonychia is characterized by an abnormally flat and broad nail.<br> '''Patient definition:''' Platonychia is characterized by an abnormally flat and broad nail.{{clr}}
*Pink and white nails are associated with kidney disease<ref name="jewel" />.
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*[[Muehrcke's lines]] are white lines across the nail associated with [[hypoalbuminemia]].
*Red skin at the base of the nail is associated with connective tissue disorders<ref name="jewel" />.
*Blue lunulae are associated with silver poisoning or lung disorder<ref name="jewel" />.
*Blue nail beds are (much like blue skin) associated with poor oxygenation of the blood ([[asthma]], [[emphysema]], etc)<ref name="jewel" />.
*[[Leukonychia|Small white patches]] are associated with zinc or calcium deficiency or malabsorption, parasites, or local injury<ref name="tool" />.
*Receded lunulae (fewer than 8) are associated with poor circulation<ref name="tool" />, shallow breathing habits or thyroid mysfunction<ref name="jewel" />.
*Large lunulae (more than 25% of the thumb nail) are associated with high blood pressure.


== Diagnosis ==
[[Image:Psoriasis fingernail.jpg|left|150x200px]][[Psoriatic nails]]<br> '''Doctor definition:''' Psoriatic nails is a common nail disease associated with people who have [[psoriasis]].<br> '''Patient definition:''' Psoriatic nails is a common nail disease associated with people who have a scaly skin rash (psoriasis).{{clr}}
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=== History and Symptoms ===
[[Image:Scleroderma nail.jpg|left|150x200px]][[Scleroderma]]<br>'''Doctor definition:''' Scleroderma is a rare, [[chronic disease]] characterized by  excessive deposits of [[collagen]] in the [[skin]] or other organs.<br>'''Patient definition:''' Scleroderma is a rare, long lasting disease characterized by excessive deposits of a structural protein in the skin or other organs.{{clr}}
* History of [[psoriasis]]
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* Family history
* Occupational history
* Hobbies


=== Physical Examination ===
[[Image:Skin_carcinoma.Nail.jpg|left|150x200px]][[Skin cancer]]<br>'''Doctor definition:''' Skin cancer is a [[malignant]] growth on the [[skin]] which can have many causes.<br>'''Patient definition:''' Skin cancer is invasive, spreading cancer on the skin which can have many causes.{{clr}}
* Complete skin exam
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=== Laboratory Studies ===
[[Image:Splinter_hemorrhage.jpg‎|left|150x200px]][[Splinter hemorrhage]]<br> '''Doctor defintion:''' Splinter hemorrhages are tiny lines that run vertically under the nails.<br>'''Patient definition:''' Splinter hemorrhages are tiny lines that run vertically under the nails.{{clr}}
* Periodic Acid-Schiff (PAS)
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* Fungal cultures
* Bacterial cultures


=== Other Diagnostic Studies ===
[[Image:HEMORRHAGESUBUNG1.JPG‎|left|150x200px]][[Subungual hematoma]]<br>'''Doctor definition:''' A subungal hematoma is a hematoma underneath a toenail or fingernail which often results from a traumatic injury such as slamming a finger in a door.<br>'''Patient definition:''' A subungal hematoma is a collection of blood underneath a toenail or fingernail which often results from a traumatic injury such as slamming a finger in a door.{{clr}}
* [[Nail matrix]] [[biopsy]]
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* Possible dermatology referral


== Differential Diagnosis of Causes of Nail changes==
[[Image:Copyleft_request.jpg|left|150x200px]][[Terry's nails]]<br>'''Doctor definition:''' Terry's nails is a physical finding in which fingernails and/or toenails appear white with a characteristic "ground glass" appearance, with no [[lunula]].<br>'''Patient definition:''' Terry's nails is a physical finding in which fingernails and/or toenails appear white with a characteristic "ground glass" appearance, with no white crescent shaped area at the bottom of the nail.{{clr}}
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=== Beau's Lines ===
[[Image:Trauma.Nail.jpg|left|150x200px]][[Trauma]]<br>'''Doctor definition:''' Trauma refers to a physical injury.<br>'''Patient definition:''' Trauma refers to a physical injury.{{clr}}
''Transverse furrows, sign of a previous arrest in the growth process''
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*[[Coronary occlusion]]
*[[Delirium]]
*[[Depression]]
*[[Gout]]
*[[Malnutrition]]
*[[Reiter's Disease]]
*[[infectious disease|Severe infectious disease]]
*[[Shock]]
*[[Surgery]]
*[[Toxin]]s
*[[Trauma]]
*[[nail matrix|Traumatic damage to nail matrix]]


