Photo Nail Assessment

Nail Fungus — Distal Type

Most common type. Starts at the tip of the nail and moves toward the cuticle. Causes yellow-brown discoloration, thickening, and crumbling. Toenails affected in 80% of cases.

Nail Fungus — White Superficial

Fungus affecting only the top layer of the nail plate. Creates chalky white patches on the surface. Easier to treat than distal type.

Paronychia (Nail Fold Infection)

Infection of the skin around the nail (nail fold). Acute type is bacterial (sudden, painful). Chronic type is often Candida (gradual, recurrent).

Green Nail Syndrome

Caused by Pseudomonas bacteria, which produce a green pigment (pyocyanin). Usually occurs under artificial nails or in chronically moist environments.

Koilonychia (Spoon Nails)

Nails that curve upward like a spoon — can hold a drop of water. Strongly associated with iron deficiency anemia. Can take 6-18 months to resolve with treatment.

Leukonychia (White Spots/Nails)

White spots or streaks on nails. Punctate leukonychia (small dots) is usually from minor trauma. True leukonychia (entire white nail) may indicate zinc deficiency or systemic issues.

Beau's Lines

Horizontal grooves across the nail. Caused by temporary growth interruption 2-3 months prior (illness, stress, surgery, chemotherapy). The nail "remembers" the event.

Vertical Ridges (Onychorrhexis)

Lines running from cuticle to tip. Affects 85% of adults over 50. A normal age-related change in nail matrix cell production — not a disease.

Ingrown Toenail

Nail edge grows into the surrounding skin, causing pain, redness, and sometimes infection. Usually caused by improper trimming, tight shoes, or genetics.

Nail Clubbing

Fingertips enlarge and nails curve downward around the fingertips. A potentially serious sign of cardiopulmonary disease, liver disease, or other systemic conditions.

Nail Psoriasis

Immune-mediated nail changes. Hallmark: ice-pick pitting + oil-drop discoloration. Affects 80-90% of psoriasis patients at some point. Fingernails more common than toenails.

Longitudinal Melanonychia

Brown or black streak running lengthwise on the nail. Common and benign in people with darker skin tones. However, a NEW streak on a single nail in lighter-skinned adults needs urgent evaluation to rule out subungual melanoma.

Habit-Tic Deformity

A central ridge or series of horizontal ridges down the middle of the nail, caused by repetitive pushing or picking at the cuticle. Self-inflicted but often unconscious.