Nail Disorders Differential Diagnosis
The following is a differential diagnosis for nail disorders, categorized for clarity and emphasis on potential severity.
- Single Most Likely Diagnosis
- Onychomycosis (fungal infection of the nail): This is a common condition, especially in older adults, and can be caused by various fungal species. It often presents with thickening, discoloration, and brittleness of the nails.
- Other Likely Diagnoses
- Psoriatic nail disease: Associated with psoriasis, this condition can cause pitting, nail thickening, and separation of the nail from the nail bed.
- Nail eczema (dyshidrotic eczema): Characterized by small blisters on the palms or soles, and sometimes the fingers, which can affect the nail area.
- Traumatic nail disorders: Injuries to the nail or nail bed can lead to various abnormalities, including nail thickening, ridging, or splitting.
- Do Not Miss Diagnoses
- Squamous cell carcinoma or melanoma of the nail: Although rare, these cancers can present with changes in the nail or surrounding skin and are critical to diagnose early.
- Systemic lupus erythematosus (SLE): Nail changes can be part of the presentation of SLE, a serious autoimmune disease.
- Thyroid disorders: Both hypothyroidism and hyperthyroidism can cause changes in the nails, such as brittleness or thinning.
- Rare Diagnoses
- Lichen planus of the nail: An autoimmune condition that can cause nail thinning, ridging, and scarring.
- Alopecia areata of the nail: An autoimmune condition that can cause nail pitting, thinning, or complete loss of the nail.
- Yellow nail syndrome: A rare condition characterized by thickening and yellowing of the nails, often associated with lymphedema and respiratory issues.
- Nail-patella syndrome: A genetic disorder that affects the development of nails and kneecaps, among other features.
Each of these diagnoses has distinct features and implications for patient care, emphasizing the importance of a thorough examination and diagnostic workup for nail disorders.