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Clin Med (Lond) 2021 05;21(3):166-169

University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK

A change in colour, size, shape or texture of finger- and toenails can be an indicator of underlying systemic disease. An appreciation of these nail signs, and an ability to interpret them when found, can help guide diagnosis and management of a general medical patient. This article discusses some common, and some more rare, nail changes associated with systemic disease. Read More

Dermatol Clin 2021 Apr 12;39(2):175-182. Epub 2021 Feb 12.

Nail Disease Centre, Rue des Serbes 42, Cannes 06400, France.

The cutaneous paraneoplastic syndromes are rare and intrinsically devoid of any neoplastic nature. The manifestations on the skin and the nails are due to various mechanisms caused by the tumor, either due to production of bioactive substances or in response to it. These disorders evolve in parallel to the malignancy, in that, they regress when the tumor is removed and reappear in the case of tumor recurrence. Read More

Dermatol Clin 2021 Apr;39(2):153-173

Saint-Pierre, Brugmann and Queen Fabiola Children University Hospitals, Université Libre de Bruxelles, Belgium. Electronic address:

Describing and listing all nail symptoms and signs in systemic disorders has already been widely detailed in dedicated textbooks. To be tutorial, this article described most common nails signs and the systemic disorders one may encounter in routine dermatologic consultation. Capsule summaries are presented for each section. Read More

Cureus 2019 Mar 11;11(3):e4216. Epub 2019 Mar 11.

Gastroenterology and Hepatology, John H. Stroger Jr. Hospital of Cook County, Chicago, USA.

Paraneoplastic gastrointestinal syndromes rarely precede the actual detection of an overt cancer with gastroparesis being a very rare initial presentation. To increase the clinical awareness of this rare clinical entity, we present a case of severe gastroparesis that was later proven to be associated with an occult poorly differentiated non-small cell lung cancer. We then continue to briefly review the relevant literature on paraneoplastic gastrointestinal syndromes to date. Read More

BMJ Case Rep 2019 Mar 31;12(3). Epub 2019 Mar 31.

Cardiology, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India.

A 14-year-old boy of Asian origin presented with a history of bluish discolouration of the finger and toenail bed with associated mild fatiguability on exertion since early childhood. Clinical examination revealed bilaterally symmetric uniform central cyanosis with no associated clubbing. Cardiovascular and respiratory system examination was normal. Read More

J Eat Disord 2019 5;7. Epub 2019 Mar 5.

3Department of Renal medicine, Gosford Hospital, Gosford, Australia.

Background: The link between clubbing and laxative abuse has been reported several times in the literature, in all cases in young females. The nature of this relationship is not understood.

Case: A young female, with no history of hepatic, pulmonary or malignant disease was found to have nail clubbing in the context of laxative abuse. Read More

Ned Tijdschr Geneeskd 2017;161:D1807

Maastricht Universitair Medisch Centrum+, afd. Kindergeneeskunde, Maastricht.

A 4-year-old boy was referred because of pan-digital clubbing and watch-glass nails. Other remarkable findings were: surgical closure of a patent arterial duct, decreased knee-mobility and consanguineous parents. This combination is suggestive for primary hypertrophic osteoarthropathy (PHO; #OMIM 259100). Read More

Ann Dermatol Venereol 2017 Dec 12;144(12):799-803. Epub 2017 Sep 12.

Department of Dermatology, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France; MAGEC, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France. Electronic address:

Background: Pachydermoperiostosis is a rare autosomal recessive genetic disorder characterized by the association of periostosis and pachydermia. To date, two genes involved in prostaglandin metabolism, HPGD and SLCO2A1, have been identified.

Patients And Methods: A 7-year-old girl presented digital clubbing of the hands and feet, curved nails, hyperhidrosis, and pachydermia, as well as eczema of the trunk and limbs. Read More

Kyobu Geka 2016 Nov;69(12):1003-1007

Department of Surgery, Oita Prefectural Hospital, Oita, Japan.

A 40-year-old woman was noted to have clubbing of the nails during an outpatient service for smoking cessation. Chest computed tomography showed an aneurysm of an aberrant artery running from the descending aorta to the left lower lobe. Hence, we diagnosed anomalous systemic arterialization of the lung. Read More

Br J Dermatol 2017 08 22;177(2):546-548. Epub 2017 Jun 22.

