Common changes in nails are

• Clubbing
• Koilonychia
• Onycholysis
• Abnormal colour like yellow, blue
• Nail bed changes
• Splinter haemorrhages
• Lines or bands- Beaus, Mees lines

Clubbing

It is the increase in the angle between the nail and the nail bed.

Place the two index fingers of the patient against each other, look for the diamond shaped gap in between the nails. If no gap is visible, clubbing is present

Causes (Remember as mnemonic CLUBBING)

• Cyanotic heart conditions
• Lung conditions- hypoxia, Bronchiectasis, Cystic fibrosis
• Ulcerative colitis, Crohns
• Biliary cirrhosis
• Infective endocarditis
• Neoplasms
• Gastrointestinal malabsorption

Koilonychia

It is spoon shaped nails

Causes

Iron deficiency

Onycholysis

It is the nail separation from nail bed

Cause

• Trauma
• Fungal infections
• Raynaud’s syndrome

Pitting of nail

Causes

• Psoriasis
• Atopic eczema
• Alopecia areata

Thickening of nails

Causes

• Psoriasis
• Fungal infection

Leukonychia

It is white spots on nails

Causes

• Normal variant
• Poisoning like arsenic, lead
• Hypoalbuminemia

Splinter haemorrhage

It’s the tiny haemorrhages in nail bed

Causes

• Infective endocarditis
• Psoriatic arthritis
• Systemic lupus erythematosus