Nail Abnormalities: Clues to Systemic Disease - American Family Physician

lem causing growth disturbance may lead to the formation of transverse lines across the nail plate, as in Mees’, Muehrcke’s, and Beau’s lines (Figure 2). Changes in the configuration of the capillaries in the proximal nail bed are responsible for some of the alterations that occur in patients with connective tissue disorders, while abnormalities in the periosteal vessels contribute to clubbing.2 The nail is bound proximally by the eponychium (the skin just proximal to the cuticle), laterally by the nail folds, and distally by the distal nail fold (defined by the separation created by the anterior ligament between the distal nail bed and the nail plate; Figure 1). Localized bacterial and fungal infections of the nail, the most common nail problems seen by family physicians, have been reviewed elsewhere.3,4