Rowland has recently returned from Africa where he was taking Chloroquine for malaria prophylaxis – and presents with blue nails. They are painless and he is otherwise well.

What is the most likely cause of this presentation of blue nails?

1. Medication use – Chloroquine

What are the causes of blue nails discolouration of the nail plate?

• Antimalarials
• Argyria

Argyria or argyrosis is a condition caused by excessive exposure to chemical compounds of the element silver, or to silver dust. The most dramatic symptom of argyriais that the skin turns purple or purple-grey. It may take the form of generalized argyria or local argyria.

How would you give Doxycycline for malaria prophylaxis?

1. doxycycline 100 mg (child 8 years or older: 2 mg/kg up to 100 mg) orally, daily (starting 1 to 2 days before entering, and continuing for 4 weeks after leaving the malarious area)

What are the non pharmacological methods of avoiding Malaria exposure?

1. applying effective insect repellent and using other insecticide products (eg mosquito coils or vaporising mats)
2. wearing light-coloured long trousers and long-sleeved shirts in the evening
3. sleeping in screened accommodation or using mosquito nets, which can be pyrethroid impregnated
4. avoiding outside activities between dusk and dawn
5. avoiding perfume and aftershave.

Reading

1. eTG- Malaria – https://tgldcdp.tg.org.au/viewTopic?topicfile=malaria&guidelineName=Antibiotic#toc_d1e516
2. Murtaghs General Practice Chapter 129 – http://murtagh.mhmedical.com/content.aspx?bookid=1522&sectionid=116046129
3. Murtaghs Practice Tips – Chapter 8 – Nail Problems – http://murtagh.mhmedical.com/content.aspx?bookid=1920&sectionid=143276631

Podcast

1. GP Core Content Podcast Episode 150 – Dermatology | Nails