Nail disorders as clinical markers of systemic disease: A literature review

Abstract

Introduction: Physical examination remains essential in clinical practice and, within it, nail assessment is often overlooked despite its semiological value. Various nail abnormalities may represent early or persistent manifestations of systemic cardiovascular, hematologic, endocrine, autoimmune, infectious, or renal diseases, underscoring the importance of integrating nail evaluation systematically into patient assessment. Objective: To critically analyze recent evidence on nail disorders as clinical markers of systemic disease, describing their associations, diagnostic implications, and utility in medical practice. Methodology: A narrative review was conducted using PubMed/MEDLINE and MeSH terms specific to nail disorders and systemic diseases. The search identified 945 records; after applying filters for the last five years, full-text access, and inclusion/exclusion criteria, 56 articles were selected, of which 19 were used for this report. The selection process followed PRISMA recommendations. Discussion: Nail findings reflect inflammatory, vascular, metabolic, or immunological alterations. Several signs with high clinical value are highlighted, including digital clubbing, splinter hemorrhages, koilonychia, leukonychia, Beau’s lines, onychomadesis, and nail changes associated with chronic kidney disease, connective tissue disorders, or nail psoriasis. The topography, distribution, and number of affected nails help guide clinicians toward specific systemic etiologies and support comprehensive diagnostic evaluation. Conclusion: Nail abnormalities represent valuable semiological tools that remain underutilized in everyday clinical practice. Their timely recognition facilitates early detection of systemic diseases, strengthens diagnostic decision-making, and contributes meaningfully to the clinical training of students and healthcare professionals.