A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; furthermore:
- Inspection (viewing).
- Nails
- Dimple or spotted nails (pinhead-sized retractions, filled with scales).
- Oil stains (yellowish discolorations).
- Longitudinal, brownish streaks (splinter hemorrhages).
- Transverse or longitudinal grooves
- Nail dystrophy (psoriatic crumbling nails – completely destroyed nail plate).
- Onycholysis (detachment of the nail, white spots may form under the nail).
- Skin [the skin around the nail may be red].
- Range of motion of the joints [movement restrictions due to joint pain (possible secondary disease)]
- Nails
- Auscultation (listening) of the heart [due todifferential diagnosis: valvular heart disease].
- Examination of the lungs [due todifferential diagnoses: asbestosis (one of the pneumoconioses (dust lung disease) lung disease, which is caused by inhaled asbestos dust); bronchiectasis (synonym: bronchiectasis; permanent outpouchings of the bronchi, which can occur congenitally or acquired as a result of inflammation); chronic obstructive pulmonary disease (COPD)]
- Inspection (viewing).
- Dermatological examination [due todifferential diagnoses:
- Acrodermatitis continua Hallopeau (focal redness and pustules on the end phalanges of the fingers and toes).
- Alopecia areata (circular hair loss).
- Atopic eczema (neurodermatitis)
- Dystrophia unguium mediana canaliformis (hereditary nail growth disorder).
- Eczema (skin inflammation associated with pruritus (itching) and erythema (areal redness of the skin).
- Lichen ruber planus (nodular lichen)
- Nail mycosis (nail fungus)
- Paronychia congenita (genetic disease of the nails associated with other hair abnormalities such as hyperhidrosis (increased sweating) and changes in mucous membranes).
- Pityriasis rosea (scale florets)
- Psoriasis (psoriasis)
- Pustulosis palmoplantaris (disease with the appearance of pustules on the palms of the hands and feet).
- Vitiligo (white spot disease)]
- If necessary, neurological examination [due topossible secondary diseases: Alcohol dependence, drug dependence, resignation, social isolation]
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.