Skip to main content

Disorders of Nails

  • Living reference work entry
  • First Online:
Atlas of Dermatology, Dermatopathology and Venereology

Abstract

Nail appearance and discomfort are the main motivators for most patients to schedule a consultation. During the patient visit, it is important for practitioners to delve into the cause of the problematic nail change, known as onychodystrophy. Onychodystrophy, which is any alteration of nail morphology, encompasses a wide spectrum of nail disorders. Caused by either exogenous or endogenous factors, nail dystrophy may manifest as a misshapen, damaged, infected, or discolored nail unit that may affect the fingernails, toenails, or both. Nails may also be affected by systemic causes (such as psoriasis, lichen planus, etc.) and by tumors (such as melanoma, squamous cell carcinoma, etc.). A special grouping is toenail disorders due to their constant trauma in shoes and from the environment (such as onychomycosis and pincer nails). This chapter explores a range of nail disorders from changes to the nail plate to infections.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

References

  • Abimelec P, Dumontier C (2005) Basic and advanced nail surgery (part 2: indications and complications). In: Scher RK, Daniel CR III (eds) Nails: diagnosis, therapy, surgery. Elsevier Saunders, Philadelphia, p 291

    Chapter  Google Scholar 

  • Adya KA, Inamadar AC, Palit A (2017) “Pitted” lesions in dermatology. Int J Dermatol 56(1):3–17

    Article  PubMed  Google Scholar 

  • Al Aboud AM, Nigam PK (2020) Wart (Plantar, Verruca Vulgaris, Verrucae) In: StatPearls [Internet]. Treasure Island: StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK431047/. Accessed 29 June 2020

  • Arisi M, Rossi MT, Sala R, Petrilli G, Marocolo D, Ungari M, Facchetti F, Calzavara-Pinton PG (2016) A case of Acrodermatitis continua of Hallopeau following chronic pustular cheilitis. Dermatol Ther (Heidelb) 6(1):89–94

    Article  Google Scholar 

  • Bae JM, Kang H, Kim HO, Park YM (2009) Differential diagnosis of plantar wart from corn, callus and healed wart with the aid of dermoscopy. Br J Dermatol 160(1):220–222

    Article  CAS  PubMed  Google Scholar 

  • Balakirski G, Loeser C, Baron JM, Dippel E, Schmitt L (2017) Effectiveness and safety of surgical excision in the treatment of digital mucoid cysts. Dermatol Surg 43(7):928–933

    Article  CAS  PubMed  Google Scholar 

  • Baran R (1978) Pigmentations of the nails (chromonychia). J Dermatol Surg Oncol 4(3):250–254

    Article  CAS  PubMed  Google Scholar 

  • Baran R (1987) Frictional longitudinal melanonychia: a new entity. Dermatologica 174(6):280–284

    Article  CAS  PubMed  Google Scholar 

  • Baran R (2012) The nail in dermatological disease. In: Baran R, de Berker DAR, Holzberg M, Thomas L (eds) Baran and Dawber’s diseases of the nails and their management, 4th edn. Wiley-Blackwell, West Sussex, pp 257–314

    Chapter  Google Scholar 

  • Baran R, Schoon D (2004) Nail fragility syndrome and its treatment. J Cosmet Dermatol 3(3):131–137

    Article  CAS  PubMed  Google Scholar 

  • Baran R, Perrin C, Baudet J, Requena L (1994) Clinical and histological patterns of dermatofibromas of the nail apparatus. Clin Exp Dermatol 19(1):31–35

    Article  CAS  PubMed  Google Scholar 

  • Baran R, Haneke E, Richert B (2001) Pincer nails: definition and surgical treatment. Dermatol Surg 27(3):261–266

    CAS  PubMed  Google Scholar 

  • Barbosa P (1998) Plantar verrucae and HIV infection. Clin Podiatr Med Surg 15(2):317–327

    CAS  PubMed  Google Scholar 

  • Benjegerdes KE, Hyde K, Kivelevitch D, Mansouri B (2016) Pustular psoriasis: pathophysiology and current treatment perspectives. Psoriasis (Auckl) 6:131–144

