Examining the Fingernails When Evaluating Presenting Symptoms in Elderly Patients

Mark E. Williams, MD

Disclosures

November 23, 2009

In This Article

Generalized Discolorations of the Nail Plate

Nail discoloration is a useful method for identifying potential problems.

White Nails

White nails can be caused by anemia, edema, or vascular conditions (Figure 24). Consider the following:

  • Anemia;

  • Renal failure;

  • Cirrhosis;

  • Diabetes mellitus;

  • Chemotherapy; and

  • Hereditary (rare).

Figure 24. Example of white nails.

Pink or Red Nails

With pink or red nail discoloration, the following should be considered (Figure 25):

  • Polycythemia (dark);

  • Systemic lupus erythematosus;

  • Carbon monoxide (cherry red);

  • Angioma; and

  • Malnutrition.

Figure 25. Example of pink and red nails.

Brown-Gray Nails

Brown-gray nails may suggest the following (Figure 26):

  • Cardiovascular disease;

  • Diabetes mellitus;

  • Vitamin B12 deficiency;

  • Breast cancer;

  • Malignant melanoma;

  • Lichen planus;

  • Syphilis; and

  • Topical agents, including hair dyes, solvents for false nails, varnish, and formaldehyde (among many others)

Figure 26. Example of brown-gray nails.

Yellow Nails

Yellow nails suggest the following (Figure 27):

  • Diabetes mellitus;

  • Amyloidosis;

  • Median/ulnar nerve injury;

  • Thermal injury; and

  • Jaundice.

Consider yellow nail syndrome if a patient has lymphedema and bronchiectasis.

Figure 27. Example of yellow nails. Image courtesy of www.dermnet.com Used with permission.

Green or Black Nails

Green or black nails indicate the following (Figure 28):

  • Topical preparations, including chlorophyll derivations, methyl green, and silver nitrate (among others);

  • Chronic Pseudomonas spp infection; and

  • Trauma.

Figure 28. Example of black nails.

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