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The pattern of nail involvement can be longitudinal streaks with wider proximal edge or diffuse which starts from the junction of proximal and lateral nail folds and spreads with irregular medial border.[16] Viral HIV patients may show diffuse melanonychia or multiple longitudinal or transverse bands in multiple fingers and toenails, often associated with hyperpigmentation of palms, soles and mucous membranes.[17] Longitudinal melanonychia can also be seen with ART drugs like zidovudine.[17] Inflammatory disorders Inflammatory skin conditions like psoriasis, lichen planus, amyloidosis, chronic radio dermatitis, and chronic paronychia in and around nail unit leads to melanocytic activation resulting in melanonychia.[7,18] Longitudinal melanonychia has also been seen in connective tissue diseases like systemic sclerosis and SLE.[19,20] Tumors Longitudinal melanonychia can also occur due to melanocytic activation by nonmelanocytic benign and malignant tumors such as onychomatricoma, Bowen's disease, squamous cell carcinoma, basal cell carcinoma, subungual fibrous histiocytoma, verruca vulgaris and subungual keratosis.[11,21] Systemic Diseases Melanonychia in systemic diseases tends to involve multiple finger and toe nails, and generally presents as either diffuse melanonychia or multiple bands

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