=== Blue discoloration ===
[[Image:Subungual_fibroma.jpg|left|150x200px]][[Tuberous sclerosis]]<br>'''Doctor definition:''' Tuberous sclerosis is a rare, multi-system [[genetic disorder|genetic disease]] that causes benign tumors to grow in the [[brain]] and on other vital organs such as the [[kidney]]s, [[heart]], [[eye]]s, [[lung]]s, and [[skin]].<br> '''Patient definition:''' [[Tuberous sclerosis]] is a rare, multi-system [[genetic disorder|genetic disease]] that causes benign tumors to grow in the [[brain]] and on other vital organs such as the [[kidney]]s, [[heart]], [[eye]]s, [[lung]]s, and [[skin]].{{clr}}
*[[Argyria]]
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*[[Dapsone|DADPS]]


=== Brown-black discoloration ===
[[Image:Secondary to warts.Nail.jpg|left|150x200px]][[Wart]]<br>'''Doctor definition:''' A wart is generally a small, rough [[tumor]], typically on hands and feet, that can resemble a cauliflower or a solid [[blister]].<br>'''Patient definition:''' A wart is generally a small, rough tumor, typically on hands and feet, that can resemble a cauliflower or a solid blister.{{clr}}
*[[Acral lentiginous melanoma]]
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*[[Alcaptonuria]]
*[[Hematoma]]
*[[Mole]]s
*[[Ochronosis]]


== Green-black discoloration ==
[[Image:Yellow nail syndrome.jpg|left|150x200px]][[Yellow nail syndrome]]<br>'''Doctor definition:''' Yellow nail syndrome is characterized by yellow nails that lack a cuticle, grow slowly, and are loose or detached ([[onycholysis]]).<br> '''Patient definition:''' Yellow nail syndrome is characterized by yellow nails that lack a cuticle, grow slowly, and are loose or detached (onycholysis).{{clr}}
*[[infection]] with [[pseudomonas aeruginosa]]
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=== Half and Half Nails ===
''White (proximal) and brown (distal) reversible coloration of the nail''
*[[Uremia]]


=== Hippocratic Nails ===
''Large, curved nails that usually occur in conjunction with clubbing''
*[[Arteriovenous fistula|Arteriovenous shunts]]
*[[Biliary Cirrhosis]]
*[[Bronchiectasis]]
*[[Bronchial carcinoma]]
*[[Cerebral contusion|Cerebrovascular trauma]]
*[[Congenital heart disease|Cyanotic congenital heart disease]]
*[[Crohn's Disease]]
*[[Emphysema]]
*[[Heart Failure]]
*[[Infectious Endocarditis]]
*[[Hepatocellular carcinoma|Liver Tumors]]
*[[Lung Abscess]]
*[[Mesothelioma]]
*[[Pachydermoperiostosis]]
*[[Pulmonary artery]] [[sclerosis]]
*[[Pulmonary fibrosis]]
*[[metastase|Pulmonary metastases]]
*[[Silicosis]]
*[[Sprue]]
*[[Tuberculosis]]
*[[Ulcerative Colitis]]


=== [[Koilonychia]] ===
''A malformation of the nails which the outer surface is concave''
*[[Addison's Disease]]
*[[Cushing's Disease]]
*[[Diabetes Mellitus]]
*[[Grave's Disease]]
*[[Hereditary]]
*[[Hypochromic anemia]]
*[[Iron deficiency]]
*[[Malnutrition]]
*[[Multiple Myeloma]]
*[[Pellagra]]
*[[Raynaud's disease]]
*[[Vitamin B12 Deficiency]]


