This article reviews 6 nail disorders that, although easy to diagnose, are misdiagnosed frequently by dermatologists and general practitioners. Diagnostic clues are emphasized to familiarize readers with features that indicate the correct diagnosis. We focus on two common tumors (onychomatricoma and onychopapilloma), two rare genetic conditions that can be diagnosed owing to nail changes (Darier disease and nail patella syndrome), and two uncommon acquired disorders (the yellow nail syndrome and lichen striatus).
Key points
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Diagnostic features of onychomatricoma are localized or diffuse thickening of the nail plate, yellow discoloration, and holes in the nail plate free edge, which can be better visualized at frontal view.
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Onychopapilloma presents as a monodactylous longitudinal erythronychia, leukonychia, or melanonychia; diagnosis is suggested by presence of a keratotic notch under the distal nail plate.
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A key diagnostic finding in Darier disease is alternating longitudinal erythronychia and longitudinal leukonychia, resembling a “candy-cane” pattern.
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Triangular lunula is a specific sign of nail patella syndrome. The other typical feature is nail hypoplasia, which is more severe on the thumb and radial side of the nail.
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In the yellow nail syndrome, diagnosis is suggested by arrested or reduced nail growth. The nails are thickened and overcurved and the cuticle is typically absent. The yellow color may not be evident.
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Nail lichen striatus is characterized by lichenoid nail changes limited to the medial or lateral side of the nail plate.
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