Terry’s nails
Terry’s nails describes white-colored opacification of most of the nail bed, sparing a narrow 1 to 2 mm band of normal pink to brown tissue at the distal end. The opacification results in disappearance of the lunula. Terry’s nails are a sign of systemic disease, such as cirrhosis, chronic heart failure, and chronic kidney disease.
Patient 1:
This patient has Terry’s nails.
Patient 3:
This patient has Terry’s nails.
Patient 4:
This is a middle-aged woman with Laennec’s cirrhosis.
Patient 5:
This is a middle-aged woman with cirrhosis.
Great collection thank you.
It appears that the pathophysiology of Terry Nails is underperfusion of the capillaries in the nails, either due to reduced oncotic pressure, which may be expected in Chronic Liver disease or in Chronic Kidney disease or increased hydrostatic pressure, causing interstitial edema and subsequent underperfusion of these nail bed capillaries.
The same mechanism also probably explains Ischaemic Bowel in patients with Heart Failure, who have gut wall edema.
Thanks for the information Aditya. Where did you learn about the pathophysiology of Terry’s nails? Do you have a reference? Many thanks.
I found that changes in nail bed vascularity may be involved, according to this seminal paper from Holzberg and Walker:
(DOI:https://doi.org/10.1016/S0140-6736(84)91351-5)
“Biochemical data showed that Terry’s nails are not associated with hypoalbuminaemia, as has been suggested, or anaemia”
“The pathological findings from all 3 patients who underwent biopsy demonstrated an underlying change in vascularity. Telangiectasias were found in the dermis of the band. Other vascular changes have been reported in each of the associated conditions-for example, cherry angiomas in normal ageing,spider telangiectasias in cirrhosis, neovascularisation in diabetes mellitus, and distal digital “tuft” erythema in chronic congestive heart failure. Several hypotheses have been advanced to account for the clinical changes found in Terry’s nails-abnormal ratio of oestrogen to androgens, abnormal steroid metabolism, and increased digital blood flow”.