1. 9/19/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 1
The hands
Photographs kindly supplied by:
http://www.dermnet.com

2. 9/19/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 2
Inspection
 Movement
 Tremor
 Flap
 Skin Texture
 Dermatitis
 Scarring
 Swelling/thickening
 Callosities
 Dupuytrens
contracture
 Skin colour
 Cyanosis
 Pallor
 Erythema
 Nicotine staining
 Nails

3. 9/19/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 3
Clubbing
Loss of angle between the nail bed and the finger
May be a feeling of sponginess of the proximal nail bed
Causes:
 lung cancer
 chronic suppurative lung disease
 infective endocarditis
 cyanotic heart disease
 cirrhosis of the liver
 inflammatory bowel disease
 congenital
http://www.dermnet.com

4. 9/19/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 4
Beau’s lines
Transverse non-pigmented grooves
Associated with arrested nail growth
 Post fever, weight loss, acute severe illness
http://www.dermnet.comm

5. 9/19/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 5
Koilonychia
Spoon-shaped depression of the nails, caused by
 Iron deficiency (may be congenital)
http://www.dermnet.comm

6. 9/19/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 6
Splinter haemorrhages
Asymmetrical, splinter- like lesions, caused by:
 trauma (usually along junction between free edge and
nail bed) this is commonest cause
 Infective endocarditis,
 vasculitis,
http://www.dermnet.comm

7. 9/19/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 7
Half-and-half nails
Distal red or brown
band
Proximal nail white or
pink
Caused by:
 Chronic renal failure,
chronic liver disease
http://health.allrefer.com/pictures-images/half-and-half-nails.html

8. 9/19/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 8
Pitting
Small indentations in the nail surface, caused by:
 Psoriasis (nails often have multiple pits of 20 or more)
http://www.dermatlas.org/derm/result.cfm?Diagnosis=-946037564

9. 9/19/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 9
Onycholysis
Separation of the free end of the nail from the underlying nail bed,
caused by:
 Psoriasis,
 fungal infections,
 thyrotoxicosis
http://www.dermnet.comm

10. 9/19/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 10
Pincer
Transverse overcurvature of the nail, caused by:
 Degenerative osteoarthritis of distal interphalangeal joints
 Ill fitting shoes
 Subungual exoxtosis
 Fungal infection
http://www.dermnet.comm

11. 9/19/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 11
Some other examples of nail changes
Nail sign Description Some causes
Onychomycosis Thickened,
crumbling nail
Fungal infections
Pale nail bed Anaemia
Leuconychia White nails Hypoalbuminaemia
Blue nails Cyanosis