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nail bed pigmentation, transverse bands, and longitudinal melanonychia can be seen either alone or together.[] Transverse melanonychia, although uncommon, is seen almost exclusively due to drugs.[] The pigmentation involves several nails that fade either partially or completely following drug withdrawal[] in 6–8 weeks but may take several months to years.[] The list of common drugs causing melanonychia and their features are listed in Table 2.[] Chemotherapeutic drugs are the most common agents.[] Intermittent administration of chemotherapy can result in alternating bands of pigmentation.[] Nutritional Deficiencies Longitudinal melanonychia is seen in malnutrition especially protein energy malnutrition and vitamin D deficiency.[] Vitamin B12 deficiency produces reversible nail pigmentation that can be longitudinal, diffuse bluish or reticulate probably due to reduced glutathione levels resulting in disinhibition of tyrosinase enzyme involved in melanogenesis.[] Exogenous Pigmentation Brown to black pigmentation of nails can be seen due to exogenous agents like henna, dirt, tobacco, potassium permanganate, tar, and silver nitrate.[] It presents as a horizontal band with the distal border parallel to the proximal nail fold and tends to move out with the nail plate [Figure 8].[] Silver nitrate presents with a dark color band with irregular medial border and staining of adjacent skin of nail folds.[] Syndromes Associated with Melanonychia Laugier–Hunziker syndrome, Peutz- Jegher and Touraine syndrome are characterized by LM along with pigmented macules in oral mucosa and lips.[] LM involves several nails, generally finger nails with one or more bands
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The accompanying DexKey ® reactors release the glutathione molecules at the desired release points in the body