Half and half nails (Lindsay's nails) can be found in patients with any degree of azotemia. The prevalence is about 21% in dialysis patients. the proximal half of the nail is white and the distal half is brown or pink. This color does not fade with nail pressure. The pathophysiology of the changes is not well understood but is thought to be due to increased beta-melanocyte stimulating hormone in the nail bed. This does not improve with dialysis.
Other changes are also seen in the nails of dialysis patients. Beau's lines are characterized by transverse deep depressions. Mee's lines have a single white band in the nail plate. Terry's nails present with the proximal 2/3 being wide and pale with the distal 1/3 narrow and red.
(Image on the left shows Beau's Lines [ source ], Image on the right show half and half nails [ source ])
This is the final post in the series on skin lesions in dialysis patients.