Indian Journal of Dermatology
: 2005  |  Volume : 50  |  Issue : 3  |  Page : 170-

Idiopathic half-and-half nail

Subhav Kumar Agrawal, Deepika Pandhi 
 Department of Dermatology & STD, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi-110 095, India

Correspondence Address:
Subhav Kumar Agrawal
Department of Dermatology & STD, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi-110 095

How to cite this article:
Agrawal SK, Pandhi D. Idiopathic half-and-half nail.Indian J Dermatol 2005;50:170-170

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Agrawal SK, Pandhi D. Idiopathic half-and-half nail. Indian J Dermatol [serial online] 2005 [cited 2021 Apr 11 ];50:170-170
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Full Text

Half-and-Half nails are also known as brown arcs or Lindsay nails.[1] They are described as red, pink, or brown transverse distal bands occupying 20-60% of the total nail length and with the remaining proximal portion exhibiting a dull whitish ground glass appearance.[1] The margin between distal and proximal zones, at times irregular, is generally parallel to the distal or free margin of the nail.[1]

A 25 year old Hindu female came to dermatology outpatients with discoloration of all 20 nails for the last 3 months.

On examination of nails, two distinct transverse bands were noted [Figure 1]. The proximal white bands and distal red bands, varied from 20-50% to 50-80% of the total nail length respectively, with normal nail plate surfaces and nail folds. On pressure over nail plates, the demarcation band did not disappear.

A detail medical history, physical examination and laboratory evaluation failed to reveal any other abnormality. There was no history of nail biting, paronychia or any kind of local trauma. The patient was reassured about the benign nature of the disorder.

Half-and-Half nails are usually diagnosed in patients with uremia and renal disease, [1],[2] and infrequently with Behcet's syndrome,[3] yellow nail syndrome with hyperthyroidism,[4] and in healthy persons.[2],[4]

The frequency of Half-and-Half nail changes in renal disease, varies from 20-50% and no correlation has been seen in the severity of renal disease and the longitudinal length of distal bands.[2] It was noted that these nails appear very early, possibly even before the dialysis treatment is begun, but are then permanent.[2] Discoloration of these nails disappear completely within 2-3 weeks after successful kidney transplantation .[2]

Leyden and Wood proposed that the discoloration was secondary to melanin deposition throughout the distal portion of the nail plate as was evident on linear nail biopsy.[5] They thought that toxic substances of uremia stimulate the nail matrix melanocytes to produce melanin, and also slow nail growth rate in acute and chronic renal diseases result in larger accumulation of the pigment.

The Half-and-Half nail is an infrequent finding especially in healthy individuals. Thus, its presence in our case with concave joining bands with convex distal margin of nail plates, contrast to Lindsay's observation.[1]


1Lubach D, Strubbe J, Schmidt J. The 'Half-and-Half nail' phenomenon in chronic hemodialysis patients. Dermatologica 1982; 164: 350-3.
2Lindsay PG. The Half-and-Half nail. Arch Intern Med 1967; 119: 583-7.
3Sachin AA, Kalyoncu AF, Selcuk ZT, et al. Behcet's disease with Half-and-Half nail and pulmonary artery aneurysm. Chest 1990; 97: 1277.
4Scher RK. Yellow nail syndrome and Half-and-Half nail. Arch Dermatol 1987; 123: 710-1.
5Leyden JJ, Wood MG. The "Half-and-Half nail". Arch Dermatol 1972; 105: 591-2.