Terry’s Nails: Clinical Correlations in Adult Outpatients

The nails have a rich history as windows into systemic disease, beginning with Hippocrates’ observation of digital clubbing as a sign of empyema in the 5th century BCE.1 In 1954, Richard Terry added to this tradition the sign which bears his name when he reported “a ground-glass-like opacity of almost the entire nail bed”.2 He observed this abnormality most frequently in patients with cirrhosis, but also in cases of congestive heart failure (CHF), diabetes, tuberculosis, rheumatoid arthritis, systemic sclerosis, some cancers, and in normal, healthy children up to age four.21 Terry’s nails have also been reported in reactive arthritis, renal transplant patients, POEMS syndrome, and leprosy, and have recently been promoted as one of the most reliable physical signs of cirrhosis3 (Fig. 1). Open in a separate window Figure 1 Terry’s nails