    CAS  Google Scholar 

  • Betz D, Fane K (2018). Herpetic whitlow. Treasure Island: StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK482379/

  • Bodman MA (2004) Nail dystrophies. Clin Podiatr Med Surg 21(4):663–687

    Article  PubMed  Google Scholar 

  • Bourcier T, Baudrimont M, Borderie V, Mayaud C, Laroche L (2002) Conjunctival changes associated with yellow nail syndrome. Br J Ophthalmol 86(8):930

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Braswell MA, Daniel CR 3rd, Brodell RT (2015) Beau lines, onychomadesis, and retronychia: a unifying hypothesis. J Am Acad Dermatol 73(5):849–855

    Article  PubMed  Google Scholar 

  • Canavan T, Tosti A, Mallory H, McKay K, Cantrell W, Elewski B (2015) An idiopathic leukonychia totalis and leukonychia partialis case report and review of the literature. Skin Appendage Disord 1(1):38–42

    Article  PubMed  PubMed Central  Google Scholar 

  • Cañueto J, Santos-Briz Á, García JL, Robledo C, Unamuno P (2011) Onychomatricoma: genome-wide analyses of a rare nail matrix tumor. J Am Acad Dermatol 64(3):573–578

    Article  PubMed  Google Scholar 

  • Carroll RE, Berman AT (1972) Glomus tumors of the hand: review of the literature and report on twenty-eight cases. J Bone Joint Surg Am 54(4):691–703

    Article  CAS  PubMed  Google Scholar 

  • Chamberlain A, Ng J (2009) Cutaneous melanoma – atypical variants and presentations. Aust Fam Physician 38(7):476–482

    PubMed  Google Scholar 

  • Chávez-López MA, Arce-Martínez FJ, Tello-Esparza A (2013) Muehrcke lines associated to active rheumatoid arthritis. J Clin Rheumatol 19(1):30–31

    Article  PubMed  Google Scholar 

  • Chiriac A, Brzezinski P, Foia L, Marincu I (2015) Chloronychia: green nail syndrome caused by Pseudomonas aeruginosa in elderly persons. Clin Interv Aging 10:265–267

    Article  PubMed  PubMed Central  Google Scholar 

  • Cohen PR (2011) Longitudinal erythronychia: individual or multiple linear red bands of the nail plate: a review of clinical features and associated conditions. Am J Clin Dermatol 12(4):217–231

    Article  PubMed  Google Scholar 

  • Cohen PR, Schulze KE, Nelson BR (2007) Subungual hematoma. Dermatol Nurs 19(1):83–84

    PubMed  Google Scholar 

  • Cutolo M, Sulli A, Smith V (2013) How to perform and interpret capillaroscopy. Best Pract Res Clin Rheumatol 27(2):237–248

    Article  PubMed  Google Scholar 

  • DaCambra MP, Gupta SK, Ferri-de-Barros F (2014) Subungual exostosis of the toes: a systematic review. Clin Orthop Relat Res 472(4):1251–1259

    Article  PubMed  Google Scholar 

  • Dahlin LB, Besjakov J, Veress B (2005) A glomus tumour: classic signs without magnetic resonance imaging findings. Scand J Plast Reconstr Surg Hand Surg 39(2):123–125

    Article  PubMed  Google Scholar 

  • Damevska K, Gocev G, Pollozahani N, Nikolovska S, Neloska L (2015) Onychomadesis following cutaneous vasculitis. Acta Dermatovenerol Croat 25(1):77–79

    Google Scholar 

  • Davis DA, Cohen PR (1996) Subungual exostosis: case report and review of the literature. Pediatr Dermatol 13(3):212–218

    Article  CAS  PubMed  Google Scholar 

  • de Berker DA, Perrin C, Baran R (2004) Localized longitudinal erythronychia: diagnostic significance and physical explanation. Arch Dermatol 140(10):1253–1257

    Article  PubMed  Google Scholar 

  • Ellia FA (1936) Pustular psoriasis: its relation to ccrodermatitis continua vel perstans. Arch Dermatol Syphilol 33(6):963–966

