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Nutritional Deficiencies Longitudinal melanonychia is seen in malnutrition especially protein energy malnutrition and vitamin D deficiency.[24] 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.[25] 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.[16] 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].[16] Silver nitrate presents with a dark color band with irregular medial border and staining of adjacent skin of nail folds.[16] 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.[7] LM involves several nails, generally finger nails with one or more bands

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