الفهرس 
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Abstract
The nail is an opalescent window to the vascular nail bed. It is held in place by the nail folds, originating at the matrix and attached to the nail bed. The nail apparatus begins to develop in utero at 9 weeks from the same primitive epidermis that gives rise to hair, sweat glands and stratum corneum.
The nail apparatus consists of: Nail plate, nail fold, nail grooves, nail matrix, lunula and nail bed.
The nail plate is approximately 0.5 mm thick in women and 0.6mm thick in men.
There are two lateral and one proximal nail folds.
There are two lateral and one proximal nail grooves. Nail grooves are potential spaces and only become real spaces in abnormal conditions of the nail.
The nail matrix splits into three parts: the dorsal matrix, intermediate matrix & the ventral matrix.
The Lunula: is a half shaped moon structure which is paler than the adjacent nail bed.
The nail bed is the vascular bed upon which the nail rests extending from the distal margin of the lunula to the hyponcychium.
Four artries supply each digit, two on either side, arising as branches of radial artery. The venous drainge is by deep and superficial systems; the deep corresponds to the arterial supply & superficial to the dorsal and palmar digital veins.
Any portion of the nail unit may get affected by various dermatological condition, systemic disease, infections, ageing process, internal and external medication, vascular insufficiency, trauma, neurological abnormalities, nutritional deficiency and both benign and malignant tumour. Various nail abnormalities result in pain or interference with functioning or both. Nail disorder may affect walking, picking up of fine objects and protective function. Abnormal nails are of utmost clinical importance, especially when they are the only presenting feature without any other apparent signs and symptom of a disease. Hence nail provides us insight of window looking through which one can establish the diagnosis. Various dermatological conditions that characteristically involve the skin and hair may also involve the nail.
Nail abnormalities include Abnormalities in shape,Abnormalities of nail attachment,Changes in nail surface,Changes in color, Congenital abnormalities of the nail,Nail changes in infections,Nail changes in dermatological conditions and Neoplasm of nails.
In general the abnormalities is due to
Modification in the configuration of the nail as; clubbing, koilonychias, transverse overcurvature of the nail, dolichonychia, parrot beak nails, claw-like nail .
Modification of the nail surface as; longitudinal lines, oblique lines, transverse grooves and Beau’s lines, pitting, trachyonychia, lamellar nail splitting .
Modification of the nail plate and soft tissue attachments; pterygium, onycholysis, subungual hyperkeratosis .
Modification in perinonychial tissues as; paronychia, ingrowing nails, tumors of the nail folds and periungual telangiectasia .
Modification in the consistency of the nail .
Modification in colour as; chromonychia or dyschromia, leuconychia, erythronoychia
The following is the classification of nail disorders:
1. Genetic disorders: congenital annonychia and macronychia
2. Nail changes in infections: Various fungal, bacteria, viral, may affect the nail.
3. Nail changes in dermatological conditions: Lichen planus, psoriasis, eczema.
4. Nail deformities due to trauma: Nail biting, habit-tic deformity.
5. Neoplasm of nails:
Benign: like glomus tumour, myxoid cyst, periungual fibroma.
Malignant: Malignant melanoma and squamous cell carcinoma.
6. Drug induced nail changes.
7. Nails in systemic conditions:
Careful examination of the fingernails and toenails can provide clues to underlying systemic diseases, systemic diseases that may cause nail affection include:
Cardiac and circulatory disorders as, cardiac failure, bacterial endocarditis, Raynaud’s phenomenon and Reynaud’s disease and cutaneous reaction to cold.
Connective tissue diseases as, systemic lupus erythematosus, dermatomyosistis, systemic sclerosis and rheumatoid arthritis. Respiratory disorders as, yellow nail syndrome, sarcoidosis, bronchial carcinoma.
Renal disorders as, haemodialysis, renal failure, renal transplantation, Henoch – Schoenlein purpra and half – and – half nails.
Gastrointestinal and hepatic disorders as, ulcerative colitis, Crohn’s disease, Helico bacter pylori infection, viral hepatitis, cirrhosis, Wilson’s disease and haemochromatosis.
Nutritional disorders and deficiencies, nail abnormality is observed in patients with pellagra, vitamin: A, B12 , C deficiencies, also seen in malnutrition.
Endocrinal disorders as, pituitary diseases, adrenal and thyroid diseases. Metabolic diseases as, diabetes, cysfic fibrosis, lipoid proteinosis, Fabry’s disease, gout, alkaptonuria, porphyria and amylodosis.
Nervous disorders as, syringomyelia, peripheral neuropathies, carpal tunnel syndrome and also psychological and psychiatric disorders.
Immunological and infections diseases as, graft – versus – host disease, Behcet’s disease, HIV disease, malaria and Kawasaki disease.
Haematological disorders as, polycythaemia, anaemias, leukaemias, lymphoma, Hodgkin’s diseases, cryoglolbinaemia.
Neoplastic disorders as, Langerhan’s cell histocytosis, juvenile xanthogranuloma, paraneoplastic disorders, lung neoplasms, leiomyosarcoma and gastro-intestinal malignancy.
from that point of view; changes in the colour, shape or texture of the nails can be indicative of a wide range of systemic diseases.
The visual appearance of the fingernails and toe nails may suggets an underlying systemic disease. Clubbing of the nails often suggests pulmonary disease or inflammatory bowel disease. Koilonychias suggest hemochromatosis or anaemia. Onycholysis should prompt a search for symptoms of hyperthyroidism. The finding of Beau’s lines may indicate previous severe illness, trauma, or exposure to cold temperatures in patients with Raynaud’s disease.
In patients with Muehrcke’s lines, albumin levels should be checked, and a work- up should be done if the level is low. Patients with splinter haemorrhages, heart murmur and unexplained fever can have endocarditis. Patients with telangiectasia, koilonych.