    Article  Google Scholar 

  • Farias DC, Tosti A, Chiacchio ND, Hirata SH (2010) Dermoscopy in nail psoriasis. An Bras Dermatol 85(1):101–103

    Article  PubMed  Google Scholar 

  • Feder HM Jr, Long SS (1983) Herpetic whitlow. Epidemiology, clinical characteristics, diagnosis, and treatment. Am J Dis Child 137(9):861–863

    Article  PubMed  Google Scholar 

  • Gordon KA, Vega JM, Tosti A (2011) Indian J Dermatol Venereol Leprol 77(6):640–645

    Article  PubMed  Google Scholar 

  • Gregoriou S, Argyriou G, Larios G, Rigopoulos D (2008) Nail disorders and systemic disease: what the nails tell us. J Fam Pract 57(8):509–514

    PubMed  Google Scholar 

  • Guarneri C, Guarneri F, Risitano G, Lentini M, Vaccaro M (2005) Solitary asymptomatic nodule of the great toe. Int J Dermatol 44(3):245–247

    Article  PubMed  Google Scholar 

  • Haber R, Khoury R, Kechichian E, Tomb R (2016) Splinter hemorrhages of the nails: a systematic review of clinical features and associated conditions. Int J Dermatol 55(12):1304–1310

    Article  PubMed  Google Scholar 

  • Haneke E (2012) Controversies in the treatment of ingrown nails. Dermatol Res Pract 2012:783924

    Article  PubMed  PubMed Central  Google Scholar 

  • Haneke E (2017) Important malignant and new nail tumors. J Dtsch Dermatol Ges 15(4):367–386

    PubMed  Google Scholar 

  • Hanno R, Mathes BM, Krull EA (1986) Longitudinal nail biopsy in evaluation of acquired nail dystrophies. J Am Acad Dermatol 14(5 Pt 1):803–809

    Article  CAS  PubMed  Google Scholar 

  • Hernández-Lugo AM, Domínguez-Cherit J, Vega-Memije ME (1999) Digital mucoid cyst: the ganglion type. Int J Dermatol 38(7):533–535

    Article  PubMed  Google Scholar 

  • Iorizzo M, Pazzaglia M, Piraccini B, Tullo S, Tosti A (2004) Brittle nails. J Cosmet Dermatol 3(3):138–144

    Article  CAS  PubMed  Google Scholar 

  • Jefferson J, Rich P (2012) Melanonychia. Dermatol Res Pract 2012:952186

    Article  PubMed  PubMed Central  Google Scholar 

  • Jellinek NJ, Lipner SR (2016) Longitudinal erythronychia: retrospective single-center study evaluating differential diagnosis and the likelihood of malignancy. Dermatol Surg 42(3):310–319

    Article  CAS  PubMed  Google Scholar 

  • Johnson LW (1995) Communal showers and the risk of plantar warts. J Fam Pract 40(2):136–138

    CAS  PubMed  Google Scholar 

  • Joo HJ, Kim MR, Cho BK, Yoo G, Park HJ (2016) Onychomatricoma: a rare tumor of nail matrix. Ann Dermatol 28(2):237–241

    Article  PubMed  PubMed Central  Google Scholar 

  • Kikuchi I, Horikawa S, Amano F (1974) Congenital onychodysplasia of the index fingers. Arch Dermatol 110(5):743–746

    Article  CAS  PubMed  Google Scholar 

  • Kikuchi I, Inoue S, Kawana N (1985) Congenital onychodysplasia of the index fingers. An abnormal grip theory. J Dermatol 12(3):258–262

    Article  CAS  PubMed  Google Scholar 

  • Kim M, Sun EY, Jung HY, Cho BK, Park HJ (2016) Onychopapilloma: a report of three cases presenting with various longitudinal chromonychia. Ann Dermatol 28(5):655–657

    Article  PubMed  PubMed Central  Google Scholar 

  • Kojima T, Nagano T, Uchida M (1987) Periungual fibroma. J Hand Surg Am 12(3):465–470

