What your Nails Speak about your Health

Table of Content

What your Nails Speak about your Health

Examining Your Fingernails

Clubbed Nails

Softening of nail bed with loss of normal lovibond angle between nail bed and the fold

Causes

  • Pulmonary & cardiovascular (80%)
  • Gastrointestinal (5%)
  • Hyperthyroidism (1%)

Koilonychia

Spoon shaped concave nails. These occur normally in children & resolve with age

Causes

  • Iron deficiency
  • Diabetes mellitus
  • Protein deficiencies, especially in sulphur containing amino acids
  • Exposure to petroleum-based solvents
  • Systemic lupus erythematosus
  • Raynaud's diseases

Beaus Growth Arrest Lines

Transverse lines in the substance of the nail as a sign of previous acute illness

Causes

  • Severe infection
  • Myocardial infarction
  • Hypotension, shock
  • Hypocalcemia
  • Surgery

Thin Brittle Nails

Thin, brittle nails can indicate the following

Causes

  • Metabolic bone diseases (nail thinness is correlated with osteopenia)
  • Thyroid disorders
  • Systemic amylidosis (yellow waxy flaking)
  • Severe malnutrition

Onychorrhexis

Presence of longitudinal striations or ridges, can be because of advanced age or also can occur with following:

Causes

  • Rheumatoid arthritis
  • Peripheral vascular disease
  • Lichen planus
  • Darier's disease (striations are red/white)
  • Central ridges can be caused by
  • Iron deficiency
  • Folic acid deficiency
  • Protein deficiency

Central Nail Canal (Median Nail dystrophy)

When the central nail canal is present the cuticle is usually normal

Causes

  • Severe arterial diseases
  • Peripheral artery disease
  • Severe malnutrition
  • Repetitive trauma

Nail Pitting

Small punctate depressions caused by nail matrix inflammation

Causes

  • Psoriasis (random appearance of pits)
  • Alopecia areata (geometric rippled grid)
  • Eczema
  • Lichen planus

Nail Beading

Beads seem to drip down the nail like wax.

Causes

Endocrine conditions

  • Diabetes mellitus
  • Thyroid disorders
  • Addison's disease
  • Vitamin B deficiency

Rough Nail Surface

When nail looks sandpapered and dull

Causes

  • Autoimmune disease
  • Psoriasis
  • Chemical exposure
  • Lichen planus

Nail Thickening

Slow nail growth produces thickness

Causes

  • Onychomycosis
  • Chronic eczema
  • Peripheral vascular disease
  • Yellow nail syndrome
  • Psoriasis

Onycholysis

Distal separation of the nail plate from the nail bed

Causes

  • Thyrotoxicosis
  • Psoriasis
  • Trauma
  • Contact dermatitis
  • Tetracycline
  • Eczema
  • Toxic exposures (solvents)
  • Blistering from autoimmune diseases
  • Blistering from sun exposure

Severe Nail Curvature

Curved or beaked nails are caused by reabsorption of distal digit

Causes

  • Hyperthyroidism
  • Renal failure
  • Psoriasis
  • Systemic sclerosis

Complete Nail Destruction

Complete local nail destruction can be caused by local mechanisms, including trauma & paronychia

Causes

  • Toxic epidermal necrolysis
  • Chemotherapy
  • Bullous diseases
  • Vasculitis

Abnormalities of Lunula

Lunula absent

Causes

  • Anemia
  • Malnutrition

Pyramidal lunula

Causes

  • Excessive manicure
  • Trauma

Pale blue lunula

Causes

  • Diabetes mellitus

Red discoloration

Causes

  • Cardiovascular diseases
  • Collagen vascular diseases

Transverse White Lines (Mee's lines)

Mee's line approximately one third of the way up the nail, suggesting a significant illness 2 months previously

Causes

  • Any acute illness
  • Heavy metal toxicity (classically arsenic)
  • Chemotherapy

Leukoncychia Striae

White splotches on the nails

Causes

  • Minor trauma to the nail matrix

Longitudinal Brown Lines

These occur because of increased melanin produced by nail melanocytes

Causes

  • Addison's diseases
  • Nevus at the nail base
  • Breast cancer
  • Melanoma
  • Trauma

Splinter Hemorrhages

They are caused by hemorrhage of the distal capillary loop

Causes

  • Subacute bacterial endocarditis
  • Systemic lupus erythematosus
  • Trichinosis
  • Pityriasis rubra pilaris
  • Psoriasis
  • Renal failure

Terry's Half and Half Nails

The proximal portion is white (edema & anaemia) & the distal portion is dark

Causes

  • Renal failure
  • Liver disease
  • Congestive heart failure
  • Adult onset diabetes mellitus
  • Malnutrition
  • Hyperthyroidism

Generalised Discoloration of White Nail Plate

White Nail

Causes

  • Anaemia
  • Renal failure
  • Cirrhosis
  • Diabetes mellitus
  • Chemotherapy
  • Hereditary

Yellow Nail

Causes

  • Diabetes mellitus
  • Amyloidosis
  • Median/ulnar nerve injury
  • Thermal injury
  • Jaundice

Brown Grey Nail

Causes

  • Cardiovascular diseases
  • Diabetes mellitus
  • Vit B12 deficiency
  • Breast cancer
  • Malignant melanoma
  • Lichen planus
  • Syphillis
  • Topical agents like hair dyes

Pink/ Red Nail

Causes

  • Systemic lupus erythematosus
  • Carbon monoxide
  • Angioma
  • Malnutrition

Green/Black Nail

Causes

  • Topical preparations (chlorophyll derinatives, methyl green & silver nitrate)
  • Chronic Pseudomanas spp infection
  • Trauma

Paronychial Inflamamation

Separation of the seal between the proximal nail fold & the nail plate that provides entry for bacteria & leads to localized infection of the paronychial tissues of the hands

Symptoms

  • Inflammation
  • Swelling
  • Scaling

Periungal Telangeictasia

It is caused by dilated capillary loops & results in atrophy of the cuticle

Causes

  • Collagen vascular disease
  • Systemic lupus erythematosus
  • Dermatomyositis
  • Scleroderma

Mucus Cyst

It is a collection of degenerative collagen that can cause swelling & ridging of the nail above the cyst, forming a "gutter"

References

  1. http://www.medscape.org/viewarticle/571916
  2. Am Fam Physician. 2004 Mar 15;69(6):1417-1424.
  3. Indian J Dermatol Venereol Leprol.2005 Nov-Dec;71(6):386-92.
  4. Can Fam Physician.2011 Feb;57(2):173-81