A 64-year-old gentleman with chronic obstructive pulmonary disease Global Initiative for Chronic Obstructive Lung Disease (GOLD) Class-3, presented with chronic discoloration of nails. He had been a chronic smoker (52 pack-years) using both bidi (unfiltered indigenous tobacco) and cigarette. He was nonalcoholic and had been diagnosed with bipolar affective disorder, controlled with quetiapine 25 mg twice daily.

On examination, he had yellow to brownish discoloration of nails, especially involving the right index and middle fingers. There were also features of chronic superficial burns involving the medial aspect of index finger and lateral aspect of middle finger (Fig. 1).

Figure 1. Yellow to brownish nicotine staining of nails of the right index and middle fingers. Stigmata of chronic burns involving the medial aspect of index finger and lateral aspect of middle finger has also been noted.

Tobacco-stained fingers may indicate not only the number of cigarettes smoked, but also intake of deeper puffs and usage of unfiltered tobacco preparation resulting in greater cumulative exposure of tobacco ¹. Tobacco-stained fingers, a sparsely described phenomenon, may act as a clinical clue for greater systemic exposure to unfiltered tobacco smoke ².

Authors’ Contribution: SC generated the idea. SC and PB conjointly wrote the article. AKD edited the same. All authors agreed upon the final version of the manuscript. All authors had access to the data.

Conflict of Interest: Nil.

Funding: Nil.

Prior Publication: Nil.

1.        John G, Pasche S, Rothen N, Charmoy A, Delhumeau-Cartier C, Genné D. Tobacco-stained fingers: a clue for smoking-related disease or harmful alcohol use? A case-control study. BMJ Open. 2013;3:e003304.

2.        Hardin ME, Greyling LA, Davis LS. Nicotine staining of the hair and nails. J Am Acad Dermatol. 2015;73(3):e105-6.