DIAGNOSIS CHECKLIST
for Nail symptoms

Why: e.g. discoloration, pale nails, brittle nails, nail bed infections, thickening of the nails, spoon shaped, clubbing of the nails, separation of nail from nail bed, pitting of the nails, lengthwise ridges - Changes in the nails can prove very helpful in diagnosis of systemic disease.

Why: Focal abnormalities include thickening (which is often due to fungal infections), inflammation (usually due to paronychia, onychia, fungal infection or syphilis), hemorrhages under the nail (due to trauma, subacute bacterial endocarditis or trichinosis), pitting of the nail (may be due to psoriasis) and atrophy of the nail (which may be due to peripheral vascular disease, epidermolysis bullosa, nail biting or peripheral neuropathy. Diffuse abnormalities of the nail may include thickening of the nails (due to syphilis, hyperthyroidism, hypothyroidism, clubbing, cyanotic heart disease, bronchiectasis, lung cancer), yellow nails (due to lymphoma or chest conditions) or spoon nails (due to iron deficiency anemia).

Why: e.g. wearing of occlusive footwear, overcrowding of toes, communal bathing areas, poor peripheral blood circulation.

Why: e.g. heavy periods, pregnancy, vegetarianism, peptic ulcer, gastrointestinal bleeding, celiac disease and frequent blood donations.

Why: e.g. injury or deformity to nail bed, faulty nail trimming, constricting shoes and poor hygiene.

Why: e.g. clubbing of the nails may be due to cyanotic congenital heart disease, bronchiectasis, cystic fibrosis, Crohn's disease, Ulcerative colitis, Celiac disease, lung cancer, lung abscess, asbestosis, liver cirrhosis and thyrotoxicosis; HIV infection may increase the risk of fungal nail infections; psoriasis; Yellow nail syndrome may be associated with bronchiectasis, pleural effusion, Hodgkin's lymphoma, uterine cancer, malignant melanoma or lymphoma; systemic lupus erythematosus may cause inflammation of the nail folds; chronic renal failure and cirrhosis may cause "half and half" nails with the proximal part of the nail white to pink and the distal half of the nail red to brown.

Why: e.g. blue nails may be caused by antimalarial medications, minocycline; chemotherapy may cause transverse opaque bands or a single transverse white band on the nails.

Why: e.g. potassium chlorate, sulfanilamide and coal tar may cause hemoglobin abnormalities and thus central cyanosis.

Why: e.g. carbon monoxide poisoning may cause cherry-red nails; arsenic poisoning may cause a single transverse white band across the nail.

Why: may indicate asbestosis or pleural mesothelioma as cause of clubbing.

Why: e.g. cystic fibrosis, cyanotic congenital heart disease, thyroid disorders, celiac disease, Crohn's disease, Ulcerative colitis; psoriasis; Wilson's disease; hemochromatosis.

Why: now and in the past? - increases the risk of lung cancer and increases the severity of asbestosis which may both cause finger clubbing.

Why: increases risk of subacute endocarditis which can cause finger clubbing; HIV increases the risk of fungal nail infections.

Why: may suggest cyanosis, Wilson's disease, ochronosis, hemochromatosis or ingestion of certain medications.

Why: may suggest polycythaemia and carbon monoxide poisoning.

Why: may suggest hypoalbuminaemia (reduced albumin in blood) which may be due to chronic liver disease, severe malnutrition, nephrotic syndrome, protein losing gut disease.

Why: e.g. a loss of the angle between the nail bed and the finger. A subtle sign may be an increased in sponginess of the proximal nail bed. May be associated with cyanotic congenital heart disease, bronchiectasis, cystic fibrosis, Crohn's disease, Ulcerative colitis, Celiac disease, lung cancer, lung abscess, asbestosis, liver cirrhosis and thyrotoxicosis.

Why: diffuse thickening may result from syphilis, hyperthyroidism or hypothyroidism. Focal thickening may be due to fungal infection.

Why: may be due to trauma, subacute bacterial endocarditism, scurvy or trichinosis.

Why: due to anemia.

Why: may be due to psoriasis.

Why: (i.e. inflammation of the nail fold)? - may suggest paronychia, onychia fungal infection, systemic lupus erythematosus or syphilis.

Why: may suggest peripheral vascular disease, peripheral neuropathy, epidermolysis bullosa or nail biting).

Why: due to iron deficiency anemia.

Why: may be due to hyperthyroidism or psoriasis.

Why: due to fever, significant weight loss due to chronic disease, malnutrition.

Why: If associated with finger clubbing determines presence of cyanosis and thus may suggest cyanotic congenital heart disease and pulmonary arteriovenous aneurysms. If associated with blue nails, may indicate hemoglobin abnormalities or cyanosis e.g. chronic obstructive pulmonary disease.

Why: if associated with finger clubbing may suggest a lung condition such as bronchiectasis, chronic interstitial fibrosis, asbestosis, emphysema, lung cancer, lung abscess, cystic fibrosis or tuberculosis. If associated with yellow nails may suggest pleural effusion (collection of fluid around the lung) or bronchiectasis.

Why: if associated with finger clubbing may suggest empyema (pus in the cavity enclosing the lungs), lung abscess, tuberculosis, subacute bacterial endocarditis. Fever itself may cause non-pigmented transverse lines on the nail.

Why: may cause finger clubbing and lifting of the nail bed e.g. intolerance to heat, tremor, agitation, weight loss, increased appetite.

Why: e.g. nail becomes thickened, cracked, crumbly and raised by underlying debris in the nail bed.

Why: e.g. similar to fungal nail infection except nail folds are swollen, red, painful and tender.

Why: e.g. nail pitting, nail thickening, lifting of the nail from nail bed, yellow-brown spots under the nail plate, may be associated with psoriasis skin rash and painful joints.

Why: e.g. blue tongue and lips, blue nails.

Why: e.g. widespread spoon-shaped nails, brittle nails, pallor of skin and conjunctiva, tiredness.