A 58-year-old woman has a 1-mm wide, slightly raised linear area along the length of her fourth left fingernail. Her other nails are normal. She is generally healthy with a history of mild intermittent asthma treated with azelastine (Astelin) nasal spray and a fluticasone and salmeterol (Advair) inhaler. Could her nail changes be related to her medical condition? — Christine Spohn, SNP-C, RN, Eaton, Colo.

It is unlikely that her nail changes are secondary to her medical condition. Nail changes that result from systemic conditions usually affect all the nails and not just a single nail plate.

The area responsible for nail-plate growth is the nail matrix, which is located beneath the proximal nail fold and extends beneath the nail plate as the lunula. A raised linear defect extending along the entire length of the nail would suggest a lesion that affected the associated nail matrix. To determine the etiology of the nail dystrophy, consider roentgenograms of the affected digit, nail-plate avulsion and biopsy of the nail matrix, or both.—Philip R. Cohen, MD (157-2)

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