    Article  CAS  PubMed  Google Scholar 

  • Langley RG, Saurat JH, Reich K (2012) Recommendations for the treatment of nail psoriasis in patients with moderate to severe psoriasis: a dermatology expert group consensus. J Eur Acad Dermatol Venereol 26(3):373–381

    Article  CAS  PubMed  Google Scholar 

  • Lee DY, Park JH, Lee JH, Yang JM, Lee ES (2009) The use of dermoscopy for the diagnosis of plantar wart. J Eur Acad Dermatol Venereol 23(6):726–727

    Article  PubMed  Google Scholar 

  • Lee JH, Lim Y, Park JH, Lee JH, Jang KT, Kwon EJ, Lee DY (2018) Clinicopathologic features of 28 cases of nail matrix nevi (NMNs) in Asians: comparison between children and adults. J Am Acad Dermatol 78(3):479–489

    Article  PubMed  Google Scholar 

  • Lenz BL, Beachkofsky TM, Kobayashi TT (2013) Painful nail with longitudinal erythronychia. J Fam Pract 62(8):429–432

    PubMed  Google Scholar 

  • Letts M, Davidson D, Nizalik E (1998) Subungual exostosis: diagnosis and treatment in children. J Trauma 44(2):346–349

    Article  CAS  PubMed  Google Scholar 

  • Li K, Barankin B (2010) Digital mucous cysts. J Cutan Med Surg 14(5):199–206

    Article  PubMed  Google Scholar 

  • Lipner SR, Scher RK (2018) Part I: onychomycosis: clinical overview and diagnosis. J Am Acad Dermatol. pii: S0190-9622(18)32188-1

    Google Scholar 

  • Lomax A, Thornton J, Singh D (2016) Toenail paronychia. Foot Ankle Surg 22(4):219–223

    Article  PubMed  Google Scholar 

  • Maddy AJ, Tosti A (2018) Hair and nail diseases in the mature patient. Clin Dermatol 36(2):159–166

    Article  PubMed  Google Scholar 

  • Maino KL, Stashower ME (2004) Traumatic transverse leukonychia. Skinmed 3(1):53–55

    Article  PubMed  Google Scholar 

  • Maisels DO, Korachi AO (1985) Lymphoedema of the eyelids in the yellow nail syndrome. Br J Plast Surg 38(1):93–96

    Article  CAS  PubMed  Google Scholar 

  • Malay S (1993) Trauma to the nail bed and associated structures. Resource document. Podiatry Institute. www.podiatryinstitute.com/pdfs/Update_1993/1993_26.pdf

  • Matsuura H, Senoo A, Saito M, Hamanaka Y (2017) Green nail syndrome. QJM 110(9):609

    Article  CAS  PubMed  Google Scholar 

  • McDermott EM, Weiss AP (2006) Glomus tumors. J Hand Surg Am 31(8):1397–1400

    Article  PubMed  Google Scholar 

  • McLean WH, Hansen CD, Eliason MJ, Smith FJ (2011) The phenotypic and molecular genetic features of pachyonychia congenita. J Invest Dermatol 131(5):1015–1017

    Article  CAS  PubMed  Google Scholar 

  • Metzner MJ, Billington AR, Payne WG (2015) Melanonychia. Eplasty 15:ic48. eCollection 2015

    Google Scholar 

  • Nakamura R, Broce AA, Palencia DP, Ortiz NI, Leverone A (2013) Dermatoscopy of nail lichen planus. Int J Dermatol 52(6):684–687

    Article  PubMed  Google Scholar 

  • Oram Y, Akkaya AD (2013) Treatment of nail psoriasis: common concepts and new trends. Dermatol Res Pract 2013:180496

    Article  PubMed  PubMed Central  Google Scholar 

  • Padilha CB, Balassiano LK, Pinto JC, Souza FC, Kac BK, Treu CM (2016) Subungual squamous cell carcinoma. An Bras Dermatol 91(6):817–819

    Article  PubMed  PubMed Central  Google Scholar 

  • Park SW, Lee DY (2013) Treatment of congenital onychodysplasia of the index finger with specialized nail device. Clin Exp Dermatol 38(7):791–792

