The harlequin nail. A marker for smoking cessation

25 Mar

Smoking Cessation

The bedside clinician, searching for clues to the presence of disease, is often rewarded by careful examination of the patients hands. The nails offer many clues to the patients physiology and habits. Yellow pigmentation of the nail plate caused by cigarette smoking is especially common (partic­ularly in our Veterans Administration Hospital); clubbing of a “nicotine nail” is an ominous sign.

The process of nicotine staining of the nail is a dynamic one: as new nail appears, it is stained by tobacco by-products from sidestream smoke. Sudden cessation of smoking (which, in a hospital-based practice, is most often due to an acute event such as a CYA) illustrates this point well, because a delicate line of demarcation appears between the pig­mented and the newly grown, nonpigmented nail. By measuring the distance between the line of demarcation and the proximal nail fold, it is possible to date the onset of the antecedent illness. viagra 10 mg

We report on two patients who demonstrated this line of demarcation, allowing us to correctly infer on bedside rounds that smoking had ceased. The reason for cessation was an intercurrent illness—a C\A in one case and radiotherapy for lung cancer in another—which made it impossible or unpalatable to smoke. The approximate date of the illness in each case was correctly inferred by measuring from cuticle to line of pigmentation.