What Is Causing These Green Nails?
Itohan H. Omorodion, MPH1 • Jack Lee, MD2 • Barrett J. Zlotoff, MD2
1School of Medicine, University of Virginia, Charlottesville, Virginia
2Department of Dermatology, University of Virginia, Charlottesville, Virginia
Omorodion IH, Lee J, Zlotoff BJ. What is causing these green nails? Consultant. 2021;61(9):e13-e15. doi:10.25270/con.2021.03.00014
Received November 6, 2020. Accepted January 8, 2021. Published online March 16, 2021.
The authors report no relevant financial relationships.
Itohan Omorodion, MPH, University of Virginia Department of Dermatology, 1221 Lee Street, Charlottesville, VA 22908 (firstname.lastname@example.org)
An 81-year-old man was referred to our dermatology clinic with discoloration of the right thumbnail. The nail discoloration had been present for a month and a half and was not associated with pain. He had been applying an antifungal solution to the affected nails with only slight reduction in the size of the streaks and no substantial change in the hue of the pigmentation.
His medical history was significant for idiopathic bronchiectasis associated with a productive cough. He had spent his daily life indoors doing office work for his personal publishing company and did not engage in outdoor hobbies, work with dyes, or do a substantial amount of wet work.
Results of a physical examination were significant for a greenish-black linear streak along the lateral edge of the right thumbnail, uniform in width and extending from the proximal nailfold to the free edge of the nail (Figure 1). A similar linear streak was present on the right index fingernail and was light green in color. He did not have Hutchinson’s sign. The color penetrated the full thickness of the affected nails and could not be scraped off. There was also distal onycholysis of the right thumbnail, as well as of the middle fingers bilaterally. The patient’s toenails had notable opacification and thickening bilaterally.
Figure 1. Thumbnail with a greenish-black linear streak extending from the proximal nail fold to the free edge of the nail and distal onycholysis.
Answer and discussion on next page.