Beau lines - Nail and Distal Digit
Alerts and Notices
Synopsis
Beau lines can be caused by trauma or local disease involving the nail fold, such as manicuring or paronychia, respectively. They may also result from metabolic or inflammatory influences, both local and systemic. When Beau lines are present in all nails at a similar location on the nail plate, there is likely to be a systemic cause, such as myocardial infarction, pemphigus vulgaris, Raynaud phenomenon, or rheumatic fever. As a drug effect, they are most commonly seen with chemotherapeutic agents. In immunosuppressed patients, they may be due to decreased nutrition from gastrointestinal disease or drugs.
In children, hand-foot-and-mouth-disease is a common cause of Beau lines.
Onychomadesis is a complete halt in nail plate production and is a severe form of Beau lines.
Codes
ICD10CM:L60.4 – Beau's lines
SNOMEDCT:
44087005 – Beau's lines
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Muehrcke lines – Paired white transverse bands resulting from hypoalbuminemia, liver disease, malnutrition, chemotherapy, or human immunodeficiency virus (HIV) infection.
- Habit tic deformity – Parallel transverse grooves.
- Mees' lines – Transverse white bands resulting from arsenic poisoning, infections, systemic lupus erythematosus, acute renal failure, heart failure, chemotherapy, or ulcerative colitis.
- Half and half nails – White band proximally and a red-brown band distally, resulting from chronic renal disease, Kawasaki disease, liver and gastrointestinal diseases, zinc deficiency, and chemotherapy.
- Terry nails – A white band involving more than 80% of the total nail length, resulting from hepatic cirrhosis, heart failure, diabetes mellitus, and infections.
- Dermatitis of the nail folds
- Contact dermatitis
- Proximal subungual onychomycosis
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:09/26/2017
Last Updated:10/17/2018
Last Updated:10/17/2018
Patient Information for Beau lines - Nail and Distal Digit
Overview
Beau's lines are horizontal (transverse) depressions in the nail plate that run parallel to the shape of the white, moon-shaped portion of the nail bed (lunula) seen at the nail's origin. They result from a sudden interruption of nail keratin synthesis and grow distally with the nail plate. As the nail grows, the Beau's lines can disappear.Beau's lines can be caused by trauma or local disease involving the nail fold. They can vary based upon the width or depth of the depression, reflecting the duration or extent of the damage. When Beau's lines are present in all nails at a similar location on the nail plate, they are likely to have a systemic cause. They may also result from metabolic, inflammatory, or traumatic influences.
Who’s At Risk
People of all ages and ethnic backgrounds can have Beau's lines. Most commonly, they are seen in chemotherapy patients in reaction to a drug.Signs & Symptoms
Beau's lines occur along the fingernails and the toenails. The grooves extending across the nail plate often span its entire breadth. The involvement of multiple nails may suggest a systemic cause, including a side effect from medication, but the phenomenon may be limited to just the thumb nails and big toe nails.It is possible to measure the distance from the area where the cuticle is seen and where the nail originates (the proximal nail fold) to the leading edge of the Beau's line to determine how much time has elapsed since the line was formed. Because fingernails grow at a rate of approximately 0.1 mm per day, and toenails grow 0.03 mm per day, the duration of the causative insult can be inferred from the width of the Beau's furrow itself.
Recurrent disease will produce repeated transverse grooves, separated by normal nail.
Self-Care Guidelines
None necessary.When to Seek Medical Care
If nail changes, such as depressions in the nails, are noted, it may be helpful to seek evaluation from a primary care provider or dermatologist.Treatments
Beau's lines are a retrospective indicator of various causes, and your physician may investigate for possible causes.References
Bolognia, Jean L., ed. Dermatology, pp.1027, 1061-1062, 1069. New York: Mosby, 2003.
Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed, pp. 13, 657, 664, 1340. New York: McGraw-Hill, 2003.
Beau lines - Nail and Distal Digit