Terry’s Nails and Lindsay’s Nails: Two Nail Abnormalities in Chronic Systemic Diseases

Abstract

A 66-year-old man with diabetes and cirrhosis due to chronic hepatitis C infection (HCV RNA >1,000,000 IU/mL) developed a creatinine rise from 0.5 mg /deciliter to 2.6 mg/deciliter. The patient's fingernails demonstrated significant changes compared to a normal fingernail, with a white band (lunula) occupying more than 50 % of the nail bed proximally, suggestive of Lindsay's nail. (Figs. 1 and 2) Renal biopsy demonstrated membranoproliferative glomerulopathy and he was started on hemodialysis.A clinical differentiation between Lindsay's nail (half-andhalf nail) and Terry's nail is difficult. In Lindsay's nail, the proximal part of the nail is white, while the distal portion occupying 20 % to 60 % of nail bed is reddish-brown and does not fade with pressure. 1,2 The cause of Lindsay's nail is unclear, but the distal reddish-brown band might be the result of an increased concentration of β-melanocyte-stimulating hormone. 2 This condition can be found in up to 40 % of patients of chronic kidney disease. 1 On the other hand, Terry's nail is defined as a 0.5-3.0 mm brown to pink distal band with proximal nail bed whiteness occupying approximately 80 % of nail bed. 3 This condition is frequently associated with cirrhosis, chronic congestive heart failure, and adult-onset diabetes mellitus. 3

Clinical and capillaroscopic findings in patients with liver disease and proximal apparent leukonychia (Terry nails and its variants)

“…[ 8 ] This additional eponymous title could only add further confusion given these individuals actually had Terry nails, Lindsay nails, and intermediate forms. [ 9 ] The term PAL would include all eponymous titles as well as intermediate types, and is more convenient for several reasons. First, both Terry nails and Lindsay nails are both forms of apparent leukonychia affecting the basal (proximal) part of the nail bed, with a distal pink-to-brown transverse band.…”

“…[ 7 ] Lindsay nails are associated with chronic renal failure. [ 7 ] Clinical distinction among these forms of PAL can be difficult [ 8 , 9 ] and there are also intermediate forms. [ 8 ]…”

Terry's nails

“…On examination, he was found to have whitish “ground glass” discoloration of the nail beds with absence of lunula and presence of distal normal pink zone (Terry's nails) (Figure ) Terry's nails were initially described by Dr Richard Terry in 1954 in patients with cirrhosis . They may also be found in congestive heart failure, chronic renal failure, and other conditions . His encephalopathy was corrected with administration of lactulose, and low potassium was replaced.…”

The Relationship between the Presence of White Nails and Mortality among Rural, Older, Admitted Patients: A Prospective Cohort Study

“…A poor nutritional status can progressively cause Terry’s nail [ 9 ]. On the other hand, whitening of the nails with brown distal nail parts due to melanin deposition is called Lindsay’s nail; this is indicative of malnutrition and renal disease [ 10 ]. The mechanism underlying Terry’s and Lindsay’s nails is not fully understood.…”