II. Pathophysiology

  1. Abnormality of vascular nail bed

III. Causes

  1. Hypoalbuminemia (<2g/dl)
  2. Nephrotic Syndrome
  3. Cirrhosis
  4. Malnutrition

IV. Signs: Transverse Linear Nail Lesion

  1. Parallel, narrow horizontal (transverse) white lines at nail bed
  2. Lines do not move with Nail Growth (involves nail bed, not the nail plate)
  3. Lines disappear when nail plate is depressed
  4. Lines resolve with treatment of hypoalbuminemia (if that was the underlying cause)

V. Differential Diagnosis

  1. Mees' Lines (move with Nail Growth)

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