Half and half nail syndrome - Nail and Distal Digit
While half-and-half nails affect an estimated 20% to 50% of chronic renal failure patients, a pattern has yet to be determined with regard to sex, age, and cause of the kidney disease. This entity is also seen in up to 84% of patients with azotemia and 8% to 13% of hemodialysis patients; there is some debate whether the frequency of these changes correlates with duration of dialysis. Other reported causes include Kawasaki's disease, hepatic cirrhosis, zinc deficiency, and Crohn's disease. Half-and-half nails have also been reported in patients without any systemic abnormality.
Finger nails are affected more often than toe nails. The condition is characterized by a proximal pale pink or dull white "ground glass appearance" that is sharply demarcated from a red, pink, or brown distal portion. The transverse distal bands occupy 20% to 60% of the total nail length.
There is no correlation between the distal band length and severity of renal failure. Furthermore, the half-and-half nail pattern appears to be persistent, as there is no tendency of the bands to move with nail growth. Nonetheless, this phenomenon may reverse itself after successful renal transplantation.
L60.8 – Other nail disorders
50077007 – Half-and-half nail
- Absence of lunula – may be associated with chronic renal failure, trauma to the terminal digit, multiple myeloma, scleroderma, hyperparathyroidism, and bone tumors, or may be seen in otherwise healthy individuals
- Splinter hemorrhages – associated with renal disease, systemic lupus erythematosus, rheumatoid arthritis, mixed connective tissue disease, vasculitic syndromes, bacterial endocarditis, and trauma
- Muehrcke lines – double white transverse bands in nail beds that regress and disappear when serum albumin normalizes; associated with nephrotic syndrome (hypoalbuminemia)
- Mees' lines – single white transverse band in nail plates; associated with acute renal failure, arsenic poisoning, septicemia, aortic dissection, sickle cell anemia in crisis, and heavy metal poisoning
- Beau's lines – transverse deep depressions in nails; same associations as Mees' nails
- Koilonychia – spoon-shaped nails; associated with chronic anemia
- Terry nails – proximal three-fourths of nail is pale and wide, distal one-fourth (1- 2-mm band) is narrow and deep red; associated with hepatic cirrhosis; may be seen in peripheral vascular disease, Raynaud phenomenon, connective tissue diseases, or in otherwise healthy individuals
- Nail pitting – seen in psoriasis, alopecia, eczema, neurotrophic conditions, Reiter syndrome
- Clubbing – seen in cyanotic congenital heart disease, inflammatory bowel disease, biliary cirrhosis, cystic fibrosis, esophageal cancer; can be familial and not associated with systemic disease
- Onycholysis – distal nail pulled away from nail bed; associated with hyperthyroidism (Plummer nails), hypothyroidism, fungal infection, psoriasis, or secondary to trauma