24 - terry's nails

The distal 1–2-mm rim of the nail (which is still in contact with the nail bed) is pink, while the rest of the nail is white. This appears to be a non-specific sign, although in the patient shown it was associated with renal failure.

Terry's nails is a physical finding in which fingernails and/or toenails appear white with a characteristic "ground glass" appearance, with no lunula. The condition is thought to be due to a decrease in vascularity and an increase in connective tissue within the nail bed. It frequently occurs in the setting of hepatic failure, cirrhosis, diabetes mellitus, congestive heart failure, hyperthyroidism, and/or malnutrition. Eighty percent of patients with severe liver disease have Terry's nails.

In patients with Terry's nails, most of the nail plate turns white with the appearance of ground glass, and the lunula is obliterated. The condition may occur on only one finger, but more commonly all fingers are affected. This condition was described originally in relation to severe liver disease, usually cirrhosis, with 80 percent of these patients having Terry's nails. Subsequently, in another study, 25 percent of hospitalized patients with varied diseases were found to have Terry's nails. The condition is thought to be caused by a decrease in vascularity and an increase in connective tissue in the nail bed.

Hepatic failure, cirrhosis, diabetes mellitus, CHF, hyperthyroidism, malnutrition are the causes .

23 - red lunula

the first image shows normal lunula which is white and the second image shows the red lunula .

Q: red lunula is seen in all of the following conditions except ? a. AIDS b. RA c. SLE d. gonorrhea answer : d . gonorrhea .

Other conditions where we can see red lunula are :

1. AIDS 2. Rheumatoid arthritis 3. systemic lupus erythematosus 4.alopecia areata 5.cardiac failure 6. chronic systemic diseases

The lunula, or lunulae (pl.) (nail moon), is the crescent-shaped whitish area of the bed of a fingernail or toenail. The lunula is the visible part of the nail matrix (i.e. the root of the nail).

It appears by week 14 of gestation, and has a primary structural role in defining the free edge of the distal nail plate (the part of the nail that actually grows outward).

Appearance

It is located at the end of the nail that is closest to the skin of the finger but still lies under the nail. It is not actually white but only appears so when seen through the nail.

It is half-moon-shaped, and has unique histologic features.

The lunula is most noticeable on the thumb, and not everyone's lunula is visible.

Clinical significance

The lunula and the nail itself are good places to find warning signs of certain diseases such as liver disease, kidney disease, heart problems, and lung diseases.Any colour differences or unusual lines may indicate some type of disease or insufficiency. However, vertical lines on one's fingernails are normal as one ages.

Lunular anomalies include changes in form, structure or colour. Lunular dysmorphologic features (that is, anomalies in form) can be characterized by macrolunula, microlunula or anolunula, and nonconvex lunula. Lunular dyschromias (colour anomalies) can be confluent or spotted or can be characterized by longitudinal coloured bands that traverse the lunula. Alterations in the morphologic features or colour (or both) of the lunula can be an indication of either a cutaneous or a systemic disorder. A deep red lunula and pale nails is associated with congestive heart failure.