Part II. Changes in Nail Structure and Growth as Signs of Systemic Disease

Area of Science:

• Dermatology
• Internal Medicine
• Pathophysiology

Background:

• Nail unit structure and growth changes can indicate underlying systemic diseases.
• Pathophysiology involves disruptions in nail vascularization, metabolism, nutrition, inflammation, infections, and genetics.
• Concurrent cutaneous findings often accompany nail changes, both pointing to systemic illness.

Purpose of the Study:

• To outline systemic diseases associated with specific nail changes.
• To describe the pathophysiology, clinical features, and workup recommendations for these nail abnormalities.
• To emphasize the role of nail changes as clinical clues for systemic disease.

Main Methods:

• Review of systemic diseases linked to nail structure and growth alterations.
• Description of pathophysiology, clinical manifestations, and diagnostic approaches.
• Focus on specific nail changes: clubbing, koilonychia, Beau's lines/onychomadesis, onycholysis, onychorrhexis, and pterygium inversum unguius.

Main Results:

• Nail changes correlate with systemic disease activity and severity.
• Dermoscopy and bedside tools can assist in diagnosis.
• Interdisciplinary referrals are crucial for timely diagnosis and improved patient outcomes.

Conclusions:

• Nail unit changes are valuable clinical indicators of systemic disease.
• Understanding nail pathophysiology aids in diagnosing associated systemic conditions.
• Prompt and collaborative medical evaluation is essential for patients with concerning nail findings.