SIGNS/SYMPTOMS NAILS (continued)


Muehrcke lines two transverse white lines parallel to the lunula in the nail bed; temporarily disappear with pressure


Mees lines


transverse white lines in nail plate; usually not on thumb; do not disappear with pressure


Other: Malnutrition^


Possible non–nutrition-related causes: Nephrotic syndrome • Glomerulonephritis • Liver diseases • Metabolic stress • Chemotherapy


Additional information: Apparent leukonychia Toxicity: Selenium


Possible non–nutrition-related causes: Poisoning (arsenic, carbon monoxide, thallium, or chronic fluoride) • Infections • Hodgkin lymphoma • Acute myeloid leukemia • Chemotherapy • Systemic lupus erythematosus


Additional information: True leukonychia


Koilonychia spoon shaped, concave


Splinter hemorrhage


Brittle Nail Syndrome (BNS) brittle, soft, dry, weak or thin, split easily


• Onychorrhexis: longitudinal ridging of the nail matrix


• Onychoschizia: lamellar splitting of the distal free edge of the nail plate


Vertical ridges severe and raised ridges


Deficiency: Iron Deficiency: Iron (with or without anemia)


Possible non–nutrition–related causes: Diabetes mellitus • Systemic lupus • Raynaud disease • Hypothyroidism


Additional information: Considered normal if seen on toenails only


Deficiency: Vitamin C


Anemia: Iron Toxicity: Selenium


Possible non–nutrition-related causes: Endocarditis • Trichinosis • Vascular disease • Psoriasis • Lichen planus


Possible non–nutrition-related causes: Aging process • Exposure to moist conditions • Hypothyroidism • Raynaud disease • Systemic amyloidosis • Medications (chemotherapy agents, retinoids, antiretrovirals) • Dermatologic conditions


Additional information: Biotin supplementation shown to improve BNS


Additional information: Slight vertical ridges are normal with aging


POSSIBLE NUTRITION-RELATED CAUSES


ADDITIONAL INFORMATION


PEDIATRIC MALNUTRITION INDICATORS


MICRONUTRIENT EXAM: CLINICAL INTERPRETATION OF NUTRITION FOCUSED PHYSICAL EXAM FINDINGS


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