“Nails protect the fingertips and toes. Diseases affecting the nail can cause cosmetic disfigurement and social embarrassment. Physical functioning may be impaired. Disorders of the nail bed may cause pain or create difficulty grasping fine objects. The nail bed is the area beneath the nail plate between the lunula and the hyponychium. Disorders of the nail bed can cause onycholysis, subungual hyperkeratosis, and/or onychogryphosis. Ventral pterygium is less common. Tumors of the nail bed are rare and commonly missed.”
Key points
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All 20 nails should be examined carefully.
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Common disorders affecting the nail bed include onycholysis, subungual hyperkeratosis, and ventral pterygium.
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Melanomas, squamous cell carcinoma, Bowen disease, and glomus tumors can also present in the nail bed.
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The ABCDEF guidelines can be used to assess a subungual melanoma.
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A glomus tumor should be considered in patients who present with severe pain triggered by cold.
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