What caused these distal nail changes?

Dermclinic

A 62-year-old man, who is currently being evaluated for weight loss and malaise of a few months’ duration, has noted changes to all of his nails during the past 6 weeks. The proximal half of the nails has become rough, while the distal portion remains normal.

Which of the disorders in the differential is the likely cause of the nail condition?

A. Psoriasis.

B. Paraneoplastic nail changes.

C. Lichen planus.

D. Trauma.

E. Sudden weight loss.

(Answer and discussion on next page)

ANSWER—Paraneoplastic nail changes

The complete workup of the patient revealed a gastrointestinal adenocarcinoma; this finding supported the suspected diagnosis of paraneoplastic nail changes, B, a rare condition that can occur with any malignancy.

Nails that are affected by psoriasis typically have an oil-slick appearance, pitting, and subungual debris. Lichen planus can produce the rough-textured nail changes seen in this patient and needs to be considered in the differential. If necessary, a biopsy of the nail can confirm the diagnosis.

Trauma commonly causes distal nail changes, such as those seen in nail biters. Sudden weight loss, hospitalization, and surgery may lead to temporary interruption of natural nail growth, which can cause a transverse groove in the nail. When the provoking event is over, affected nails regrow normally. ■