Volume 1 • Issue 5 • 1000136 Pigmentary Disorders ISSN: JPD, JPD, hybrid open access journal Haneke, Pigmentary Disorders 2014, 1:5 DOI: 10.4172/JPD.1000136 Research Article Open Access Pigmentations of the Nails Eckart Haneke* 1 Deptartment of Dermatology, Inselspital, University Berne, Bern, Switzerland 2 Dermaticum, Freiburg, Germany 3 Centro de Dermatología, Institute CUF, Porto, Portugal 4 Deptartment of Dermatology, Academy Hospital, University Ghent, Gent, Belgium *Corresponding author: Eckart Haneke, chlippehof 5, 79110 Freiburg, Germany, Tel: 22 60 51 400; E-mail: haneke@gmx.net Received September 16, 2014; Accepted September 19, 2014; Published September 21, 2014 Citation: Haneke E (2014) Pigmentations of the Nails. Pigmentary Disorders 1:136. doi:10.4172/JPD.1000136 Copyright: © 2014 Haneke E. the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Keywords: Nail discoloration; Melanonychia; Ungual melanoma; Microbial pigmentation; Internal diseases Introduction Nail pigmentations can exhibit many diferent colors and shades. Most of them are harmless but cosmetically embarrassing, others are potentially serious and may lead to death if not adequately diagnosed and treated. Tis short review gives an explanation for a number of nail dyschromias and their etiologies as well as some hints as to their treatment. Material and Methods Tis review is based on 40 years of personal experience with patients having nail changes, the evaluation of their patient charts and more than 50,000 color photographs. Te scientifc literature was followed back for one century. Results Nail discolorations or nail dyschromias are frequently seen in general medicine, in dermatology and particularly in a specialized nail clinic. Tey may be classifed according to their medical relevance or the color displayed, and the latter is the most commonly applied criterion. For most colors, a specifc term is known. Leukonychia Tis term (leukos white, onyx nail) designates a white color. Many diferent forms are known: patchy and difuse; punctate, striate; longitudinal and transverse, partial and complete, acquired and genetic, idiopathic and induced by a variety of conditions [1]. In addition, apparent and pseudoleukonychia have to be diferentiated from true leukonychia. Punctate leukonychia is particularly frequently seen in young girls when they start to perform their own manicure. It is thought to be of traumatic origin, but this only explains a part of the cases. Punctate und short striate leukonychia is ofen a sign of a hammer blow when it overlies a subungual hematoma. Crush injuries are usually bigger (Figure1). Transverse leukonychia may be a sign of limited growth retardation, such as afer high fever or during chemotherapy cycles. Longitudinal leukonychia is usually the sign of a thread of subungual keratin, such as in subungual flamentous tumor or onychopapilloma. Difuse leukonychia may be congenital or acquired; the latter is ofen seen in chronic hepatic disease. When the distal third or half of the nail is normal it is called partial leukonychia. So-called half-and-half nails are a sing of chronic renal failure (Figure 2). Histologically, leukonychia displays nucleated nail plate cells (onychocytes). Pallor of the nail bed is seen as apparent leukonychia, pressure on the nail makes is either even more visible or disappear. Pseudoleukonychia is a classical sign of white superfcial onychomycosis, which represents a fungal infection of the nail plate surface of toes and is due to Trichophyton mentagrophytes (interdigitale) in temperate climates (Figure 3) and to a variety of non-dermatophyte molds in hot climates. Another type of superfcial fungal infection is seen in HIV patients and caused by T rubrum. Whereas the former exhibits chalk-white patches the latter keeps a nail plate surface shine and resemble a white cloud (Figure 4). A white nail discoloration is further caused by fungal infections that invade the nail plate such as proximal (white) subungual onychomycosis (Figure 5) and endonyx onychomycosis. Finally, virtually all onycholytic parts of a nail and massive subungual keratosis (Figure 6) appear whitish-yellow due to loss of nail plate transparency. Yellow Nails Xanthonychia (Greek xanthos yellow) is not rare. It is seen in onychomycoses (Figure 7), psoriasis, onychogryphosis and a variety of onycholysis types overlying oozing processes of the nail bed, such as squamous cell carcinoma or amelanotic melanoma. Te most characteristic disease exhibiting xanthonychia is the Yellow Nail Syndrome (YNS). It is characterized by the trias of yellow nails, distal extremity lymphedema and chronic respiratory infection [2]. However, the full trias is not always seen. Te most common type of respiratory infections are sino-bronchial syndrome and bronchiectasis [3], but other internal diseases and carcinomas were observed in association with the YNS [4-6]. Te nails show a yellow discoloration, the cuticle is lost spontaneously; the nails virtually stop growing and lose their attachment to the nail bed (Figure 8). With time, most of them fall of. Te exact mechanism of these nail changes is not known although hypotheses abound, such as anatomical or functional alterations of the lymphatic or vascular microcirculation. Red Nails Erythronychia (erythros red) is seen as a spot, a streak or as a difuse discoloration. Longitudinal erythronychia is a longitudinal streak in the matrix and nail bed. It is most frequently a sign of an Abstract Nail pigmentations can exhibit many different colors and shades. Most of them are harmless but cosmetically embarrassing, others are potentially serious and may lead to death if not adequately diagnosed and treated. This short review gives an explanation for a number of nail dyschromias and their etiologies as well as some hints as to their treatment. J o u r n a l o f P i g m e n t a r y D i s o r d e r s World Health Academy ISSN: 2376-0427 Journal of Pigmentary Disorders