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Nails in Systemic Disease — SCE Dermatology MCQ

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HardNail DisordersNails in Systemic DiseaseSCE Dermatology

A 68-year-old woman develops half-and-half nails (Lindsay nails). The proximal portion of the nail bed is white and the distal 20-60% is red-brown. What systemic condition is most commonly associated?

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Correct answer: B — Advanced chronic kidney disease with uraemic nail-bed change

The best answer is “Advanced chronic kidney disease with uraemic nail-bed change”. Nail findings localise disease to matrix, bed or periungual tissue; a new changing longitudinal pigmented or erythronychic band requires specialist assessment because benign and malignant causes overlap. The alternatives “Chronic liver disease with portal hypertension”, “Congestive cardiac failure with peripheral oedema”, “Iron-deficiency anaemia with epithelial change, when the full phenotype supports it”, “Hyperthyroidism with accelerated nail growth, within an appropriate UK pathway” are clinically adjacent possibilities, but they do not fit the defining morphology, distribution, histopathology, risk signal or management sequence in this stem.

Reference: DermNet specialist nail terminology reference: https://dermnetnz.org/topics/nail-terminology