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L60.3 – Nail dystrophy
66270006 – Koilonychia
SynopsisThis summary discusses koilonychia in adults. Koilonychia in infants is discussed separately.
Koilonychia refers to a nail being concave with the edges everted, often nicknamed "spoon-nail." Koilonychia can be categorized as acquired, idiopathic, and hereditary.
Acquired koilonychia, the most common form, can be caused by trauma; dermatologic diseases such as psoriasis, fungal infections, and Raynaud phenomenon; or systemic disease such as iron deficiency anemia or Plummer-Vinson syndrome. A common presentation is in babies who wear excessively rigid or ill-fitting shoes. In iron deficiency anemia koilonychia, the above will be seen in addition to nail ridging and brittleness. In Plummer-Vinson syndrome, a postcricoid web is associated with koilonychia, angular stomatitis, a sore tongue, and usually iron deficiency anemia. Between 5–10% of patients with a postcricoid web will develop carcinoma at the site. Koilonychia occurs in about 50% of cases and commonly involves the first 3 digits of the hands. Nail brittleness is also frequent.
Idiopathic koilonychia is the second most common form and may be assumed after an exhaustive search for an alternate cause. It can present as serrated koilonychia, a combination of koilonychia and deep longitudinal grooves. Hereditary koilonychia, the least common form, is inherited in a dominant fashion and may be seen in conjunction with total leukonychia.