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Terry's nail; Lindsey's nails (1/2 & 1/2 nails)

Etiology: 1) hypoalbuminemia associated with hepatic cirrhosis (Terry's nails) - also congestive heart failure, diabetes mellitus, hyperthyroidism, aging [4,7] 2) uremia secondary to chronic renal failure (Lindsey's nails) [3] Pathology: - Lindsey's nails: whiteness is due to edema & anemia [7] - Terry's nails are caused by reduced vascular supply to nailbed [7] Clinical manifestations: - the proximal 2/3 of the nail is white which may obliterate the lunula - the distal 1/3 of the nail is the normal red color of the nail bed - no correlation between the degree of azotemia & the % of nail bed that is white [3] * images [5,6] Management: - no specific therapy beyond treatment of the underlying etiology

Related

lunula nail bed

General

leukonychia; achromia unguium; canities unguium; leukopathia unguis; white nails

References

  1. Color Atlas & Synopsis of Clinical Dermatology, Common & Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY, 1997, pg 497
  2. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 179
  3. Yang CS, Robinson-Bostom L Lindsay's Nails in Chronic Kidney Disease. N Engl J Med 2015; 372:1748. April 30, 2015 PMID: 25923554 http://www.nejm.org/doi/full/10.1056/NEJMicm1406572
  4. Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018.
  5. Wikipedia: Terry's nails (image) https://en.wikipedia.org/wiki/Terry's_nails - Wikipedia: Half and half nails https://en.wikipedia.org/wiki/Half_and_half_nails
  6. Family Practice Notebook. Terry's Nail (images) http://www.fpnotebook.com/derm/Nails/TrysNl.htm
  7. Brady MP Fingernail and Toenail Abnormalities: Nail the Diagnosis. Medscape March 17, 2021 https://reference.medscape.com/slideshow/fingernail-abnormalities-6002456