=== [[Leukonychia]] ===
''White coloration of nails''
*[[Anemia]]
*[[Heart disease|Cardiac Diseases]]
*[[Cirrhosis]]
*[[Darier's disease]]
*[[Fever]]
*[[Hypoalbuminemia]]
*[[Mycosis]]
*[[Nitrate]] [[solution]]
*[[Silver]] [[solution]]
*[[Noxa]]
*[[Trauma]]
=== Mee's Lines ===
''Horizontal white bands of the nails''
*[[Drug]]s/[[Toxin]]s
*[[Fluorosis]]
*Occasionally occurs in [[leprosy]]
===Onychogryphosis ===
''Brittle, Split nails''
*[[Anemia]]
*Chronic [[chemical]] damage
*[[Lichen|Lichen ruber]]
*[[Thyroid Disease]]
=== Onchodystrophy ===
''Deformed, brittle, rough, discolored nails''
*[[Eczema]]
*[[Fungal infection]]
*[[Psoriasis]]
=== Onycholysis ===
''Painless loss of the nail''
*[[ICD-10 Chapter IX: Diseases of the circulatory system|Circulatory system diseases]]
*[[Diabetes Insipidus]]
*[[Diabetes Mellitus]]
*[[Drug]]s
*[[Eczema]]
*[[Hemangioma]] under the nail
*[[Onychomycosis]]
*[[Psoriasis]]
*[[Reiter's Disease]]
*[[Thyroid Disease]]
*[[Tumor]]
=== Paronychia ===
''Inflammation of the nail bed''
*[[Bacteria]]l
*[[Candida]]
*[[Syphillis]]
=== Pitted Nails ===
''Pinpoint depressions in the nails''
*[[Alopecia areata]]
*[[Lichen|Lichen ruber]]
*[[Lupus erythematosus]]
*[[Neurodermatitis]]
*[[Psoriasis]]
*[[Rheumatic Fever]]
=== Yellow nails ===
''Yellow-greenish discoloration of the nails (some or all) with subsequent [[onycholysis]]''
*[[Congenital]] [[hypoplasia]] / [[dysplasia]] of peripheral [[lymph vessel]]s
*Diseases of the [[bronchial tube]]s
*Diseases of the [[paranasal sinus]]es
*Smoker's fingers
==Pathological Findings==
[http://www.peir.net Images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]
<div align="left">
<gallery heights="175" widths="175">
image:Acrocyanosis.jpg|[[Acrocyanosis]]: Gross, an excellent example of cyanotic nail beds.
image:Trophic changes.jpg|Trophic Changes: Gross natural color distorted nails and thick skin typical of chronic ischemia
</gallery>
</div>
<div align="left">
<gallery heights="175" widths="175">
image:Halfandhalf.jpg|[[Renal failure]], chronic with nail changes; half and half nails. Left hand more typical. Unusual asymmetrical
image:Hydroxyurea nails.jpg|[[Hydroxyurea]] Nails; Nail changes associated with Hydroxyurea therapy in a patient with essential thrombocythemia.
</gallery>
</div>
<div align="left">
<gallery heights="175" widths="175">
image:Brown banding.jpg|Nail disease, brown banding
image:Secondary to psoriasis.jpg|Nail disease, secondary to [[psoriasis]]
</gallery>
</div>
<div align="left">
<gallery heights="175" widths="175">
image:Paronychia candida.jpg|[[Paronychia]] due to [[Candida]]; nail diseases
image:White banding.jpg|Nail disease; white banding
</gallery>
</div>
<div align="left">
<gallery heights="175" widths="175">
image:Bowens carcinoma.jpg|Nail: Bowen's carcinoma
image:Scleroderma nail.jpg|Nail changes in [[Scleroderma]]. Posterior nail fold.
</gallery>
</div>
<div align="left">
<gallery heights="175" widths="175">
image:Subungual melanoma.jpg|This is a subungual radial growth phase of acral-lentiginous type with two amelanotic vertical growth phase tumor nodules. Radial growth phase is just beginning to grow onto the cuticle of the nail, displaying a subtle example of "Hutchinson's sign."
image:Subungual fibroma.jpg|[[Tuberous sclerosis]]; Subungual fibroma; Beneath the Left Index Nail
</gallery>
</div>
<div align="left">
<gallery heights="175" widths="175">
image:Periungual fibroma.jpg|[[Tuberous sclerosis]], Periungual Fibroma; Lateral Side of Left Great Toe Nail
image:Trauma.Nail.jpg|Traumatic nail changes
</gallery>
</div>
<div align="left">
<gallery heights="175" widths="175">
image:Secondary aterosclerotic changes.Nail.jpg|Secondary atherosclerosis caused nail disorders.
image:Onykomycosis.Nail.jpg|Onychomycosis
</gallery>
</div>
<div align="left">
<gallery heights="175" widths="175">
image:Beaus groove.Nail.jpg|Beau's groove
image:Clubbing.Nail.jpg|Clubbing
</gallery>
</div>
<div align="left">
<gallery heights="175" widths="175">
image:Splitting.Nail.jpg|Splitting
image:Secondary to warts.Nail.jpg|Nail changes secondary to wart.
</gallery>
</div>
<div align="left">
<gallery heights="175" widths="175">
image:Onycholysis.Nail.jpg|Onycholysis
image:Whitlow.Herpetic disease.Nail.jpg|Herpes simplex caused nail disease.
</gallery>
</div>
<div align="left">
<gallery heights="175" widths="175">
image:Lichen planus.Nail.jpg|Nail changes is Lichen planus
image:Skin carcinoma.Nail.jpg|Skin carcinoma
</gallery>
</div>
{{clr}}
== Treatment ==
=== Acute Pharmacotherapies ===
* Systemic antifungals
* Intralesional steroids
* Topical paint-on ciclopirox
* Systemic antipsoriatic therapies
== References ==
{{Reflist|2}}
==See also==
* [[Leukonychia]]
* [[Mee's lines]]
* [[Beau's lines]]
* [[Occupational hazards associated with exposure to human nail dust]]
== External links ==
* [http://www.mckinley.uiuc.edu/handouts/ingrown%5Ftoenail/ingrown%5Ftoenail.html Ingrown Toenail] - explanation covering causes, treatment, and prevention (with diagram)
* [http://www.lib.uiowa.edu/hardin/md/nailspictures.html Links to pictures of Nail Diseases (Hardin MD/Univ of Iowa)]
*[http://www.associatedcontent.com/article/38824/how_fingernail_fungus_spreads_and_how.html How Fingernail Fungus Spreads, and How to Treat It] a practical guide for the layman.
*[http://www.aafp.org/afp/20040315/1417.html Nail Abnormalities: Clues to Systemic Disease]


