Half-and-Half Nails in a Patient with Graves Disease

Proximally white and distally pink nails

“…Half-and-half nails appear as two-coloured nails with a transverse border: the proximal part of the nail bed is whitish; the distal part is red, pink, or brown and occupies 20-60% of the nail length 1. They are seen in approximately 10-50% of patients with chronic kidney disease 12. The pathophysiology is unclear.…”

“…Half-and-half nails have also occasionally been reported in other conditions, including Kawasaki’s disease, Behcet’s disease, Crohn’s disease, Graves’ disease, pellagra, cirrhosis, HIV infection, and after isoniazid therapy, but also in healthy individuals 12. Differentiating from Terry’s nails can be challenging: Terry’s nails show a similar apparent leukonychia with a distal pink or brown band of 1-2 mm wide, and they are associated with liver disease, cirrhosis, chronic congestive heart failure, chronic kidney disease, and adult-onset diabetes as well 1…”

“…Identifying and treating the underlying systemic disease may be a viable and effective strategy for half-and-half nails 2. Nail discoloration may regress after successful kidney transplantation, but haemodialysis is often ineffective 34…”