Nail fold changes in the fingers

I remember, when doing the MRCP examination, using the term ‘nail fold changes’ and thinking that it was a sign of my expertise that I had managed not only to look at the nail folds, but also to determine that they had changed in some way. A few years and some thought later, I realise that there is much to be analysed in the appearance of the nail folds. They can provide the focus of a complaint, presenting with their own collection of rashes, infections and tumours which require interpretation and an approach to treatment which can differ from treatment of the same condition presenting elsewhere.