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Differential Diagnoses and Approach to Melanonychia The following are the differential diagnoses of melanonychia according to the presentation-[34] Nonmelanin pigmentation: The first and essential step is to establish the melanin or nonmelanin (e.g., exogenous, infections, hematoma) etiology Multiple nail involvementRacial, systemic causes, or frictional Single nail explained by skin and nail diseasesTrauma, inflammatory disorders, or tumors LM in childrenNail matrix nevus, Regular follow ups required LM in adultsHistopathology may be needed if doubtful

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Carnitine in the environment Recent work makes it clear that while animals represent the most readily accessible source of carnitine, carnitine is often present and sometimes abundant in soil and natural waters