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Diagnosis: Beau's lines
Also known as: Beau-Reil cross furrows

Transverse grooves or lines seen on fingernails following an exhausting disease, usually a sign of systemic disease. May be due to trauma, coronary occlusion, hypocalcaemia, or skin disease. The lines are visible until the affected area of the nail has grown out and been trimmed away.

First described by Beau in 1846, these transverse depressions of the nail plate surface result from a temporary interruption of the mitotic activity of the proximal nail matrix. The depth of the depression indicates the extent of the damage within the matrix, the width of the depression indicates the duration of the insult. Beau's lines grow distally with the nail plate, with multiple lines indicating repeated damage. Most commonly, lines are caused by mechanical traumas (e.g. manicures, onychotillomania) or dermatologic diseases of the proximal nail fold (e.g. eczema, chronic paronychia). The presence of Beau's lines at the same level in all nails indicates a systemic cause (e.g. severe or febrile illness, erythroderma, drugs). []

In this particular case the patient had undergone chemotherapy (producing the 'systemic insult' that affects the nail matrix) for leukemia approximately 2 1/2 months before the photo. Because fingernails take approximately 6 months to grow out, it can be deduced that (since the grooves are about half-way from the base) the nail matrix insult occurred about 3 months ago.

J. H. S. Beau:
Note sur certains caractères de séméiologie rétrospective présentés par les ongles.
Archives générales de médecine, Paris, 1846, 10: 447-458.

J. C. Reil:
Exercitationum anatomicarum fasciculus primus. De structura nervorum.
Halle, 1796.

Charles E. Crutchfield III, MD
Clinical Adjunct Associate Professor of Dermatology
At the
University of Minnesota Medical School
Medical Director, Crutchfield Dermatology

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