History taking and focused clinical examination often suffice
in clenching diagnosis with investigation in most cases to refute or aid
treatment. This is once again proven when one considers the wealth of
information gained from examination of the nails. The visual appearance of the
finger nails and toe nails may suggest an underlying systemic disease. One of
such findings on the examination may be the Terry nails. Terry nail is a
physical finding in which finger nails and/or toe nails appear white with a
characteristic ground glass appearance with no lunula. There is a brown arc
near the end of the nails.
The exact
cause of Terry nail is unknown but the underlying mechanism appears to be a
decrease in vascularity and an increase in connective tissue within the nail
bed1. Terry occur in the setting of hepatic cirrhosis/hepatic
failure (with 80 percent of these patients having Terry’s nails1 );
diabetes mellitus, congestive cardiac failure, hyperthyroidism, malnutrition,
renal failure, etc.
Patients
rarely present with complaints related to the appearance of their nails.
Therefore, it is necessary for the physician not only to be familiar with
common nail findings, but also to inspect nails carefully during physical
examinations. Nail findings may provide important clues to the diagnosis of
systemic illness, limit the differential diagnosis, and focus further work-up.
Reference: 1. Mayeaux EJ Jr. Nail
disorders. Prim Care. 2000;27:333–51.
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