{{Diseases of the skin and subcutaneous tissue}}
{{Diseases of the skin and subcutaneous tissue}}
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[[Category:Signs and symptoms]]
[[Category:Medical signs]]
[[Category:Dermatology]]
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Latest revision as of 22:52, 29 July 2020

For patient information, click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Michael Maddaleni, B.S.

Synonyms and keywords: Nail abnormality; nail disorders; nail signs

Overview

Nail diseases are distinct from diseases of the skin. Although nails are a skin appendage, they have their own signs and symptoms which may relate to other medical conditions. Nail conditions that show signs of infection or inflammation require medical assistance and cannot be treated at a beauty parlor. Deformity or disease of the nails may be referred to as onychosis.

There are many examples of how nail changes can play a role in helping to diagnose certain conditions. For example, short, small nail beds, and redness are associated with various heart conditions.

Classification Scheme

Some images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

Acral lentiginous melanoma
Doctor definition: Acral lentiginous melanoma is a kind of skin melanoma, and it is also known as subungual melanoma.
Patient definition: Acral lentiginous melanoma is a kind of skin cancer, and it is also know as a skin cancer that manifests under the nail.

Acrocyanosis
Doctor definition: Acrocyanosis is a persistent blue or cyanotic discoloration of the digits.
Patient definition: Acrocyanosis is a blue discoloration (cyanosis) of the fingers and the fingernails.

Atherosclerosis
Doctor definition: Atherosclerosis is a disease affecting arterial blood vessels and it can cause changes to the nail beds.
Patient definition: Atherosclerosis is a disease affecting arterial blood vessels and it can cause changes to the nail beds.

Beau's lines
Doctor definition: Beau's lines are deep grooved lines that run from side to side on the fingernail.
Patient definition: Beau's lines are deep grooved lines that run from side to side on the fingernail.

Bowen's disease
Doctor definition: Bowen's disease is a sunlight induced skin disease considered either as an early stage or intraepidermal form of squamous cell carcinoma.
Patient definition: Bowen's disease is a sunlight induced skin disease considered an early stage for of skin cancer.

