Nail Abnormality

Aka: Nail Abnormality, Nail Disorder, Nail Disease, Nail Shape Abnormality, Nail-Related Growths, Tumors Under or Around the Nail, Subungual Mass, Sunungual Neoplasm, Nail Growth Abnormal, Nail Abnormalities, Anonychia, Onychodystrophy, Onychogryposis, Onychoschizia, Onychotillomania, Dystrophic Nail, Nail Dystrophy, Dystrophia Unguium

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II. Definitions

  1. Anonychia
    1. Absent nails
  2. Chromonychia (see Nail Discoloration)
    1. Color changes of nails
  3. Koilonychia
    1. Spoon-shaped nails
  4. Onychodystrophy
    1. Degenerative changes of nail
  5. Onychogryposis
    1. Hypertrophic shape changes of nail
  6. Onycholysis
    1. Loosening or detachment of nail from nail bed
  7. Onychomadesis
    1. Spontaneous separation from nail matrix
  8. Onychomycosis
    1. Fungal infections of the nail
  9. Onychophagia
    1. Nail biting
  10. Onychoschizia
    1. Splitting, horizontal layering of distal nail edge
  11. Onychotillomania
    1. Compulsive pulling or picking of nails
  12. Paronychia
    1. Inflammation of skin around nails

III. Findings: Nail Changes

  1. Nail Discoloration
  2. Nail Groove (Beau's Lines)
  3. Nail Pitting
  4. Muehrcke's Lines
  5. Terry's Nails
  6. Koilonychia
  7. Onycholysis
  8. Nail Clubbing
  9. Infection
    1. Onychomycosis
    2. Acute Paronychia
    3. Chronic Paronychia
  10. Trauma
    1. Nail Bed Laceration
    2. Subungual Hematoma
  11. Nail Telangiectasias
  12. Nail Splinter Hemorrhages
  13. Longitudinal striations or bands
  14. Psoriatic Onychodystrophy (e.g. Nail Pitting, Onycholysis)

IV. Findings: Growths under or around the nail

  1. Malignant Growths
    1. Squamous Cell Carcinoma (most common)
      1. Higher risk in older men, HPV 16 or 18, Tobacco Abuse, Trauma or radiation exposure
      2. May present with hyperkeratosis, Onycholysis, Dystrophic Nail plate or Subungual Mass
      3. Refer to dermatology for evaluation and often MOHS excision
    2. Bowen's Disease
    3. Subungual Melanoma
  2. Benign Growths
    1. Digital Mucous Cyst
    2. Digital fibrokeratoma
    3. Exostosis
    4. Glomus tumor
      1. Rare, soft tissue tumor seen in age 20 to 40 years old
      2. Presents with subungual tenderness, cold sensitivity and painful paroxysms
    5. Keratocathoma
    6. Pyogenic Granuloma
    7. Tendon sheath giant cell tumor
    8. Periungual or Subungual Wart
      1. See Common Wart
      2. Presents with periungual Papules and Plaques with small thrombosed vessels ("black seeds)

V. References

  1. Habif (1996) Clinical Dermatology, Mosby, p. 778-9
  2. Collins (2025) Am Fam Physician 111(2): 177-8 [PubMed]
  3. Tully (2012) Am Fam Physician 85(8): 779-87 [PubMed]

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