Blue nails: window to micronutrient deficiency

Description

A 12-year-old boy presented with progressive darkening of nails of both hands and feet for the past 3 months. He noticed the blue-black pigmentation of all the fingernails and toenails (figure 1A,B). Pigmentation was more marked in fingernails, particularly over thumbnails (figure 1C,D). The pigmentation started proximally and progressed distally. It was associated with hyperpigmentation of distal phalanges and nail bed. There was no history of any exposure to dyes or work in factory, trauma or exposure to any other agents. There was no history of dermatitis or rash prior to this complaint. He was a non-vegetarian. Other systemic examination was unremarkable.

Figure 1

Hyperpigmentation of nails. Blue-black pigmentation of all the fingernails and toenails (A,B) with associated hyperpigmentation of nail bed, distal phalanges and knuckles. It is more marked on thumbs and great toes (C,D).

Lab...

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