Portal de Periódicos da CAPES

Dirty Nails

2005; Oxford University Press; Volume: 90; Issue: 4 Linguagem: Inglês

10.1210/jc.2004-2439

1945-7197

Hans K. Ghayee, John Q. A. Mattern, David S. Cooper,

Autoimmune Bullous Skin Diseases

42-YR-OLD MAN presented with symptoms and signs of hyperthyroidism, including a large symmetrical goiter with a bruit, tachycardia, brisk reflexes, and fingernail changes consistent with onycholysis (Plummer’s nails), shown in Fig. 1. After thyroidectomy, he has remained well with normal thyroid function tests. A photograph of his fingernails after 18 months of follow-up is shown in Fig. 2. The patient’s fingernails are examples of Plummer’s nails, first described by Henry Stanley Plummer in 1918 (1), in a patientwithhyperthyroidism.Hisfindingswerefirstdescribed in Oxford Medicine by Boothby and Plummer in 1937 (1, 2). Plummer’s nails represent a separation of the distal nail body from the nail bed. This separation, or onycholysis, is characteristically concave, and the hyponichium commonly traps dirt, giving the nail a dark appearance. The detachment isprobablyaresultofthyrotoxiccatabolismand/ortherapid growth of the nail body (3). For unknown reasons, onycholysis most commonly occurs on the fourth finger (3). With progressive disease, most other fingernails become affected (1). One study reported a 5.2% prevalence of onycholysis in hyperthyroidism (4). Onycholysis is not specific to thyrotoxicosis. Thedifferentialdiagnosisofonycholysisincludespsoriatic arthritis, lung cancer, sarcoidosis, bronchiectasis, trauma,