A disruption of the distal matrix may cause problems with the deeper layers, resulting in ridging or splitting. This production is important, because a disruption of function in the proximal matrix (as may occur in patients with psoriasis) results in more superficial nail problems (e.g., pitting). As the nail grows, the distal part of the matrix produces the deeper layers of the nail plate, while the proximal portion makes the superficial layers. The nail plate is generated by the nail matrix at the proximal portion of the nail bed ( Figure 1). The nail plate is the hard keratin cover of the dorsal portion of the distal phalanx. Rheumatoid arthritis, SLE, dermatomyositis, scleroderma Subacute bacterial endocarditis, SLE, rheumatoid arthritis, antiphospholipid syndrome, peptic ulcer disease, malignancies, oral contraceptive use, pregnancy, psoriasis, trauma Melanoma, benign nevus, chemical staining, normal variant in darkly pigmented peopleĪlopecia areata, vitiligo, atopic dermatitis, psoriasis Hepatolenticular degeneration (Wilson’s disease), silver poisoning, quinacrine therapyĪrsenic poisoning, Hodgkin’s disease, CHF, leprosy, malaria, chemotherapy, carbon monoxide poisoning, other systemic insults Hepatic failure, cirrhosis, diabetes mellitus, CHF, hyperthyroidism, malnutrition Lymphedema, pleural effusion, immunodeficiency, bronchiectasis, sinusitis, rheumatoid arthritis, nephrotic syndrome, thyroiditis, tuberculosis, Raynaud’s disease Psoriasis, Reiter’s syndrome, incontinentia pigmenti, alopecia areataĪny severe systemic illness that disrupts nail growth, Raynaud’s disease, pemphigus, trauma Psoriasis, infection, hyperthyroidism, sarcoidosis, trauma, amyloidosis, connective tissue disorders Iron deficiency anemia, hemochromatosis, Raynaud’s disease, SLE, trauma, nail-patella syndrome Inflammatory bowel disease, pulmonary malignancy, asbestosis, chronic bronchitis, COPD, cirrhosis, congenital heart disease, endocarditis, atrioventricular malformations, fistulas
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