Red Lines in Nails
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Try one of these related symptoms.
Red lines under nails
Nails with lines
Nail bed discoloration
Red spot under nail
Streaks in nails
Red lines on nails after acrylics
Red spot on nail after acrylic
Nail discoloration brown
Horizontal red line under fingernail
Red lines in my fingernails
Splinter hemorrhage
Small areas of bleeding under nails
Possible Causes
Generally, Red lines in nails can be related to:
- IgA Vasculitis (Henoch-Schonlein Purpura)
A disease that causes inflammation and bleeding of small blood vessels, commonly affecting the skin, joints, intestines, and kidneys. This can lead to rashes, stomach pain, and kidney damage. Though it can affect anyone, it is more common in children under 10 years old. The cause is not well understood, but it may result from an immune system issue.
- Vasculitis (including Cryoglobulinemia)
A condition where the body's immune system attacks blood vessels throughout the body, causing inflammation. The vasculitis can impede blood flow and cause tissue or organ damage. There are many different types of vasculitis, each with its own triggers including infection, medications, and cancers.
- Scleroderma
Scleroderma is a connective tissue disorder that causes the skin to thicken and harden, though it may also affect other organs. It is categorized as localized or widespread (systemic scleroderma). It is a disorder where the immune system mistakenly attacks its own body.
- Giant Cell Arteritis (Temporal Arteritis)
Related Serious Diseases
Sometimes, Red lines in nails may be related to these serious diseases:
- Kawasaki Disease
Kawasaki disease causes swelling, called inflammation, in the walls of small to medium-sized blood vessels that carry blood throughout the body. Kawasaki disease most often affects the heart arteries in children. Those arteries supply oxygen-rich blood to the heart. It also causes swelling in glands, called lymph nodes, and mucous membranes inside the mouth, nose, eyes and throat. Symptoms include a fever greater than 102.2 degrees Fahrenheit (39 degrees Celsius) for five or more days, a rash on the main part of the body or in the genital area, an enlarged lymph node in the neck, very red eyes without a thick discharge, red, dry, cracked lips and a red, swollen tongue, swollen, red skin on the palms of the hands and the soles of the feet. Later the skin on fingers and toes peels.
Doctor's Diagnostic Questions
Your doctor may ask these questions to check for this symptom:
- Do you have bleeding under your nails in 2 or more places?
- How has bleeding under a fingernail or toenail changed since it started?
- How often do you experience bleeding under your nails?
- How long have you had bleeding under a fingernail or toenail?
Reviewed By:
Sarita Nori, MD (Dermatology)
Dr. Sarita Nori was drawn to dermatology because of the intersection of science and medicine that is at the heart of dermatology. She feels this is what really allows her to help her patients. “There is a lot of problem-solving in dermatology and I like that,” she explains. “It’s also a profession where you can help people quickly and really make a difference in their lives.” | Some of the typical skin problems that Dr. Nori treats include skin cancers, psoriasis, acne, eczema, rashes, and contact dermatitis. Dr Nori believes in using all possible avenues of treatment, such as biologics, especially in patients with chronic diseases such as eczema and psoriasis. “These medications can work superbly, and they are really life-changing for many patients.” | Dr. Nori feels it’s important for patients to have a good understanding of the disease or condition that is affecting them. “I like to educate my patients on their problem and have them really understand it so they can take the best course of action. Patients always do better when they understand their skin condition, and how to treat it.”
Yoshinori Abe, MD (Internal Medicine)
Dr. Abe graduated from The University of Tokyo School of Medicine in 2015. He completed his residency at the Tokyo Metropolitan Health and Longevity Medical Center. He co-founded Ubie, Inc. in May 2017, where he currently serves as CEO & product owner at Ubie. Since December 2019, he has been a member of the Special Committee for Activation of Research in Emergency AI of the Japanese Association for Acute Medicine. | | Dr. Abe has been elected in the 2020 Forbes 30 Under 30 Asia Healthcare & Science category.
Content updated on Feb 6, 2025
Following the Medical Content Editorial Policy
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People with similar symptoms also use Ubie's symptom checker to find possible causes
- Red lines under the nails
- Bleeding in/or nailbed
- Red dots under nail
- Red lines in nails
- Nailbed bleeding
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FAQs
Q.
Are black streaks in nails always a cause for concern?
A.
Black streaks in nails, known as melanonychia, aren't always a cause for concern and can have various causes, including normal changes during pregnancy or congenital conditions.
References:
Skornšek N, Orešič Barač T, & Marko PB. (2017). Congenital longitudinal melanonychia: a case report. Acta dermatovenerologica Alpina, Pannonica, et Adriatica, 29264905.
https://pubmed.ncbi.nlm.nih.gov/29264905/
Kouskoukis CE, Scher RK, & Hatcher VA. (1982). Melanonychia striata longitudinalis. A case report. The Journal of dermatologic surgery and oncology, 7076969.
https://pubmed.ncbi.nlm.nih.gov/7076969/
Plachouri KM, Kolonitsiou F, & Georgiou S. (2019). Melanonychia Striata: Nail Alterations during Pregnancy. Skinmed, 31904335.
Q.
Are red lines under nails indicative of any specific health condition?
A.
Red lines under nails, known as erythronychia, can be a sign of various health issues, including nail trauma or more serious conditions. It's important to have them checked by a healthcare provider if they appear suddenly or change over time.
References:
Chang C, Beutler BD, & Cohen PR. (2017). Report of a Patient with Multiple Horizontal Red Bands .... Dermatology and therapy, 28260214.
https://pubmed.ncbi.nlm.nih.gov/28260214/
Cohen PR. (2011). Longitudinal erythronychia: individual or multiple linear red .... American journal of clinical dermatology, 21668031.
https://pubmed.ncbi.nlm.nih.gov/21668031/
Lipner SR, & Scher RK. (2016). Evaluation of nail lines: Color and shape hold clues. Cleveland Clinic journal of medicine, 27168515.
Q.
Can brown discoloration of nails be reversed?
A.
Brown nail discoloration can sometimes be reversed, especially if it is caused by external factors like iron-containing water or certain chemicals.
References:
Platschek H, & Lubach D. (1989). [Brown hair and nail discoloration by water containing iron]. Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete, 2759859.
https://pubmed.ncbi.nlm.nih.gov/2759859/
Carhart P, Espinosa J, & Lucerna A. (2024). A Case of Green Nail Syndrome Diagnosed in the .... Cureus, 38681312.
https://pubmed.ncbi.nlm.nih.gov/38681312/
Parlak AH, Aydoğan I, & Kavak A. (2003). Discolouration of the fingernails from using hydroquinone .... Journal of cosmetic dermatology, 17163930.
Q.
Could ridges in my nails be a sign of a thyroid problem?
A.
Yes, ridges in your nails can be linked to thyroid problems, as thyroid disease can cause various nail changes.
References:
Rosenberg A, & Lipner SR. (2022). Nail Changes Associated With Thyroid Disease. Cutis, 36219640.
https://pubmed.ncbi.nlm.nih.gov/36219640/
Kumar P, Sharma PK, Gautam RK, Jain RK, & Kar HK. (2007). Late-onset Rothmund-Thomson syndrome. International journal of dermatology, 17472679.
https://pubmed.ncbi.nlm.nih.gov/17472679/
Oanță A, Iliescu V, & Țărean S. (2017). Half and Half Nails in a Healthy Person. Acta dermatovenerologica Croatica : ADC, 30064606.
Q.
How can I differentiate between a splinter hemorrhage and melanoma in my nails?
A.
Splinter hemorrhages are small, thin, red or brown lines under the nails, while melanoma usually appears as a dark, irregular streak. It's important to have any concerning nail changes checked by a healthcare provider.
References:
Tully AS, Trayes KP, & Studdiford JS. (2012). Evaluation of Nail Abnormalities. American family physician, 22534387.
https://pubmed.ncbi.nlm.nih.gov/22534387/
Cohen PR. (2011). Longitudinal erythronychia: individual or multiple linear red .... American journal of clinical dermatology, 21668031.
https://pubmed.ncbi.nlm.nih.gov/21668031/
Hafner J, Haenseler E, Ossent P, Burg G, & Panizzon RG. (1995). Benzidine stain for the histochemical detection of .... The American Journal of dermatopathology, 8600800.
Q.
How can I prevent lines from forming in my nails?
A.
To prevent lines in your nails, keep your nails healthy by protecting them from injury and maintaining good overall health.
References:
Lipner SR, & Scher RK. (2016). Evaluation of nail lines: Color and shape hold clues. Cleveland Clinic journal of medicine, 27168515.
https://pubmed.ncbi.nlm.nih.gov/27168515/
Braswell MA, Daniel CR 3rd, & Brodell RT. (2015). Beau lines, onychomadesis, and retronychia: A unifying .... Journal of the American Academy of Dermatology, 26475537.
https://pubmed.ncbi.nlm.nih.gov/26475537/
Lee DK, & Lipner SR. (2022). Optimal diagnosis and management of common nail .... Annals of medicine, 35238267.
Q.
How common are splinter hemorrhages in the general population?
A.
Splinter hemorrhages are small lines of blood under the nails and are not very common in the general population, though they can occur more frequently in older adults.
References:
Haber R, Khoury R, Kechichian E, & Tomb R. (2016). Splinter hemorrhages of the nails: a systematic review .... International journal of dermatology, 27420914.
https://pubmed.ncbi.nlm.nih.gov/27420914/
Young J, & Mulley G. (1987). Splinter haemorrhages in the elderly. Age and ageing, 3577946.
https://pubmed.ncbi.nlm.nih.gov/3577946/
Monk BE. (1980). The prevalence of splinter haemorrhages. The British journal of dermatology, 7426414.
Q.
What are the potential causes of horizontal red lines under my fingernails?
A.
Horizontal red lines under your fingernails can be caused by various conditions, and it is important to consider medical evaluation.
References:
Chang C, Beutler BD, & Cohen PR. (2017). Report of a Patient with Multiple Horizontal Red Bands .... Dermatology and therapy, 28260214.
https://pubmed.ncbi.nlm.nih.gov/28260214/
Oanță A, Iliescu V, & Țărean S. (2017). Half and Half Nails in a Healthy Person. Acta dermatovenerologica Croatica : ADC, 30064606.
Q.
What are the underlying causes of splinter hemorrhages in nails?
A.
Splinter hemorrhages are small, dark streaks under the nails caused by tiny blood clots or damaged blood vessels. They can be linked to nail injuries, infections, or other health conditions.
References:
Haber R, Khoury R, Kechichian E, & Tomb R. (2016). Splinter hemorrhages of the nails: a systematic review .... International journal of dermatology, 27420914.
https://pubmed.ncbi.nlm.nih.gov/27420914/
Tully AS, Trayes KP, & Studdiford JS. (2012). Evaluation of Nail Abnormalities. American family physician, 22534387.
https://pubmed.ncbi.nlm.nih.gov/22534387/
Fawcett RS, Linford S, & Stulberg DL. (2004). Nail abnormalities: clues to systemic disease. American family physician, 15053406.
Q.
What causes a splinter hemorrhage to appear on a nail?
A.
Splinter hemorrhages on the nails are often caused by small injuries to the nail or can appear without a known cause.
References:
Haber R, Khoury R, Kechichian E, & Tomb R. (2016). Splinter hemorrhages of the nails: a systematic review .... International journal of dermatology, 27420914.
https://pubmed.ncbi.nlm.nih.gov/27420914/
Saladi RN, Persaud AN, Rudikoff D, & Cohen SR. (2004). Idiopathic splinter hemorrhages. Journal of the American Academy of Dermatology, 14726890.
https://pubmed.ncbi.nlm.nih.gov/14726890/
Mortimer PS, & Dawber RP. (1985). Trauma to the Nail Unit Including Occupational Sports .... Dermatologic clinics, 3830505.
Q.
What could a horizontal red line on my nail bed signify?
A.
A horizontal red line on your nail could be a sign of various conditions, including trauma or underlying health issues. It's important to consider other symptoms and consult a healthcare provider for an accurate diagnosis.
References:
Chang C, Beutler BD, & Cohen PR. (2017). Report of a Patient with Multiple Horizontal Red Bands .... Dermatology and therapy, 28260214.
https://pubmed.ncbi.nlm.nih.gov/28260214/
Oanță A, Iliescu V, & Țărean S. (2017). Half and Half Nails in a Healthy Person. Acta dermatovenerologica Croatica : ADC, 30064606.
https://pubmed.ncbi.nlm.nih.gov/30064606/
Lipner SR, & Scher RK. (2016). Evaluation of nail lines: Color and shape hold clues. Cleveland Clinic journal of medicine, 27168515.
Q.
What could a horizontal red line under my big toenail signify?
A.
A horizontal red line under your big toenail could be a sign of something called 'half and half nails,' which can sometimes appear in healthy people.
References:
Oanță A, Iliescu V, & Țărean S. (2017). Half and Half Nails in a Healthy Person. Acta dermatovenerologica Croatica : ADC, 30064606.
Q.
What could cause bleeding around my fingernails?
A.
Bleeding around the fingernails can be caused by splinter hemorrhages, onycholysis, or drug-induced nail disorders.
References:
Haber R, Khoury R, Kechichian E, & Tomb R. (2016). Splinter hemorrhages of the nails: a systematic review .... International journal of dermatology, 27420914.
https://pubmed.ncbi.nlm.nih.gov/27420914/
Ghetti E, Piraccini BM, & Tosti A. (2003). Onycholysis and subungual haemorrhages secondary to .... Journal of the European Academy of Dermatology and Venereology : JEADV, 12834462.
https://pubmed.ncbi.nlm.nih.gov/12834462/
(2014). Drug-induced nail disorders. Prescrire international, 25162091.
Q.
What could small blood lines under my fingernails suggest?
A.
Small blood lines under your fingernails could be a sign of a systemic disease or a nail injury. It's important to check with a healthcare provider to understand the cause.
References:
Fawcett RS, Linford S, & Stulberg DL. (2004). Nail abnormalities: clues to systemic disease. American family physician, 15053406.
https://pubmed.ncbi.nlm.nih.gov/15053406/
Damevska K, Gocev G, Pollozahani N, Nikolovska S, & Neloska L. (2017). Onychomadesis Following Cutaneous Vasculitis. Acta dermatovenerologica Croatica : ADC, 28511755.
https://pubmed.ncbi.nlm.nih.gov/28511755/
Egger A, & Tosti A. (2020). Carpal tunnel syndrome and associated nail changes. Journal of the American Academy of Dermatology, 32199899.
Q.
What do different types of lines in fingernails indicate about my health?
A.
Lines in fingernails can tell us about your health. They might show past illness, injury, or even a health condition.
References:
Lipner SR, & Scher RK. (2016). Evaluation of nail lines: Color and shape hold clues. Cleveland Clinic journal of medicine, 27168515.
https://pubmed.ncbi.nlm.nih.gov/27168515/
Braswell MA, Daniel CR 3rd, & Brodell RT. (2015). Beau lines, onychomadesis, and retronychia: A unifying .... Journal of the American Academy of Dermatology, 26475537.
https://pubmed.ncbi.nlm.nih.gov/26475537/
Fawcett RS, Linford S, & Stulberg DL. (2004). Nail abnormalities: clues to systemic disease. American family physician, 15053406.
Q.
What do small hemorrhages under the nail bed indicate?
A.
Small hemorrhages under the nail bed, known as splinter hemorrhages, can be caused by trauma or may indicate underlying health issues like psoriasis or heart conditions.
References:
Haber R, Khoury R, Kechichian E, & Tomb R. (2016). Splinter hemorrhages of the nails: a systematic review .... International journal of dermatology, 27420914.
https://pubmed.ncbi.nlm.nih.gov/27420914/
Tully AS, Trayes KP, & Studdiford JS. (2012). Evaluation of Nail Abnormalities. American family physician, 22534387.
https://pubmed.ncbi.nlm.nih.gov/22534387/
Canal-García E, Bosch-Amate X, Belinchón I, & Puig L. (2022). Nail Psoriasis. Actas dermo-sifiliograficas, 35697407.
Q.
What is the significance of developing ridges in nails as you age?
A.
Nail ridges can develop as you age due to changes in the nails, and they might be linked to conditions like osteoarthritis.
References:
Alarcon-Segovia S, & Vega-Ortiz JM. (1981). Heberden's nodes' nails. The Journal of rheumatology, 7288768.
https://pubmed.ncbi.nlm.nih.gov/7288768/
Cutolo M, Cimmino MA, & Accardo S. (1990). Nail involvement in osteoarthritis. Clinical rheumatology, 2390855.
https://pubmed.ncbi.nlm.nih.gov/2390855/
Tully AS, Trayes KP, & Studdiford JS. (2012). Evaluation of Nail Abnormalities. American family physician, 22534387.
Q.
What might a small red spot under my nail suggest about my health?
A.
A small red spot under your nail could be related to nail psoriasis, a condition that affects the nails and can cause discoloration or spots.
References:
Nieradko-Iwanicka B. (2017). Nail psoriasis - what a rheumatologist should know about. Reumatologia, 28386142.
https://pubmed.ncbi.nlm.nih.gov/28386142/
Perrin C, Coutts M, Boukari F, & Ambrosetti D. (2024). Onychocytic Matricoma: A Clinical, Dermoscopic, and .... The American Journal of dermatopathology, 38513115.
https://pubmed.ncbi.nlm.nih.gov/38513115/
Canal-García E, Bosch-Amate X, Belinchón I, & Puig L. (2022). Nail Psoriasis. Actas dermo-sifiliograficas, 35697407.
Q.
What might cause brown discoloration of my nail beds?
A.
Brown discoloration of nail beds can be caused by chronic kidney disease or conditions like melanonychia, which involves pigment changes in the nails.
References:
Stewart WK, & Raffle EJ. (1972). Brown nail-bed arcs and chronic renal disease. British medical journal, 5014252.
https://pubmed.ncbi.nlm.nih.gov/5014252/
Gradinaru TC, Mihai M, Beiu C, Tebeica T, & Giurcaneanu C. (2020). Melanonychia - Clues for a Correct Diagnosis. Cureus, 32064201.
https://pubmed.ncbi.nlm.nih.gov/32064201/
Johannessen JT, & Juel J. (2023). Benign or malign disturbances of the nail apparatus. Ugeskrift for laeger, 38018740.
Q.
What might red lines across my fingernails indicate?
A.
Red lines across your fingernails might be caused by different health issues, including skin conditions or infections, and can sometimes indicate changes in your overall health.
References:
Chang C, Beutler BD, & Cohen PR. (2017). Report of a Patient with Multiple Horizontal Red Bands .... Dermatology and therapy, 28260214.
https://pubmed.ncbi.nlm.nih.gov/28260214/
Lipner SR, & Scher RK. (2016). Evaluation of nail lines: Color and shape hold clues. Cleveland Clinic journal of medicine, 27168515.
https://pubmed.ncbi.nlm.nih.gov/27168515/
Preda-Naumescu A, Penney K, Pearlman RL, Brodell RT, Daniel CR, & Nahar VK. (2021). Nail Manifestations in COVID-19: Insight into a Systemic .... Skin appendage disorders, 34580633.
Q.
What should I do if I notice lines appearing on my nails?
A.
If you notice lines on your nails, it could be due to various reasons, including normal aging or health issues. It's best to see a doctor to understand what might be causing the changes.
References:
Lipner SR, & Scher RK. (2016). Evaluation of nail lines: Color and shape hold clues. Cleveland Clinic journal of medicine, 27168515.
https://pubmed.ncbi.nlm.nih.gov/27168515/
Fawcett RS, Linford S, & Stulberg DL. (2004). Nail abnormalities: clues to systemic disease. American family physician, 15053406.
https://pubmed.ncbi.nlm.nih.gov/15053406/
Lee DK, & Lipner SR. (2022). Optimal diagnosis and management of common nail .... Annals of medicine, 35238267.
Q.
What should I do if my nails start bleeding after getting acrylics?
A.
If your nails start bleeding after getting acrylics, it might be due to skin irritation or damage. Consider removing the acrylics and consulting a healthcare professional if the issue persists.
References:
Adigun CG, & Shoaf H. (2020). Psoriasiform Onychodystrophy Induced by Photobonded .... The Journal of Clinical and Aesthetic Dermatology, 7819586.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7819586/
Anderson SE, & Meade BJ. (2014). Potential Health Effects Associated with Dermal Exposure .... Environmental Health Insights, 4270264.
https://pmc.ncbi.nlm.nih.gov/articles/PMC4270264/
Fonseca A, Jacob SE, & Sindle A. (2020). Practical interventions in lip-licking dermatitis. International Journal of Women's Dermatology, 8060673.
Q.
When should I be concerned about ridges on my fingernails?
A.
Ridges on fingernails can be a normal sign of aging but can also indicate health issues if they are deep or accompanied by other changes.
References:
Braswell MA, Daniel CR 3rd, & Brodell RT. (2015). Beau lines, onychomadesis, and retronychia: A unifying .... Journal of the American Academy of Dermatology, 26475537.
https://pubmed.ncbi.nlm.nih.gov/26475537/
Fawcett RS, Linford S, & Stulberg DL. (2004). Nail abnormalities: clues to systemic disease. American family physician, 15053406.
https://pubmed.ncbi.nlm.nih.gov/15053406/
Cutolo M, Cimmino MA, & Accardo S. (1990). Nail involvement in osteoarthritis. Clinical rheumatology, 2390855.
Q.
Why are my nail beds red after getting acrylics and what can I do about it?
A.
Red nail beds after getting acrylics might be due to an allergic reaction to the materials used. You should consider removing the acrylics and consulting a dermatologist if redness persists.
References:
Rieder EA, & Tosti A. (2016). Cosmetically Induced Disorders of the Nail with Update on .... The Journal of Clinical and Aesthetic Dermatology, 4898583.
https://pmc.ncbi.nlm.nih.gov/articles/PMC4898583/
Moreira J, Gonçalves R, Coelho P, & Maio T. (2017). Eyelid Dermatitis Caused by Allergic Contact to Acrylates .... Dermatology Reports, 5452630.
https://pmc.ncbi.nlm.nih.gov/articles/PMC5452630/
Carhart P, Espinosa J, & Lucerna A. (2024). A Case of Green Nail Syndrome Diagnosed in the .... Cureus, 11047019.
Q.
Why are there vertical lines forming on my fingernails?
A.
Vertical lines on fingernails, also called ridges, can occur naturally with age or may be linked to certain health conditions like arthritis.
References:
Lipner SR, & Scher RK. (2016). Evaluation of nail lines: Color and shape hold clues. Cleveland Clinic journal of medicine, 27168515.
https://pubmed.ncbi.nlm.nih.gov/27168515/
Cutolo M, Cimmino MA, & Accardo S. (1990). Nail involvement in osteoarthritis. Clinical rheumatology, 2390855.
https://pubmed.ncbi.nlm.nih.gov/2390855/
Michel C, Cribier B, Sibilia J, Kuntz JL, & Grosshans E. (1997). Nail abnormalities in rheumatoid arthritis. The British journal of dermatology, 9470915.
Q.
Why do I have red lines under my nails and what do they mean?
A.
Red lines under your nails can be a sign of various conditions, and understanding their pattern and color can help identify the cause.
References:
Chang C, Beutler BD, & Cohen PR. (2017). Report of a Patient with Multiple Horizontal Red Bands .... Dermatology and therapy, 28260214.
https://pubmed.ncbi.nlm.nih.gov/28260214/
Cohen PR. (2011). Longitudinal erythronychia: individual or multiple linear red .... American journal of clinical dermatology, 21668031.
https://pubmed.ncbi.nlm.nih.gov/21668031/
Lipner SR, & Scher RK. (2016). Evaluation of nail lines: Color and shape hold clues. Cleveland Clinic journal of medicine, 27168515.
Q.
Why is my nail bed red after getting acrylics?
A.
Redness in your nail bed after getting acrylics might be due to irritation or an allergic reaction to the chemicals used in the process.
References:
Rieder EA, & Tosti A. (2016). Cosmetically Induced Disorders of the Nail with Update on .... The Journal of Clinical and Aesthetic Dermatology, 4898583.
https://pmc.ncbi.nlm.nih.gov/articles/PMC4898583/
Moreira J, Gonçalves R, Coelho P, & Maio T. (2017). Eyelid Dermatitis Caused by Allergic Contact to Acrylates .... Dermatology Reports, 5452630.
https://pmc.ncbi.nlm.nih.gov/articles/PMC5452630/
Carhart P, Espinosa J, & Lucerna A. (2024). A Case of Green Nail Syndrome Diagnosed in the .... Cureus, 11047019.
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https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1References
Lipner SR, Scher RK. Nail signs of systemic disease. In: Callen JP, Jorizzo JL, Zone JJ, Piette WW, Rosenbach MA, Vleugels RA, eds. Dermatological Signs of Systemic Disease. 5th ed. Philadelphia, PA: Elsevier; 2017:chap 44.