Human Medical Genetics and Genomics Program, University of Colorado School of Medicine, Aurora, CO, 80045, U.S.A.

Rev Med Chil 2016 Apr;144(4):516-20

POEMS syndrome is characterized by Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal protein and Skin changes. We report a woman with the syndrome, who had peripheral polyneuropathy, osteosclerotic myeloma, monoclonal IgA elevation, hypothyroidism, hypogonadotrophic hypogonadism, hyperprolactinemia, adrenal insufficiency, hepatosplenomegaly, lymphadenopathy, thyroid and parotid enlargement, Castleman’s disease, papilledema, stiff and hyperpigmented skin, white nails, clubbing, ascites and chronic diarrhea. She had also a nephropathy characterized by microscopic hematuria, proteinuria, renal insufficiency and a unilateral kidney retraction. Read More

Ann Dermatol Venereol 2016 Apr 2;143(4):284-8. Epub 2016 Mar 2.

Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, 1, rue Jean-Burguet, 33000 Bordeaux, France. Electronic address:

Background: Acro-osteolysis (AO) involves partial or total destruction of the distal phalanges of the fingers or toes. The range of forms of AO is extremely wide. A distinction is generally made between the acquired forms and the genetic and idiopathic forms. Read More

Prim Care 2015 Dec;42(4):677-91

Department of Family and Community Medicine, Penn State Milton S. Hershey Medical Center, 500 University Avenue, Hershey, PA 17033, USA. Electronic address:

A variety of nail deformities commonly presents in the primary care office. An understanding of nail anatomy coupled with inspection of the nails at routine office visits can reveal undetected disorders. Some problems are benign, and treatment should be attempted by the primary care provider, such as onychomycosis, paronychia, or ingrown toenails. Read More

Z Rheumatol 2015 Oct;74(8):728-30

Klinik für Rheumatologie, HELIOS Seehospital Sahlenburg, Nordheimstr. 201, 27476, Cuxhaven, Deutschland.

Secondary hypertrophic osteoarthropathy, also known as Marie-Bamberger disease, occurs in up to 5 % of patients with non-small cell lung cancer (NSCLC). If the syndrome constellation of finger clubbing and bone pain on palpation is recognized early, lung cancer can be diagnosed at an early stage. This article reports the case of a 52-year-old male patient with knee pain, distal edema, watchglass nails and finger clubbing which first appeared in August 2013. Read More

Presse Med 2014 Nov 23;43(11):1208-15. Epub 2014 Oct 23.

Nail disease centre, 42, rue des Serbes, 06400 Cannes, France. Electronic address:

For those interested in nails, a fairly good knowledge of the anatomy of the nail unit is indispensable. But nothing will replace a careful, clinical examination of the nail apparatus. The shape of the nail, surface abnormalities and coloration, with or without a magnifying glass, may well provide a medical diagnosis not only in dermatology but also for medicine in general. Read More

J Rheumatol 2014 Mar 15;41(3):523-7. Epub 2014 Jan 15.

From the UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan; Department of Radiology, Faculty of Medicine, Shimane University, Shimane, Japan; Medical Physics and Engineering, Leeds Teaching Hospitals UK National Health Service (NHS) Trust, Leeds, UK.

Objective: Hypervascularization in finger clubbing is recognized, but its microanatomical basis remains unclear. This pilot descriptive study used magnetic resonance imaging (MRI) to explore this further.

Methods: High-resolution MRI acquired with contrast agent was carried out in 4 patients with finger clubbing and 4 healthy volunteers. Read More

Int J Dermatol 2013 Nov 4;52(11):1349-56. Epub 2013 Apr 4.

Department of Dermatology, Mayo Clinic, RochesterDepartment of Laboratory Medicine and Pathology, Mayo Clinic, RochesterDivision of Hematology, Mayo Clinic, RochesterDivision of Clinical Biochemistry and Immunology, Mayo Clinic, RochesterDivision of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.

Background: Polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes syndrome is a rare multisystem paraneoplastic condition associated with plasma cell dyscrasia.

Methods: From our institution's dysproteinemia database, 107 patients met criteria for polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes syndrome between January 1, 2000, and October 1, 2009. Medical records were reviewed for documented syndrome features at diagnosis. Read More

Saudi J Kidney Dis Transpl 2013 Jan;24(1):36-40

Department of Nephrology, Golestan University of Medical Sciences, Gorgan, Iran.

