Dr. Ratzan writes us: "Although i am not a dermatologist, i have long been interested in physical diagnosis and especially nails. i usually take a good look at my patients' nails. What struck me as interesting in this man was the following: i had never seen this pattern before; i could not and still can not imagine a pathophysiological process leading to such an unusual symmetrical pattern of feathered chevrons that were non-continuous across the longitudinal midline of the nail; and lastly, from a strictly aesthetic point of view, i find them almost weirdly beautiful!"
References:
1.
Arch Dermatol. 1983 Apr;119(4):334-5. Chemotherapy-induced transverse white lines in the
fingernails. James WD, Odom RB. (A
good review, but no abstract – only useful for those with access to Archive of
Derm)
2.
CMAJ. 2012 Aug 27. Muehrcke
lines Sharma V, Kumar V. (Shows why our patient does not have this.)
3.
Traumatic transverse leukonychia. Maino KL, Stashower ME. Skinmed. 2004 Jan-Feb;3(1):53-5. No abstract available.
Just a random thought... please get the Arsenic estimation in this patient and also of the drinking water in the viscinity of the patient.
ReplyDeleteBTW, Is there any chance of history of suicidal attempts in last 6 months to one year?
from Robert Shapiro, Hili, Hawaii: I don't think a systemic cause can cause a white nail line that's interrupted and not a straight line and also different line on different nails. A systemic effect should be the same on all nails."
ReplyDeletefrom Ashok Kumar Sharma. "The clinical entity purely from morphology is 'Transverse leukonychia'. Now the probable causes have been enumerated by the reporting author. Many patients present out of concern for these white spots. Important is to reassure them about this manifestation. I have seen transverse leukonychia in apparently normal people also."
ReplyDeletefrom Prof. Dr. Eckart Haneke (Germany): "The white lines are mostly very regular in their arrangement and they are confined to one or both sides of the nails. This is highly unlikely to be of self-injurious cause. On the other hand, a systemic event should cause lines reaching from one side to the other. Baran claimed that subungual proximal onychomycosis may cause repeated white transverse lines."
ReplyDeleteStriate leukonychia (true leukonychia) can be considered. It is commonly observed in the fingernails of women and the cuase can be matrix trauma secondary to manicures. Also it looks like nail abnormalities are mostly limited to the first three digits. Does she have any hx of carpal tunnel syndrome? Peripheral neuropathies could also cause nail changes per literature. Thank you for presenting the patient's case.
ReplyDeletefrom R. Baran: "
ReplyDeleteTransverse leuconychia may be genetic, traumatic or systemic.
The picture of the case you sent me is genetic.
May I suggest you to get my book: “Nail diseases and their management” 4th ed (2012) Wiley-Blackwell.
Robert BARAN, MD
Honorary Professor of the University of Franche-Comté
Nail Disease Centre - 42, rue des Serbes - 06400 CANNES (France)
from Mary Maloney, U Mass Dept. of Dermatology: "It must represent trauma of some nature. If all the lines were at the same location from the growing nail plate, you could think ECT etc, but they are all staggered."
ReplyDelete