[...]... Faster growth Slower growth Day-time Night-time First day of life Pregnancy Minor trauma/nail biting Left-hand nails Right-hand nails Old age Youth, increasing age Fingers Toes Summer Winter or cold environment Middle, ring and index fingers Thumb and little finger Male (?) Female (?) THE NAILS IN CHILDHOOD AND OLD AGE Childhood In early childhood, the nail plate is thin and may show temporary koilonychia... keratinized and hardened Linear nail growth Many studies have investigated the linear growth rates of the nail plate in health and disease; their findings are summarized in Tables 1. 1 and 1. 2 Finger nails grow Science of the nail apparatus 7 approximately 1 cm every 3 months and toe nails at half this rate Table 1. 1 Physiological and environmental factors affecting the rate of linear nail growth Faster... clubbing is measurement of the phalangeal depth ratio (Figure 2.3) In a normal finger the distal phalangeal depth is smaller than the interphalangeal depth In clubbing this relationship is reversed ( >1) The measurement can easily be taken using a caliper in less than a minute Nail configuration abnormalities 11 Figure 2 .1 (a, b) Clubbing Figure 2.2 Clubbing, demonstrating typical nail curvature and. .. reduced to 16 0° or even 14 0° However, the best indicator may be the simple clinical method adopted by Schamroth: in normal individuals a distinct aperture or ‘window’, usually diamond-shaped, is formed at the base of the nail bed; early clubbing obliterates this window (Fig 2.2) Radiological changes occur in less than one-fifth of cases These include phalangeal demineralization and irregular thickening of... nail plate and the proximal nail fold when the finger is viewed from the radial aspect This is normally 16 0°, but exceeds 18 0° in clubbing A modified profile sign is assessed by measuring the angle between the middle and the terminal phalanx at the interphalangeal joint: in normal fingers the distal phalanx forms an almost straight (18 0°) extension of the middle phalanx, whereas in severe clubbing this... dermatoscopy in the nail and periungual tissues, reflecting the increasing subtlety of this technique in the diagnosis of pigmentary conditions Ultrasonography and Magnetic Resonance Imaging (MRI) have become very important in diagnosis and presurgical assessment and a contribution by JeanLuc Drape shows the advances in this field Many of our dermatological and podiatric colleagues use this book as their main... lateral and/ or the distal margin Koilonychia is more often due to local rather than systemic factors 1 In neonates and in infancy, koilonychia is a temporary physiological condition (Figures 2 .12 , 2 .13 ) There is a proven correlation between koilonychia and iron deficiency (with normal haemoglobin values) in infants 2 Koilonychia is a common manifestation of the rare Plummer-Vinson syndrome in association... homogeneous on X-ray examination and does not impinge on the medullary space Acro-osteolysis of the distal phalanges has been reported Figure 2.4 Clubbing in pachydermoperiostosis The pachydermal change of the extremities and face, with furrowing and oiliness of the skin, is the most characteristic feature of the disorder; it is termed the Touraine-SolenteGolé syndrome Nevertheless, in hypertrophic... hypoalbuminaemia may be seen in normal individuals Longitudinal ridging is present to some degree in most people after 50 years of age and this may give a ‘sausage links’ appearance A text atlas of nail disorders 8 Table 1. 2 Pathological factors affecting the rate of linear nail growth Faster growth Slower growth Psoriasis Finger immobilization normal nails Fever pitting Beau’s lines onycholysis Denervation... Pulmonary Cardiovascular Gastrointestinal inflammatory bowel disease parasitosis liver disease tropical sprue Endocrine/metabolic thyroid, acromegaly (Figure 2.6) malnutrition AIDS Secondary to pulmonary and other infections A text atlas of nail disorders 16 Acquired forms 1 Thoracic disorders are involved in about 80% of cases of clubbing, often with the common denominator of hypoxia: • bronchopulmonary . have investigated the linear growth rates of the nail plate in health and disease; their findings are summarized in Tables 1. 1 and 1. 2. Finger nails grow T he nail grows continuously througout life . g rowth Da y -time N i g h t -time Pre g nanc y First da y of life Minor trauma/nail bitin g Ri g h t -hand nails Lef t -hand nails Youth, increasin g a g e Old a g e Fingers Toes Summer Winter. 8 418 4 096 3 (Print Edition) Distributed in the USA by Fulfilment Center Taylor & Francis 10 650 Tobben Drive ISBN 0-2 0 3-4 4 213 -X (Adobe e-Reader Format) Independence, KY 410 51, USA Toll