Beau lines are transverse depressions in the nail plate that are sometimes seen to be parallel to the shape of the lunula. Beau lines are common and nonspecific nail changes. They result from a sudden interruption of nail keratin synthesis and grow distally with the nail plate. They can vary with the width or depth of the depression, reflecting the duration or extent of the damage, respectively. As the nail plate grows distally, the Beau lines disappear.
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.
Beau lines - Nail and Distal Digit
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Synopsis
Codes
ICD10CM:
L60.4 – Beau's lines
SNOMEDCT:
44087005 – Beau's lines
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.
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References
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Last Reviewed:09/26/2017
Last Updated:10/17/2018
Last Updated:10/17/2018
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Beau lines - Nail and Distal Digit