Proximally white and distally pink nails

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.bmj;382/sep21_4/e076299/F1F1f1Fig 1Fingernails showing white proximal nail beds with no lunula and a distal pink transverse arcuate bandQuestionsWhat are the differential diagnoses?What is the most likely diagnosis?How would you manage this condition?Answers1.What are the differential diagnoses?Leukonychia, or white nails, can be caused by abnormalities of the nail plate or nail bed and is classified anatomically into three subtypes: true leukonychia (Mees lines and hereditary leukonychia totalis), apparent leukonychia (Muehrcke’s…
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