Nail as a window of systemic diseases

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Abstract

Certain nail changes are specific for various dermatological disorders. In addition, examination of nails may also provide an insight into more sinister systemic manifestations in the form of both subtle as well as specific changes. These findings may present as a defect of various anatomical components of the nail unit; nail matrix, nail plate and/or nail bed or vasculature. This article is an attempt to equip the dermatologists with a foresight to suspect and diagnose the unapparent systemic connotations that may be possible by a simple but detailed nail examination.

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Most cited references 41

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Yellow nails, lymphoedema, and pleural effusions.

Charles P Emerson (1966)

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The rational clinical examination. Does this patient have clubbing?

Linda K Myers, Jason Farquhar (2001)

The association between digital clubbing and a host of diseases has been recognized since the time of Hippocrates. Although the features of advanced clubbing are familiar to most clinicians, the presence of early clubbing is often a source of debate. To perform a systematic review of the literature for information on the precision and accuracy of clinical examination for clubbing. The MEDLINE database from January 1966 to April 1999 was searched for English-language articles related to clubbing. Bibliographies of all retrieved articles and of standard textbooks of physical diagnosis were also searched. Studies selected for data extraction were those in which quantitative or qualitative assessment for clubbing was described in a series of patients. Sixteen studies met these criteria and were included in the final analysis. Data were extracted by both authors, who independently reviewed and appraised the quality of each article. Data extracted included quantitative indices for distinguishing clubbed from normal digits, precision of clinical examination for clubbing, and accuracy of clubbing as a marker of selected diseases. The profile angle, hyponychial angle, and phalangeal depth ratio can be used as quantitative indices to assist in identifying clubbing. In individuals without clubbing, values for these indices do not exceed 176 degrees, 192 degrees, and 1.0, respectively. When clinicians make a global assessment of clubbing at the bedside, interobserver agreement is variable, with kappa values ranging between 0.39 and 0.90. Because of the lack of an objective diagnostic criterion standard, accuracy of physical examination for clubbing is difficult to determine. The accuracy of clubbing as a marker of specific underlying disease has been determined for lung cancer (likelihood ratio, 3.9 with phalangeal depth ratio in excess of 1.0) and for inflammatory bowel disease (likelihood ratio, 2.8 and 3.7 for active Crohn disease and ulcerative colitis, respectively, if clubbing is present). We recommend use of the profile angle and phalangeal depth ratio as quantitative indices in identifying clubbing. Clinical judgment must be exercised in determining the extent of further evaluation for underlying disease when these values exceed 180 degrees and 1.0, respectively.

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Occupational koilonychia of the toe nails.

B Bentley-Phillips, M Bayles (1971)

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Author and article information

Journal

Journal ID (nlm-ta): Indian Dermatol Online J

Journal ID (iso-abbrev): Indian Dermatol Online J

Journal ID (publisher-id): IDOJ

Title: Indian Dermatology Online Journal

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 2229-5178

ISSN (Electronic): 2249-5673

Publication date (Print): Mar-Apr 2015

Volume: 6

Issue: 2

Pages: 67-74

Affiliations

[1]Department of Dermatology and STD, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, New Delhi, India

Author notes

Address for correspondence: Dr. Archana Singal, B-14, Law Apartments, Karkardooma, Delhi - 110 092, India. E-mail: archanasingal@ 123456hotmail.com

Article

Publisher ID: IDOJ-6-67

DOI: 10.4103/2229-5178.153002

PMC ID: 4375768

PubMed ID: 25821724

SO-VID: 7f5fd921-8a99-4c15-9073-a44299c89040

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Nail as a window of systemic diseases

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Abstract

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Karger: Dermatology

Most cited references 41

Yellow nails, lymphoedema, and pleural effusions.

The rational clinical examination. Does this patient have clubbing?

Occupational koilonychia of the toe nails.

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