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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2014  |  Volume : 25  |  Issue : 1  |  Page : 168-169
Half and half nail

Assistant Professor, Department of Endocrinology and Metabolism, Pondicherry Institute of Medical Sciences, Puducherry, India

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Date of Web Publication7-Jan-2014

How to cite this article:
Sahoo JP. Half and half nail. Saudi J Kidney Dis Transpl 2014;25:168-9

How to cite this URL:
Sahoo JP. Half and half nail. Saudi J Kidney Dis Transpl [serial online] 2014 [cited 2021 Jun 18];25:168-9. Available from: https://www.sjkdt.org/text.asp?2014/25/1/168/124558
To the Editor,

A 60-year-old non-smoker male with type-2 diabetes mellitus has been on maintenance hemodialysis for the past six months because of end-stage renal disease due to diabetic nephropathy. He has also evidence of other chronic complications of diabetes mellitus, including neuropathy and retinopathy without the macrovascular components. He was admit­ted to our hospital for the treatment of an in­fected diabetic foot. The physical examination revealed pallor, dry skin and "half and half" nails [Figure 1] and [Figure 2]. Routine investigation showed serum creatinine 4.3 mg% and serum albumin 2.7 gm% in the presence of normal liver function tests.
Figure 1: Right hand showing "Half and Half" nails.

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Figure 2: Left index finger showing "Half and Half" nail.

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Half and half nail is characterized by redness in the distal half and whiteness in the proximal half. It was first described by Lindsay in chronic renal failure patients. [1] It is seen in 15- 50% of hemodialysis patients as compared with 1-2% of the general hospital population, [2],[3] and it disappears after renal transplantation. [4] There is no correlation between the severity of the kidney disease and the depth of the distal color in the nail. It is either due to deposition of melanin in the nail plate [5] or due to increased capillary density under the nail plate. [6]

Half and half nail is also seen rarely in other conditions, e.g. pellagra, zinc deficiency, che­motherapy, cirrhosis of liver, Kawasaki disease, Behcet's disease, Crohn's disease, Yellow nail syndrome and citrullinemia. [7],[8],[9],[10],[11] However, it is relatively a specific clinical marker of end-stage kidney disease.

   References Top

1.Lindsay PG. The half-and-half nail. Arch Intern Med 1967;119:583-7.  Back to cited text no. 1
2.Bencini PL, Montagnino G, Citterio A, Graziani G, Crosti C, Ponticelli C. Cutaneous abnormalities in uremic patients. Nephron 1985;40:316-21.  Back to cited text no. 2
3.Lubach D, Strübbe J, Schmidt J. The 'half and half nail' phenomenon in chronic hemodialysis patients. Dermatologica 1982;164:350-3.  Back to cited text no. 3
4.Saray Y, Seçkin D, Güleç AT, Akgün S, Haberal M. Nail disorders in hemodialysis patients and renal transplant recipients: A case control study. J Am Acad Dermatol 2004;50: 197-202.  Back to cited text no. 4
5.Leyden JJ, Wood MG. The 'half and half nail': A uremic onychopathy. Arch Dermatol 1972; 105:591-2.  Back to cited text no. 5
6.Kint A, Bussels L, Fernandes M, Ringoir S. Skin and nail disorders in relation to chronic renal failure. Acta Derm Venereol 1974;54: 137-40.  Back to cited text no. 6
7.Cakmak SK, Gönül M, Aslan E, Gül U, Kiliç A, Heper AO. Half and half nail in a case of Pellagra. Eur J Dermatol 2006;16:695-6.  Back to cited text no. 7
8.Scher RK, Farrell DS. Yellow nail syndrome and half and half nail. Arch Dermatol 1987;123:710-1.  Back to cited text no. 8
9.Sahin AA, Kalyoncu AF, Selçuk ZT, Cöplü L, Celebi C, Baris YI. Behcet's disease with half and half nail and pulmonary artery aneurysm. Chest 1990;97:1277.  Back to cited text no. 9
10.Bonafe JL, Pieraggi MT, Abravanel M, Benque A, Abravanel G. Skin, hair and nail changes in a case of citrullinemia with late manifestation. Dermatologica 1984;168:213-8.  Back to cited text no. 10
11.Mendiratta V, Jain A. Nail dyschromias. Indian J Dermatol Venereol Leprol 2011;77: 652-8.  Back to cited text no. 11
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Correspondence Address:
Jaya Prakash Sahoo
Assistant Professor, Department of Endocrinology and Metabolism, Pondicherry Institute of Medical Sciences, Puducherry
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DOI: 10.4103/1319-2442.124558

PMID: 24434405

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