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Beau's lines; Mee's lines; onychomadesis

Horizontal depressions across the nail plate secondary to a transient arrest in nail growth. Etiology: temporary arrest of nail growth can result from - acute stress or illness, such as: - circulatory shock - myocardial infarction - pulmonary embolism - high fever - toxic epidermal necrolysis, erythroderma, scarlet fever [3] - surgery - cold tempertature [5] - drugs may also cause formation of Beau's lines [2] - chemotherapy or immunosuppressive agents in particular - severe zinc deficiency (proposed as cause) [5] - because nail & hair growth are under the same influences, Beau's lines & telogen effluvium often occur together [4] - Mee's lines are white bands associated with - arsenic poisoning [2,5] - carbon monoxide poisoning - Hodgkin's disease - malaria - leprosy [5] Pathology: - onychomadesis is a painless spontaneous periodic separation of the nail plate from the bed, beginning at the proximal end with subsequent shedding of the nail as the new nail grows - onychomadesis occurs as a result of temporary arrest of nail growth at the nail matrix, the cause of Beau's lines Clinical manifestations: - Beau's lines are transverse furrows beginning in the nail matrix - Mee's lines are transverse white lines in the nail - timing of the disease or event can be determined by the location of the lines on the nail [5] * images [4] Notes: - from the age of the patient & position of the line, it is possible to identify the time of the stressful event

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nail plate

General

nail disease

References

  1. Color Atlas & Synopsis of Clinical Dermatology, Common & Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY, 1997, pg 501
  2. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 180
  3. Medical Knowledge Self Assessment Program (MKSAP) 16, 18 American College of Physicians, Philadelphia 2012, 2018.
  4. DermNet NZ. Telogen effluvium (images) http://www.dermnetnz.org/hair-nails-sweat/telogen-effluvium.html
  5. Brady MP Fingernail and Toenail Abnormalities: Nail the Diagnosis. Medscape March 17, 2021 https://reference.medscape.com/slideshow/fingernail-abnormalities-6002456