Transverse Lines

Transverse, band-like depressions extending from one lateral edge of the nail to the other, and affecting all nails at corresponding levels, are called Beau's lines (Figures 3.183.22). They may be noted after any severe, sudden (particularly febrile) illness. In milder cases the nails of the thumb and the great toe are the most reliable markers, as the former supplies information for the previous 6-9 months and the latter shows evidence of disease for up to 2 years (relating to the different rates of linear nail growth).

The width of the transverse groove relates to the duration of the disease that has affected the matrix. The distal limit of the furrow, if abrupt, indicates a sudden attack of disease; if sloping, a more protracted onset. The proximal limit of the depression may be abrupt, and both limits may well be sloped. If the the disease can completely inhibit the activity of the matrix for 1-2 weeks or longer, the transverse depression will result in total division of the nail plate, a defect known as 'onychomadesis' (Figures 3.23, 3.24). As the nail adheres firmly to the nail bed the onychomadesis remains latent for several weeks before leading to temporary shedding.

The presence of Beau's lines on all 20 nails is usually the result of systemic disease

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Figure 3.17

(a) Herringbone nail appearance with oblique lines meeting in the midline—a temporary change of early childhood; (b) nail-patella syndrome—more subtle, but similar lines to (a); associated with pointed lunula. (Part (a) from Parry EJ, Morley WN, Dawber RPR (1995), Herringbone nails: an uncommon variant of nail growth in childhood? Br J Dermatol 132:1021-1022.)

Figure 3.17

(a) Herringbone nail appearance with oblique lines meeting in the midline—a temporary change of early childhood; (b) nail-patella syndrome—more subtle, but similar lines to (a); associated with pointed lunula. (Part (a) from Parry EJ, Morley WN, Dawber RPR (1995), Herringbone nails: an uncommon variant of nail growth in childhood? Br J Dermatol 132:1021-1022.)

Figure 3.18

Beau's lines.

Figure 3.19

Beau's lines—contact dermatitis.

Transverse furrows may be due to measles in childhood, zinc deficiency (often multiple), Stevens-Johnson and Lyell's syndromes, cytotoxic drugs and many other nonspecific events. Beau's lines can also be physiological, e.g. marks appearing with each menstrual cycle, particularly in dysmenorrhoea. They have also been noted in babies aged 4-5 weeks, without any obvious cause. When only a few digits are involved this may indicate trauma, carpal tunnel syndrome, chronic paronychia or chronic eczema. If the lines appear following a chronic condition, they are often numerous and curvilinear.

Figure 3.20

Transverse lines due to chemotherapy cycles. (Courtesy of L.Requena.)

Figure 3.20

Transverse lines due to chemotherapy cycles. (Courtesy of L.Requena.)

Figure 3.21

Beau's lines in psoriasis.

Figure 3.21

Beau's lines in psoriasis.

Figure 3.22

Long Beau's line (depression) due to more prolonged arrest of growth. (Courtesy of J.P.Ortonne, Nice.)

Long Beau's line (depression) due to more prolonged arrest of growth. (Courtesy of J.P.Ortonne, Nice.)

Figure 3.23 Onychomadesis due to bleomycin therapy for warts on the proximal nail fold.

Figure 3.24

Beau's lines and onychomadesis due to psoriasis.

Figure 3.24

Beau's lines and onychomadesis due to psoriasis.

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