Nail Formation Disorders: Or something else? Differential Diagnosis

Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99).

  • Congenital heart defects, unspecified
  • Heart valve defects

Respiratory system (J00-J99)

  • Asbestosis – lung disease belonging to the pneumoconioses (dust lung diseases), said to result from inhaled asbestos dust.
  • Bronchiectasis (synonym: bronchiectasis) – permanently existing irreversible saccular or cylindrical dilatation of the bronchi (medium-sized airways), which may be congenital or acquired; symptoms: chronic cough with “mouthful expectoration” (large-volume three-layered sputum: foam, mucus, and pus), fatigue, weight loss, and a reduced performance capacity
  • Chronic bronchitis – inflammation of the mucous membranes in the bronchi.
  • Chronic obstructive pulmonary disease (COPD)
  • Pleural effusion – pathological increase in fluid between the sheets of the pleura (lung pleura).

Blood, hematopoietic organs – immune system (D50-D90).

  • Iron deficiency anemia (→ koilonychia/nail change with trough-like depression and increased brittleness of the nail plate).
  • Plummer-Vinson syndrome (synonyms: sideropenic dysphagia, Paterson-Brown-Kelly syndrome) – symptom complex of trophic disorders (mucosal defects, oral rhagades (tears in the corner of the mouth), brittle nails and hair, burning of the tongue, and dysphagia (difficulty swallowing) caused by major mucosal defects) specifically triggered by iron deficiency.
  • Sarcoidosis – granulomatous inflammation; considered an inflammatory multisystem disease, the cause of which is still unclear.Often the lungs and hilar lymph nodes are almost always affected (up to 95% of cases).

Endocrine, nutritional and metabolic diseases (E00-E90).

Skin and subcutaneous (L00-L99)

  • Alopecia areata (circular hair loss).
  • Atopic eczema (neurodermatitis)
  • Dystrophia unguium mediana canaliformis – hereditary nail growth disorder.
  • Epidermolysis bullosa (butterfly disease) – genetic skin disease in which the mechanical connection between the different layers of the skin is insufficiently developed; the result is blisters and wounds with possible scarring.
  • Exfoliative dermatitis (peeling redness).
  • Yellow fingernail syndrome (yellow-nail syndrome) – yellowish discolored nails; e.g. in chronic bronchitis, bronchiectasis (synonym: bronchiectasis), pleural effusion, sinusitis.
  • Hand eczemaskin inflammation associated with pruritus (itching) and erythema (areal skin redness).
  • Leukonychia (dot, dash or patchy white spots on the nails) – e.g. in liver disease, diabetes mellitus, heart failure (cardiac insufficiency), nephrotic syndrome.
  • Lichen ruber (nodular lichen)
  • Onychogrypose (synonyms: claw nail, crooked nail, ram’s horn) – claw-like growth of the nails with thickening and partial lateral growth, usually genetic.
  • Pachyonychia congenita – mostly autosomal dominant inheritance with varying degrees of cornification disorders of the skin; characteristic are thickened fingernails and toenails (onychauxis) and painful keratomas (swollen thickened horny layer on the skin) on the palm of the hand due to cornification disorder.
  • Paronychia, chronic (nail bed inflammation).
  • Psoriasis (psoriasis)
  • Vitiligo (white spot disease)

Cardiovascular system (I00-I99)

  • Cor pulmonale – dilatation (widening) and/or hypertrophy (enlargement) of the right ventricle (main chamber) of the heart due to pulmonary hypertension (increase in pressure in the pulmonary circulation: pulmonary arterial mean pressure (mPAP) > 25 mmHg at rest – normal mPAP is 14 ± 3 and does not exceed 20 mmHG), which may be due to various diseases of the lung
  • Endocarditis (inflammation of the inner lining of the heart).
  • Heart failure (cardiac insufficiency)
  • Raynaud’s disease – disease that leads to functional vasoconstriction of the hands and feet.