Mucocutaneous manifestations are common among patients on hemodialysis (HD). This study was undertaken to determine the prevalence of mucocutaneous manifestations in patients with end-stage renal disease (ESRD) who are on HD. In this cross-sectional, descriptive and analytic study conducted in 2009, 100 patients on HD at the Five Azar Hospital in Gorgan city were randomly selected. Read More

Int J Dermatol 2013 Jan;52(1):1-5

Second Affiliated Hospital, Chongqing Medical University, China.

Background: Current methods to diagnose clubbing have drawbacks. This study was done to test a novel and convenient method for the diagnosis of digital clubbing using high-frequency ultrasound.

Methods: Index fingers from a healthy control group without digital clubbing and a patient group with digital clubbing were examined by ultrasound. Read More

Interact Cardiovasc Thorac Surg 2012 Dec 11;15(6):1080-1. Epub 2012 Sep 11.

Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium.

A 46-year old male patient was admitted with a history of an extremely painful right upper arm, associated with unilateral clubbing. Duplex scanning and magnetic resonance imaging were suggestive of a pseudo-aneurysm of the brachial artery. Digital angiography showed an irregular brachial artery, associated with a small pseudo-aneurysm. Read More

J Invest Dermatol 2012 Oct 14;132(10):2473-2476. Epub 2012 Jun 14.

Center for Human Genetics, Bioscientia, Ingelheim, Germany; Department of Human Genetics, RWTH Aachen University, Aachen, Germany; Center for Clinical Research, University Hospital Freiburg, Freiburg, Germany. Electronic address:

Am Fam Physician 2012 Apr;85(8):779-87

Cleveland Clinic, Stongsville, OH, USA.

Knowledge of the anatomy and function of the nail apparatus is essential when performing the physical examination. Inspection may reveal localized nail abnormalities that should be treated, or may provide clues to an underlying systemic disease that requires further workup. Excessive keratinaceous material under the nail bed in a distal and lateral distribution should prompt an evaluation for onychomycosis. Read More

An Pediatr (Barc) 2012 Aug 13;77(2):141-2. Epub 2012 Apr 13.

Anadolu Kardiyol Derg 2012 Apr 20;12(3):E14-5. Epub 2012 Apr 20.

Clinic of Cardiology, Türkiye Yüksek İhtisas Hospital, Ankara, Turkey.

Hand Surg 2011 ;16(3):383-6

Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Seoul National University Bundang Hospital, Seongnam, Korea.

The authors present a case that developed acute painful nail hypertrophy of the ipsilateral four fingers which resembled finger clubbing after undergoing elective hand surgery on the little finger. The patient was diagnosed as having complex regional pain syndrome (CRPS), and the nail hypertrophy subsided gradually on pain control, and completely normalized one year after onset. Recognizing this phenomenon may help initiate early treatment for CRPS and avoid unnecessary antibiotic or antifungal medications for postoperative infection. Read More

Hautarzt 2011 Oct;62(10):722-5

Hautklinik, Universitätsklinikum Düsseldorf.

POEMS syndrome is a rare paraneoplastic syndrome due to a plasma cell dyscrasia, which includes peripheral neuropathy, organomegaly, endocrinopathy, monoclonal plasma cell proliferation and skin changes. Elevated levels of VEGF (vascular endothelial growth factor) in the serum of patients are suggested to play a pivotal role in the pathophysiology. A 60-year-old male presented with POEMS syndrome and painful edema, skin thickening of the distal extremities and livid-erythematous discoloration. Read More

J Assoc Physicians India 2010 Apr;58:253-5

Department of Medicine, Sawai Man Singh Medical College and Hospital, Jaipur, India.

A case of pachydermoperiostosis presented to us in rheumatology clinic with complaints of pain and swelling in knee joints unresponsive to treatment, characteristic facial features, grade four clubbing of nails and broadening of distal parts of extremities. He also complained of fatiguability which was due to anemia. The natural history of the disease was reviewed and investigated. Read More

JAMA 2010 Jul;304(2):159-61

Pulmonology Service, Complexo Hospitalario Universitario de Vigo, Vigo, Spain.