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  Table of Contents  
IMAGES IN NEPHROLOGY
Year : 2015  |  Volume : 25  |  Issue : 3  |  Page : 184
 

Terry's nails


Department of Nephrology, Sri Venkateshwara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India

Date of Web Publication13-May-2015

Correspondence Address:
R Ram
Department of Nephrology, Sri Venkateshwara Institute of Medical Sciences, Tirupati, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-4065.146030

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How to cite this article:
Lakshmi B S, Ram R, Kumar V S. Terry's nails. Indian J Nephrol 2015;25:184

How to cite this URL:
Lakshmi B S, Ram R, Kumar V S. Terry's nails. Indian J Nephrol [serial online] 2015 [cited 2020 Jul 4];25:184. Available from: http://www.indianjnephrol.org/text.asp?2015/25/3/184/146030


A 45-year-old male renal allograft recipient with chronic allograft nephropathy was on tacrolimus, mycophenolate mofetil and steroids. He was not a diabetic. He was hypertensive with blood pressure under control. On examination of his nails, All finger nails were dull white with brownish pink pigmentary band at the distal portion measuring 3 mm band width suggestive of Terry's nails [Figure 1].
Figure 1: Terry's nails

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Richard Terry was the first to describe this abnormality in the nails in patients of cirrhosis. He described it in 82 of 100 consecutive patients with cirrhosis. [1] His description was white nail bed showing ground-glass opacity not affected by venous congestion and indistinguishable from the lunula with a 1-2 mm distal band of normal pink. However, Terry's criteria were later revised: The distal band width may be between 0.5 mm and 3 mm, can be brown in color and the proximal nail bed can be light pink. [2] Terry's nails are the result of changes in the nail bed vascularity, a decrease in the proximal portion and the increase in the distal edge. Usually, all the nails are affected uniformly. Biochemical data correlation in association with Terry's nails revealed no relation with hypoalbuminemia and anemia but, abnormal ratio of estrogen to androgen and abnormal steroid metabolism were identified. [2] In one report, this nail change has preceded the renal impairment. [3]

Often, Lindsay's (half and half) nails are needed to be considered in the differential diagnosis. In Terry's nail, the proximal three-fourth of the nail is dull pale while the distal one-fourth was pink or red, Lindsay nails appear split where the proximal half (20-60%) of the nail is opaque, and the distal half (40-80%) is pink to red-brown. [4] These half and half nails may be found in approximately 10-40% of patients with chronic renal disease. [5]

Terry's nail is described in congestive cardiac failure, adult onset diabetes mellitus, peripheral vascular disease, chronic renal failure, [6] peritoneal dialysis, [7] hemodialysis and renal transplant patients [8] and in human immunodeficiency disease.

 
  References Top

1.
Terry R. White nails in hepatic cirrhosis. Lancet 1954;266:757-9.  Back to cited text no. 1
    
2.
Holzberg M, Walker HK. Terry′s nails: Revised definition and new correlations. Lancet 1984;1:896-9.  Back to cited text no. 2
    
3.
Nia AM, Ederer S, Dahlem KM, Gassanov N, Er F. Terry′s nails: A window to systemic diseases. Am J Med 2011;124:602-4.  Back to cited text no. 3
    
4.
Bean WB. A discourse on nail growth and unusual fingernails. Trans Am Clin Climatol Assoc 1962;74:152-67.  Back to cited text no. 4
    
5.
Lindsay PG. The half-and-half nail. Arch Intern Med 1967;119:583-7.  Back to cited text no. 5
    
6.
Raffle EJ. Terry′s nails. Lancet 1984;1:1131.  Back to cited text no. 6
    
7.
Ozturk P, Ozyurt K, Kurutas E, Kalender M, Atasevend A, Dogan E. Nail disorders in patients with chronic renal failure undergoing peritoneal dialysis. World J Nephrol Urol 2014;3:30-4.  Back to cited text no. 7
    
8.
Al-Hamamy HR, Al-Mashhadani SA, Fadheel BM, Salman SH. Nail changes in hemodialysis patients and renal transplant recipients (a case-control study). Am J Dermatol Venereol 2014;3:30-4.  Back to cited text no. 8
    


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