    PubMed  Google Scholar 

  • Park DH, Singh D (2012) The management of ingrowing toenails. BMJ 344:e2089

    Article  PubMed  Google Scholar 

  • Patel PP, Hoppe IC, Bell WR, Lambert WC, Fleegler EJ (2011) Perils of diagnosis and detection of subungual squamous cell carcinoma. Ann Dermatol 23(Suppl 3):S285–S287

    Article  PubMed  PubMed Central  Google Scholar 

  • Piraccini BM (2014) Nail disorders: a practical guide to diagnosis and management. Springer, Milan

    Book  Google Scholar 

  • Pulkkinen L, Uitto J (1999) Mutation analysis and molecular genetics of epidermolysis bullosa. Matrix Biol 18(1):29–42

    Article  CAS  PubMed  Google Scholar 

  • Rallis E, Paparizos V, Flemetakis A, Katsambas A (2010) Pseudomonas fingernail infection successfully treated with topical nadifloxacin in HIV-positive patients: report of two cases. AIDS 24(7):1087–1088

    Article  PubMed  Google Scholar 

  • Rich P, Scher RK (2003) Nail Psoriasis Severity Index: a useful tool for evaluation of nail psoriasis. J Am Acad Dermatol 49(2):206–212

    Article  PubMed  Google Scholar 

  • Richert B (2001) Frictional pyogenic granuloma of the nail bed. Dermatology 202(1):80–81

    Article  CAS  PubMed  Google Scholar 

  • Richert B, Lecerf P, Caucanas M, André J (2013) Nail tumors. Clin Dermatol 31(5):602–617

    Article  PubMed  Google Scholar 

  • Rockwell PG (2001) Acute and chronic paronychia. Am Fam Physician 63(6):1113–1116

    CAS  PubMed  Google Scholar 

  • Salem A, Gamil H, Hamed M, Galal S (2010) Nail changes in patients with liver disease. J Eur Acad Dermatol Venereol 24(6):649–654

    Article  CAS  PubMed  Google Scholar 

  • Seaberg DC, Angelos WJ, Paris PM (1991) Treatment of subungual hematomas with nail trephination: a prospective study. Am J Emerg Med 9(3):209–210

    Article  CAS  PubMed  Google Scholar 

  • Sharma S, Gupta A, Deshmukh A, Puri V (2016) Arsenic poisoning and Mees’ lines. QJM 109(8):565–566

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Shemer A, Daniel CR 3rd (2013) Common nail disorders. Clin Dermatol 31(5):578–586

    Article  PubMed  Google Scholar 

  • Singal A, Pandhi D, Gogoi P, Grover C. Subungual Melanoma is Not so Rare: Report of Four Cases from India. Indian Dermatol Online J (2017) Nov-Dec;8(6):471–474. https://doi.org/10.4103/idoj.IDOJ_411_16. PMID: 29204392; PMCID: PMC5707841

    Google Scholar 

  • Smith FJD, Hansen CD, Hull PR, Kaspar RL, McLean WHI, O’Toole E, Sprecher E (2017) Pachyonychia Congenita. In: Adam MP (ed) GeneReviews. https://www.ncbi.nlm.nih.gov/books/NBK1280

  • Sterling JC, Gibbs S, Haque Hussain SS, Mohd Mustapa MF, Handfield-Jones SE (2014) British Association of Dermatologists’ guidelines for the management of cutaneous warts 2014. Br J Dermatol 171(4):696–712

    Article  CAS  PubMed  Google Scholar 

  • Stosiek N, Peters KP, Hiller D, Riedl B, Hornstein OP (1993) Yellow nail syndrome in a patient with mycosis fungoides. J Am Acad Dermatol 28(5 Pt 1):792–794

    Article  CAS  PubMed  Google Scholar 

  • Sweeney E, Fryer A, Mountford R, Green A, McIntosh I (2003) Nail patella syndrome: a review of the phenotype aided by developmental biology. J Med Genet 40(3):153–162

