![]() We also discuss grooves in the nail plate, or Beau lines. In this review, we delineate the three basic types of nail lines -white lines (leukonychia striata), brown-black lines (longitudinal melanonychia), and red lines (longitudinal erythronychia)-and the differential diagnosis for each type. A basic understanding of nail anatomy and recognition of several basic types of nail lines and bands allow the clinician to properly diagnose and treat the nail disease, to recognize possible underlying systemic diseases, and to know when to refer the patient to a dermatologist for specialized evaluation and biopsy. I nspection of the fingernails and toenails should be part of a complete physical examination. In apparent leukonychia, the white discoloration is due to abnormal nail bed vasculature, and the whiteness disappears with pressure.Ä«rown-black nail lines may represent blood from trauma bacterial, fungal, or viral infection drug reaction endocrine disorders exogenous pigmentation excess melanin production within the nail matrix nevi or melanoma. In true leukonychia, there is abnormal keratinization of the underlying nail matrix, resulting in a white discoloration that is unaffected by pressure. Transverse white nail lines, or Mees lines, have been associated with acute systemic stress, such as from acute renal failure, heart failure, ulcerative colitis, breast cancer, infection (measles, tuberculosis), and systemic lupus erythematosus, and with exposure to toxic metals such as thallium. ![]()
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