The patient, a 40‐year‐old woman with a longstanding history of systemic lupus erythematosus (SLE) and lupus nephritis, reported a changed appearance of her fingernails over the past two years. Our patient was diagnosed with lupus nephritis at age 13 and developed chronic kidney disease (CKD) more than 10 years ago despite receiving treatment with multiple courses of various immunosuppressives. She presented with nail changes several years after being diagnosed with SLE and CKD. During our clinic visit, she was found to have a glomerular filtration rate of 44 mL/min.
On examination, she was found to have half and half nails (HHN) (Figure 1), also known as Lindsay's nails, which is characterized by a whitish appearance in the proximal segment and pink or brownish appearance in the distal segments of the nailbeds. The proximal band is attributed to chronic anemia and the distal band to increased melanin deposition. The two different colors of the nailbeds are well‐defined and do not disappear under pressure. HHN may not improve with dialysis but can improve after renal transplantation. HHN are most frequently seen in patients with CKD but less frequently have been reported in people with cirrhosis, hepatocellular carcinoma, Graves’ disease, Behcet's disease, Crohn's disease, pellagra, antituberculosis medications, and limited systemic sclerosis and, rarely, even in healthy people.
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