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Endgames Case Review

Proximally white and distally pink nails

BMJ 2023; 382 doi: https://doi.org/10.1136/bmj-2023-076299 (Published 21 September 2023) Cite this as: BMJ 2023;382:e076299
  1. Li-wen Zhang, attending dermatologist1*,
  2. Juan Wu, attending dermatologist2 *,
  3. Tao Chen, professor of dermatology1,
  4. Rong-hua Xu, professor of neurosurgery3
  1. 1Department of Dermatovenereology, Chengdu Second People’s Hospital, 165 Caoshi Street, Chengdu 610017, Sichuan, China
  2. 2Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
  3. 3Institute of Dermatology, Chengdu Second People’s Hospital, Chengdu, Sichuan, China
  4. *. Contributed equally to this work
  1. Correspondence to: T Chen 13980427003{at}163.com, R Xu elvis0508{at}sina.com

A man in his 60s presented with a six month history of fingernail discoloration. The patient had a 10 year history of hypertension and diabetes. He had been diagnosed with chronic renal failure five years previously and had been receiving regular haemodialysis for end stage renal disease for the past three years. His fingernails showed white proximal nail beds with no lunula and a distal pink transverse arcuate band (fig 1). The toenails were unaffected. Fungal examination of the nail fragments was negative.

Fig 1

Fingernails showing white proximal nail beds with no lunula and a distal pink transverse arcuate band

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