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Pesticide-induced nail changes - Nail and Distal Digit
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Pesticide-induced nail changes - Nail and Distal Digit

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Contributors: Bertrand Richert MD, Robert Baran MD
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Synopsis

The dipyridilium herbicides, paraquat, and diquat are widely used worldwide and may cause local reactions in the skin and nails of handlers (mixers, loaders, and applicators). Due to restrictions on its use, paraquat is not available for residential use, and, thus, reactions are limited to occupations with frequent exposure to commercial herbicides (farm workers, foresters). Toxic exposures to either concentrated or diluted paraquat occur in mixers or sprayers who fail to wear appropriate protective equipment.

Nail changes include transverse leukonychia, transverse ridging or furrowing, onycholysis, and nail shedding. Fingernails are most commonly involved, though toenail involvement has been seen in barefoot spray operators on coffee plantations in Kenya. Dinobuton handlers may present with yellow nails and hair. Paraquat exposure may also be associated with irritant contact dermatitis and paronychia of exposed fingers.

Codes

ICD10CM:
L60.8 – Other nail disorders

SNOMEDCT:
17790008 – Disorder of nail

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Transverse leukonychia secondary to trauma
  • Yellow nails secondary to other causes (yellow nail syndrome, nail enamel and hardeners, AIDS, carotene, onychomycosis, tetracyclines, penicillamine, jaundice)
  • Nail shedding secondary to other causes

Best Tests

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Management Pearls

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Therapy

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References

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Last Updated: 05/25/2018
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Pesticide-induced nail changes - Nail and Distal Digit
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Pesticide-induced nail changes : All fingernails or distal fingers, Insecticide exposure, Onycholysis - lifting nail, Pesticide exposure, Transverse white nail lines, Yellow color
Clinical image of Pesticide-induced nail changes
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