Koilonychia, commonly known as “spoon nails,” refers to flattening of the middle part of the nail plate in conjunction with upward curvature of the distal nail plate and/or lateral edges [1]. It may be caused by abnormal blood flow to the digit, nail bed hyperkeratosis leading to an abnormal shape, or a protein/amino acid deficiency state, although the pathophysiology is debated [1, 2]. Koilonychia may occur in association with primary dermatologic disease or systemic illness. Most causes of koilonychia can be classified as acquired, idiopathic, or hereditary [1].