Brittle nails
Doctor definition: Brittle nails is a condition where the nails are fragile and break frequently.
Patient definition: Brittle nails is a condition where the nails are fragile and break frequently.

Digital clubbing
Doctor definition: Digital clubbing is a deformity of the fingers and fingernails that is associated with a number of diseases, mostly of the heart and lungs.
Patient definition: Digital clubbing is a deformity of the fingers and fingernails that is associated with a number of diseases, mostly of the heart and lungs.

Half and half nails
Doctor definition: Half and half nails refer to a change in the appearance of the nails due to internal diseases and nutritional deficits.
Patient definition Half and half nails refer to a change in the appearance of the nails due to internal diseases and nutritional deficits.

Herpes simplex
Doctor definition: Herpes simplex is a viral disease caused by Herpes simplex viruses.
Patient definition: Herpes simplex is a viral disease caused by Herpes simplex viruses.

Ischemia
Doctor definition: Ischemia is a restriction in blood supply, generally due to factors in the blood vessels, which result in damage or dysfunction of tissue.
Patient definition: Ischemia is a restriction in blood supply, generally due to factors in the blood vessels, which result in damage or dysfunction of tissue.

Koilonychia
Doctor definition: Koilonychia refers to nails (usually of the hand) which have lost their convexity, becoming flat or even concave in shape.
Patient defintion: Koilonychia literally means spoon nails. It is when your nails become flat or sunken in.

Leukonychia
Doctor definition: Leukonychia is a medical term for white discoloration appearing on nails.
Patient defintion: Leukonychia is a medical term for white discoloration appearing on nails.

Lichen planus nail changes
Doctor definition: Lichen planus is an inflammatory disease that affects the skin and the oral mucosa.
Patient definition: Lichen planus is an inflammatory disease that affects the skin and the mouth.

Mee's lines
Doctor definition: Mees' lines are lines of discoloration across the nails of the fingers and toes after an episode of poisoning with arsenic or thallium or other heavy metals.
Patient definition: Mees' lines are lines of discoloration across the nails of the fingers and toes after an episode of poisoning with arsenic or thallium or other heavy metals.

Melanonychia
Doctor definition: Melanonychia is a black or brown pigmentation of the normal nail plate that can present as horizontal or longitudinal bands.
Patient definition: Melanonychia is a black or brown pigmentation of the normal nail plate that can present as horizontal or longitudinal bands.

Muehrcke's lines
Doctor definition: Muehrcke's lines are white lines across the nail associated with hypoalbuminemia.
Patient definition: Muehrcke's lines are white lines across the nail associated with low levels of the most abundant blood protein (albumin).

Onychia
Doctor definition: Onychia is an inflammation of the matrix of the nail with formation of pus and shedding of the nail.
Patient definition: Onychia is an inflammation of the surrounding tissue (matrix) of the nail with formation of pus and shedding of the nail.

Onychocryptosis
Doctor definition: Onychocryptosis is a painful condition in which the nail grows or cuts into one or both sides of the nail bed.
Patient defintion: Onychocryptosis is a painful condition in which the nail grows or cuts into one or both sides of the nail bed.

Onychodystrophy
Doctor definition: Onychodystrophy is a deformation of the nails that can result from cancer chemotherapy which includes bleomycin, hydroxyurea, or 5-fluorouracil.
Patient definition: Onychodystrophy is a deformation of the nails that can result from certain cancer drugs (bleomycin, hydroxyurea, or 5-fluorouracil).

Onychogryphosis
Doctor definition: Onychogryposis, also called "ram's-horn nail", is a thickening and increase in curvature of the nail.
Patient definition: Onychogryposis, also called "ram's-horn nail", is a thickening and increase in curvature of the nail.

Onycholysis
Doctor definition: Onycholysis is a loosening of the exposed portion of the nail from the nail bed, usually beginning at the free edge and continuing to the lunula.
Patient definition: Onycholysis is a loosening of the exposed portion of the nail from the nail bed, usually beginning at the free edge and continuing to the crescent-shaped whitish area of the bed of a fingernail or toenail.