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Taguchi Y, Takashima S, Tanaka K (2013) Koilonychia in a patient with subacute iron-deficiency anemia. Intern Med 52(20):2379

    Article  PubMed  Google Scholar 

  • Tavares GT, Chiacchio NG, Chiacchio ND, Souza MV (2015) Onychomatricoma: a tumor unknown to dermatologists. An Bras Dermatol 90(2):265–267

    Article  PubMed  PubMed Central  Google Scholar 

  • Theumann NH, Goettmann S, Le Viet D, Resnick D, Chung CB, Bittoun J, Chevrot A, Drapé JL (2002) Recurrent glomus tumors of fingertips: MR imaging evaluation. Radiology 223(1):143–151

    Article  PubMed  Google Scholar 

  • Tosti A, Peluso AM, Fanti PA, Piraccini BM (1993) Nail lichen planus: clinical and pathologic study of twenty-four patients. J Am Acad Dermatol 28(5 Pt 1):724–730

    Article  CAS  PubMed  Google Scholar 

  • Tosti A, André M, Murrell DF (2011) Nail involvement in autoimmune bullous disorders. Dermatol Clin 29(3):511–513

    Article  CAS  PubMed  Google Scholar 

  • Tosti A, Schneider SL, Ramirez-Quizon MN, Zaiac M, Miteva M (2016) Clinical, dermoscopic, and pathologic features of onychopapilloma: a review of 47 cases. J Am Acad Dermatol 74(3):521–526

    Article  PubMed  Google Scholar 

  • Venencie PY, Dicken CH (1984) Yellow nail syndrome: report of five cases. J Am Acad Dermatol 10(2 Pt 1):187–192

    Article  CAS  PubMed  Google Scholar 

  • Viac J, Thivolet J, Chardonnet Y (1977) Specific immunity in patients suffering from recurring warts before and after repetitive intradermal tests with human papilloma virus. Br J Dermatol 97(4):365–370

    Article  CAS  PubMed  Google Scholar 

  • Wagner G, Rose C, Sachse MM (2013) Clinical variants of lichen planus. J Dtsch Dermatol Ges 11(4):309–319

    PubMed  Google Scholar 

  • Walker J, Baran R, Vélez N, Jellinek N (2016) Koilonychia: an update on pathophysiology, differential diagnosis and clinical relevance. J Eur Acad Dermatol Venereol 30(11):1985–1991

    Article  CAS  PubMed  Google Scholar 

  • Whitley R, Kimberlin DW, Prober CG (2007) Pathogenesis and disease. In: Arvin A, Campadelli-Fiume G, Mocarski E, Moore PS, Roizman B, Whitley R, Yamanishi K (edn) Human herpesviruses: biology, therapy, and immunoprophylaxis. Cambridge University Press, Cambridge

    Google Scholar 

  • Wright MJ, Ain MC, Clough MV, Bellus GA, Hurko O, McIntosh I (2000) Achondroplasia and nail-patella syndrome: the compound phenotype. J Med Genet 37(9):E25

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Wu IB, Schwartz RA (2007) Herpetic whitlow. Cutis 79(3):193–196

    PubMed  Google Scholar 

  • Wulkan AJ, Tosti A (2013) Pediatric nail conditions. Clin Dermatol 31(5):564–572

    Article  PubMed  Google Scholar 

  • Yaghoobi R, Alamshahi F, Bagherani N, Rizi MS, Paziar N (2015) Squamous cell carcinoma of the toenail bed: a case report. Glob Dermatol 2. https://doi.org/10.15761/GOD.1000154

  • Zook EG (2000) Understanding the Perionychium. J Hand Ther 13(4):269–275

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Tracey C. Vlahovic .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Vlahovic, T.C. et al. (2021). Disorders of Nails. In: Smoller, B., Bagherani, N. (eds) Atlas of Dermatology, Dermatopathology and Venereology . Springer, Cham. https://doi.org/10.1007/978-3-319-45134-3_52-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-45134-3_52-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-45134-3

  • Online ISBN: 978-3-319-45134-3

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics