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sofia khan
sofia khan,
Category: Dermatology
Satisfied Customers: 957
Experience:  Consultant Family physician with special interest in dermatology at Rehman Medical Institute
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I have vertical stipe seen on my middle finger nail, I would

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hello I have brown vertical stipe seen on my middle finger nail, I would like to get a dermatologist opinion please


Thank you for contacting Justanswer.

My name is***** khan. I am board certified family physician with specialist training in dermatology. I shall try and help you today with your query.

Let me have a quick read through and I’ll get back to you shortly.

to begin with, can you upload a picture please?

Customer: replied 8 months ago.
ok please check
Customer: replied 8 months ago.
Hello Dr Sofia
Customer: replied 8 months ago.
I am of Indian origin 45 years
Customer: replied 8 months ago.

Hi, let me have a look

Customer: replied 8 months ago.
thank you

is it just one nail or many nails are involved?

Customer: replied 8 months ago.
just one nail and hence worried

when did you first notice it, any symptoms?

Customer: replied 8 months ago.
2 weeks ago, no other symptoms
Customer: replied 8 months ago.
what could be the reason pls?

I see!

give me a couple of minutes to type the answer

Customer: replied 8 months ago.
ok sorry

No thats OK.

By the looks of it, it appears as melanonychia.

The term melanonychia describes a black-brown-gray pigmentation of the nail plate that, in most cases, appears as a longitudinal band. Melanonychia can be observed at any age, affecting one digit or several digits, in both fingernails and toenails.

However, only a picture can not say that it is a benign pigmentation. It needs to be seen under dermatoscopy to rule out sinister causes like melanoma especially if the history is short and secondly due to your ethnic origin.

I would suggest that you see your Gp regarding this. This is probably nothing to worry about but should be seen in person.

Customer: replied 8 months ago.
Thank you Dr Sophie, but in Indian I heard less Melanoma?
Customer: replied 8 months ago.
GP thinks it could trauma induced but I requestd for a private dermatogist referral
Customer: replied 8 months ago.
would the GP have access to dermatoscopy?
Customer: replied 8 months ago.
I did injure my finger trying to open car door a month ago, could that be a cause as well

In Asians generally, melanomas are low but acral melanomas i.e the ones which appear on hands and feet are higher in incidence.

if you have a history of trauma recently it is quite likely that it might have appeared secondary to that.

In this case,One of the other things that you can do is to give it a couple of weeks and monitor its progress with a photograph. If it fades then its nothing to worry but if remains the same then you must see your GP to be referred to dermatologist.

Gps dont do dermoscopy, but if they have a Gp with special interest in dermatology in your area, that referral might be quicker and easier for them.

Customer: replied 8 months ago.
Thank you very much Dr Sofie, really worried. But I will go through GP ASAP

I think that would be the sensible thing to do and will put your mind at rest too.

I hope this answers your question.

If you are happy with the response, Can I ask you to take some time to rate the consultation? Your feedback is very important for my professional growth and also for the fact that until you have rated the consultation we do not get paid for our work.

This does not mean that your query gets closed after that. You can come back as many times as you like through the thread and ask me further questions regarding this problem.

Best wishes and good luck.

Dr Khan

sofia khan and other Dermatology Specialists are ready to help you
Customer: replied 8 months ago.
sure thank you I will rate 5 star

thank you. I hope it turns out all good.

Customer: replied 8 months ago.
Dr Khan sorry to bother you again - on the net I read this which kinf of matches with my nail piture, would you agree? I measured mine and it is less than irregular lines, defined border etc...Benign longitudinal melanonychia is recognized by the appearance of light to dark brown stripes that are parallel and regular in color, thickness, and spacing. The border is clearly defined and less than 3 millimeters (mm), which is roughly 1/10th of an inch, in width.
Customer: replied 8 months ago.
just looking for some re-assurance from expert like you until I get my Dermatologist appointment for Dermascope examination...looks like 2 weeks minimum

you are absolutely right with the above information. That's the reason why I said that grossly it appears as benign melanonychia and it is very likely that it has appeared secondary to injury but I am just being more careful and looking at it under dermatoscope will completly rule out sinister causes.

2 weeks wait is appropriate to wait.

Customer: replied 8 months ago.
this makes me feel better, thank you very much Dr Khan. I can wait now as I was so worried I have Subungal Melanoma!
Customer: replied 8 months ago.
one last question, could a recent trauma related turn into malignancy soon? also in your experience what is the % of Indian race with SM you have seen, high? or low?

Subungual melanomas represent approximately 20% in dark-skinned and oriental populations compared to about 2% of cutaneous melanomas in white populations. There have been cases where subungal melanomas have occurred secondary to direct injury.

We are just being more cautious in your case. grossly it appears OK.

Customer: replied 8 months ago.
I am indian and 45, what could be the possibility, brown tone on hands, and light color skin body and face. Have you seen any cases in the past that ended up in SUM in your experience?

I have not seen them personally but this does not mean they do not happen.

We don't just rely on personal experiences but look at the research and evidence and give you advice accordingly.

Telemedicine can only guide you towards the next appropriate step but can not make an accurate 100% diagnosis. We have previously had cases on teledermatology where the lesions have looked completely benign but turned out malignant on biopsies and dermoscopy. That is why it has changed our attitude towards dealing with such cases. I am very hopeful that this is being but without dermoscopy, I can only give you a probable diagnosis.

Customer: replied 8 months ago.
Thank you very much, I understand, much appreciated
Customer: replied 8 months ago.
Dr Khan, sorry to bother you again, as suggsted by you my urgent referral dermatologist appointment is tomorrow morning, when I see the consultant I would like to present some more info, which I would like to run past with you. I also noticed "diffused pigmentation" on few of the feet nails and one feet nail is "distorted" and another hand nail only has "brown pigementation" to wards the edge, could my issue probably be racial melanonychia as well? Please find attaced pics for furter review.
Customer: replied 8 months ago.
File attached (QS536MS)
Customer: replied 8 months ago.
File attached (M5ZMML3)
Customer: replied 8 months ago.
File attached (2L53P17)

This does not seem anything significant.

With Nail pigmentation, the number of affected digits is an important diagnostic clue: if more than one nail is involved, the first clinical suspicion should be a benign condition due to melanocytic activation. The most common causes of multiple digit NP are racial pigmentation, systemic disorders, exogenous pigment, drug induction and mechanical triggers . For this reason, taking a good medical history and a full body examination is mandatory in order to reach a correct diagnosis. Mention this to the dermatologist too. to me it looks more like racial pigmentation but more detailed history and examination is needed.

Customer: replied 8 months ago.
Thanks Dr Khan, I feel slightly relived before my appointment my Dermatologist NHS Consultant. I do have some mild pigmentation on my toe nails, I also had minor trauma on the nail I have reported to be worrisome. I am sure the consultant will do these through checks and may be say that this is benign. Fingers crossed. You shared a great knowledge and information to me. Very nice of you.

no problem.

I hope all goes well tomorrow. let me know.

good luck.

Customer: replied 8 months ago.
Dear Dr Khan,one question, as I was really tensed I ended up seeing total 3 dermatologist consultants1) Dr Bashir gave me 2 options i.e wait and see 3 months or biopsy (hutchison's sign negative)2) Dr Rosbotham private consultant, said my grey bar is benign and nothing needs doing (hutchison's sign negative)3) Dr Laheru via NHS he is dermatologist consultant with specialization in nails (he himself told me, he nails gets referred for all nail issues in nhs)again he too said this is benign and racial is the reason nothing to do. (hutchison's sign negative)Only one thing that's bugging is even though 2 consultants said it is benign, one did suggest a biopsy hopefully gods grace I am not missing anything. For now I am just monitoring for any changes, hope it stays the same or gets wiped out with nail growth. Fongers crossed. Will wait for your thoughts, thanks

I can understand all your anxiety.

Sometimes when the patients are too stressed and nothing else would reassure them, we do do a test to confirm it for them. This might be one of the reasons, one of the consultants might have mentioned it. personally, as I told you before as well that this looked benign and two consultants confirming this is good enough.

The wait and watch policy looks sensible. You keep monitoring it for now. If they have given you a follow up appointment in 3 months that is good enough.

Customer: replied 7 months ago.
Thanks a lot Dr Khan. I agree with your point to monitor for changes to be on safeside. I also glad you thought it was benign too, gives me some reassurance. I will request for a follow-up appointment in 2 to 3 months time to get this double checked again. Much appreciated.

No worries. You are welcome.

Customer: replied 7 months ago.
Dear Dr Khan, just quick followup, j find attached physical letter from GP the grey bits highlighted for monitoring, is this something I should be concerned about? sorry to bother you many times on this? just wanted to check your thoughts, thanks, Satish
Customer: replied 7 months ago.
File attached (24L2LQM)


There is nothing concerning in this letter. The dermatologist has just explained signs to look out for to your GP. They think it is benign and just needs observing.

Customer: replied 7 months ago.
Thanks a lot Dr Khan, much appreciated.

you are welcome.