AL amyloidosis - Nail and Distal Digit
Nail changes in amyloidosis are much less common than cutaneous manifestations. Nail dystrophy is secondary to nail matrix and bed amyloid deposition leading to faulty nail plate production. Nail dystrophy usually slowly worsens over time. In about one-half of cases, cutaneous manifestations precede nail changes. In about 25% of cases, nail changes may be the presenting sign of amyloidosis.
The most common underlying diagnosis in patients with nail changes is myeloma-associated systemic amyloidosis, followed by an underlying monoclonal gammopathy; in some cases, amyloidosis is idiopathic.
For nail dystrophy due to amyloidosis, there is a slight male predominance. It usually presents in the sixth or seventh decade (range: 49-81 years).
Related topics: multiple myeloma, monoclonal gammopathy
E85.81 – Light chain (AL) amyloidosis
23132008 – AL amyloidosis
Differential Diagnosis & Pitfalls
- Cases of AL amyloidosis mimicking giant cell arteritis have been reported. These patients may experience cranial and ocular symptoms including jaw pain and transient or permanent vision loss.
- Lichen planus
- Brittle nail syndrome
- Sjögren syndrome
- Graft-versus-host disease