A 7-year-old girl presented to the dermatology clinic with a 4-week history of progressive nail changes. Her mother reported a sudden onset of brittle nails with cracks followed by painless sloughing of nails. Initially only the fingernails had been affected, but the toenails soon showed the same pathology. The family was concerned and suspected an internal disease or vitamin deficiency. The child was otherwise well and no previous skin or nail conditions were known. On clinical examination, most fingernails showed semilunar whitish grooves in the middle of the nail plate (Figure, A). The toenails had transverse partial cracks of the proximal nail plate with distal onycholysis but normal proximal nail growth (Figure, B).
Kasper RS, Nobbe S, Theiler M, Weibel L. Sudden Painless Nail Shedding. JAMA Pediatr. 2015;169(4):405-406. doi:10.1001/jamapediatrics.2014.3286