Onychomadesis
Doctor definition: Onychomadesis is a periodic idiopathic shedding of the nails beginning at its proximal end.
Patient definition: Onychomadesis is a periodic, spontaneous shedding of the nails beginning at the end closer to the finger.

Onychomycosis
Doctor definition: Onychomycosis is a fungal infection of the nails.
Patient definition: Onychomycosis is a fungal infection of the nails.

Onychophosis
Doctor definition: Onychophosis is a localized or diffuse hyperkeratotic tissue that develops on the lateral or proximal nailfolds, within the space between the nailfolds and the nail plate.
Patient definition: Onychophosis is a localized or diffuse excess of the nail proteins that develops on the side of the nail closer to the finger. This forms specifically in the space between the nail folds and nail plate.

Onychoptosis
Doctor definition: Onychoptosis is the periodic shedding of the nails.
Patient definition: Onychoptosis is the periodic shedding of the nails.

Pachyonychia
Doctor definition: Pachyonychia is an autosomal dominant skin disorder.
Patient definition: Pachyonychia is a skin disorder that is expressed when the specific gene is present.

Paronychia
Doctor defintion: Paronychia is an often tender bacterial or fungal infection where the nail and skin meet at the side or the base of a finger or toenail.
Patient definition: Paronychia is an often tender infection where the nail and skin meet at the side or the base of a finger or toenail.

Pitted nails
Doctor definition: Pitted nails are pinpoint depressions in the nails.
Patient definition: Pitted nails are pinpoint depressions in the nails.

Platonychia
Doctor definition: Platonychia is characterized by an abnormally flat and broad nail.
Patient definition: Platonychia is characterized by an abnormally flat and broad nail.

Psoriatic nails
Doctor definition: Psoriatic nails is a common nail disease associated with people who have psoriasis.
Patient definition: Psoriatic nails is a common nail disease associated with people who have a scaly skin rash (psoriasis).

Scleroderma
Doctor definition: Scleroderma is a rare, chronic disease characterized by excessive deposits of collagen in the skin or other organs.
Patient definition: Scleroderma is a rare, long lasting disease characterized by excessive deposits of a structural protein in the skin or other organs.

Skin cancer
Doctor definition: Skin cancer is a malignant growth on the skin which can have many causes.
Patient definition: Skin cancer is invasive, spreading cancer on the skin which can have many causes.

Splinter hemorrhage
Doctor defintion: Splinter hemorrhages are tiny lines that run vertically under the nails.
Patient definition: Splinter hemorrhages are tiny lines that run vertically under the nails.

Subungual hematoma
Doctor definition: A subungal hematoma is a hematoma underneath a toenail or fingernail which often results from a traumatic injury such as slamming a finger in a door.
Patient definition: A subungal hematoma is a collection of blood underneath a toenail or fingernail which often results from a traumatic injury such as slamming a finger in a door.

Terry's nails
Doctor definition: Terry's nails is a physical finding in which fingernails and/or toenails appear white with a characteristic "ground glass" appearance, with no lunula.
Patient definition: Terry's nails is a physical finding in which fingernails and/or toenails appear white with a characteristic "ground glass" appearance, with no white crescent shaped area at the bottom of the nail.

Trauma
Doctor definition: Trauma refers to a physical injury.
Patient definition: Trauma refers to a physical injury.

Tuberous sclerosis
Doctor definition: Tuberous sclerosis is a rare, multi-system genetic disease that causes benign tumors to grow in the brain and on other vital organs such as the kidneys, heart, eyes, lungs, and skin.
Patient definition: Tuberous sclerosis is a rare, multi-system genetic disease that causes benign tumors to grow in the brain and on other vital organs such as the kidneys, heart, eyes, lungs, and skin.

Wart
Doctor definition: A wart is generally a small, rough tumor, typically on hands and feet, that can resemble a cauliflower or a solid blister.
Patient definition: A wart is generally a small, rough tumor, typically on hands and feet, that can resemble a cauliflower or a solid blister.

Yellow nail syndrome
Doctor definition: Yellow nail syndrome is characterized by yellow nails that lack a cuticle, grow slowly, and are loose or detached (onycholysis).
Patient definition: Yellow nail syndrome is characterized by yellow nails that lack a cuticle, grow slowly, and are loose or detached (onycholysis).




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