Infectious and parasitic diseases (A00-B99).

  • Leprosy – tropical infectious disease caused by mycobacterium leprae, which occurs mainly on the skin and nerves.
  • Malaria – tropical infectious disease transmitted by the Anopheles mosquito.
  • Onychomycosis (nail fungus)
  • Pseudomonas aeruginosa infection, local
  • Tuberculosis (consumption)

Liver, gallbladder and bile ducts – pancreas (pancreas) (K70-K77; K80-K87).

Musculoskeletal system and connective tissue (M00-M99).

  • Dermatomyositis – chronic systemic disease belonging to the collagenoses, affecting the skin, muscles and internal organs.
  • Hypertrophic pulmonary osteoarthropathy (lung tumors, bronchiectasis).
  • Collagenoses – autoimmune diseases that lead to systemic involvement, mainly in connective tissue and blood vessels.
  • Reactive arthritis (synonym: postinfectious arthritis / joint inflammation) – secondary disease after gastrointestinal (gastrointestinal tract concerning), urogenital (urinary and genital organs concerning) or pulmonary (lungs concerning) infections; refers to an arthritis, where pathogens in the joint (usually) can not be found (sterile synovialitis).
  • Reiter’s disease (synonyms: Reiter’s syndrome; Reiter’s disease; arthritis dysenterica; polyarthritis enterica; postenteritic arthritis; posturethritic arthritis; undifferentiated oligoarthritis; urethro-oculo-synovial syndrome; Fiessinger-Leroy syndrome; English Sexually acquired reactive arthritis (SARA)) – special form of a “reactive arthritis” (see above. ); secondary disease after gastrointestinal or urogenital infections, characterized by the symptoms of Reiter’s triad; seronegative spondyloarthropathy, which is triggered especially in HLA-B27 positive persons by an intestinal or urinary tract disease with bacteria (mostly chlamydia); Can manifest as arthritis (joint inflammation), conjunctivitis (conjunctivitis), urethritis (urethritis) and partly with typical skin changes.
  • Rheumatoid arthritis
  • Scleroderma – group of diseases belonging to the collagenoses with unclear cause, associated with connective tissue hardening of the skin and internal organs.
  • Systemic lupus erythematosus (SLE) – systemic disease affecting the skin and connective tissue of the vessels, leading to vascular inflammation (vasculitides) of numerous organs such as the heart, kidneys or brain.

Neoplasms – tumor diseases (C00-D48).

  • Bronchial carcinoma (lung cancer)
  • Malignant melanoma (black skin cancer), subungual (under the fingernail).
  • Hodgkin’s disease – malignant disease of the lymphatic system associated mainly with lymphadenopathy (lymph node enlargement) and splenomegaly (spleen enlargement).
  • Pigment cell nevus (mole).

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99).

  • Drumstick finger (synonyms: Digiti hippocratici, osteoarthropathy hypertrophique pneumique, “piston finger”) – medical term for a visible distension of finger and toe end limbs as a symptom of cardiac or pulmonary disease.

Genitourinary system (kidneys, urinary tract – sex organs) (N00-N99).

  • Nephrotic syndrome – collective term for symptoms that occur in various diseases of the glomerulus (renal corpuscles); symptoms include: Proteinuria (increased excretion of protein in urine) with protein loss greater than 1 g/m²/body surface area per day; hypoproteinemia, peripheral edema due to serum hypalbuminemia of < 2.5 g/dL, hyperlipoproteinemia (dyslipidemia).
  • Renal insufficiency (kidney weakness).

Injuries, poisoning, and other consequences of external causes (S00-T98).

  • Irradiation of the hand
  • Trauma (injury), unspecified (e.g., of the nail bed, from nail biting)

Medication

  • See “Causes” under medications

Environmental pollution – intoxications (poisoning).

  • Arsenic poisoning
  • Thallium poisoning
  • Carbon monoxide poisoning