Part II. Changes in Nail Structure and Growth as Signs of Systemic Disease
Access to this document is restricted. Some items have been embargoed at the request of the author, but will be made publicly available after the "No Access Until" date.
During the embargo period, you may request access to the item by clicking the link to the restricted file(s) and completing the request form. If we have contact information for a Cornell author, we will contact the author and request permission to provide access. If we do not have contact information for a Cornell author, or the author denies or does not respond to our inquiry, we will not be able to provide access. For more information, review our policies for restricted content.
Changes in structure and growth of the nail unit may serve as clinical clues to underlying systemic disease. Pathophysiology may involve disruption to nail vascularization, metabolism and nutrition, inflammation, infections, and genetic disorders. Patients with nail changes often present with concurrent cutaneous findings, either of which or both together may indicate underlying systemic disease. Nail involvement may also correlate with systemic disease activity and severity. Dermoscopy and bedside diagnostic tools can aid in diagnosis. Prompt interdisciplinary referrals are important for systemic disease diagnosis and improved patient outcomes. In Part II of this continuing medical education series, we outline systemic diseases associated with changes in nail structure and growth, including clubbing, koilonychia, Beau's lines/onychomadesis, onycholysis, onychorrhexis, and pterygium inversum unguius. In addition, we describe their pathophysiology, clinical features, and recommendations for workup.