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Nails: Window to your overall health

Health warnings your nails may be sending… Are your nails looking normal? Perhaps you should have a closer look.


Abnormalities of Nails – Nailing the diagnosis

From nutritional deficiency to malignancy, nails can give a significant amount of information pertaining to your overall health. Nails abnormalities can arise in conjunction with or as a result of injury, infection, disease, poisoning, abuse, nutritional deficiency or side effect of medicine. It’s a body’s way of sending you a message that something somewhere is lurking below the surface.

Typically a nail should be pale pink in color and should be matching your skin tone, some people have lighter half moon shaped lacuna near the base and a white rim over the tip, while some may not have visible lacuna.

However, besides individual variation following abnormalities in shape, texture, color and pliability should not be sidelined, as they can help you spot some early warning signs.


1. Clubbing of Nails

Clubbing of Nails is characterized by increased convexity of the nail fold with thickening of whole distal digit. It occurs when the lovibond angle i.e. angle made by proximal nail fold and nail plate becomes greater than 1800.

It suggests low oxygen in your blood, commonly seen in lung and heart diseases.

Associated conditions:

  • Cardiovascular diseases
  • Neoplastic conditions
  • Infections
  • Hepatobiliary conditions
  • Mediastinal diseases
  • Endocrine disorders
  • Gastrointestinal diseases
  • Liver diseases
  • AIDS


2. Beau’s lines

Beau’s lines are horizontal deeply grooved lines, going across the nails that may appear as indentations or ridges on the nail plate. It is commonly seen in divers.

It may be caused by temporary cessation of cell division in the nail matrix, caused by infection, injury or trauma to that area. Other causes:

  • Coronary occlusion
  • Hypocalcaemia
  • Skin disease
  • Chemotherapy used for cancer
  • Malnutrition


3. Koilonychias (Spoon Nails)

Koilonychias (Spoon Nails) is characterized by depression of the nails with increase in concavity, giving an appearance of a spoon where in water droplet can be placed.

Common causes for Koilonychias (Spoon Nails):

It is more closely associated with iron deficiency anemia. It is sometimes seen in otherwise healthy infants and disappears as the child ages. Other causes are:

  • Haemochromatosis
  • Component of nail-patella syndrome(genetic disease)
  • Associated with plummer-vinson syndrome
  • Malnutrition
  • Gastrointestinal blood loss
  • Worms
  • Gastrointestinal malignancy
  • Celiac disease
  • High altitude
  • Trauma
  • Can be hereditary


4. Pitting of Nails

Pitting of Nails is characterized by depressions on the surface of the nails, mainly caused due to defect in the development of the layers of superficial nail plate. Trauma to the nail itself can lead to pitting but seen with some serious health problems as well.

Mainly seen in almost 50% of psoriatic patients and any condition causing superficial and localized inflammation of the skin or dermatitis

It is seen with other abnormalities of nails like nail separation, flaking or crumbling. Other causes are:

  • Connective tissue disorder
  • Alopecia areata
  • Sarcoidosis
  • Eczema
  • Reactive arthritis


5. Yellow Nails

Yellow Nails is characterized by marked thickening and yellow or yellow-green discoloration of nails, which grow very slowly and are usually detached from the nail bed.

Most of the patients with yellow nails have lymphedema due to underdevelopment of lymph vessels.

  • lung conditions including chest infections and bronchiectasis.
  • Fungal nail infections
  • Psoriasis
  • Frequent nail polish application
  • Sinusitis
  • Jaundice
  • Drugs including mepacrine or carotene

Some studies have shown vitamin E to be effective in controlling yellowing of nails.


6. Green-black Nails

Green-black Nails is caused by over-growth of bacteria pseudomonas generally grown under loose nails. Local application of antibiotics or soaking affected part in antiseptic solution has shown to be effective in treating green-black nails


7. Grey Nails

Grey Nails can be the result of certain medications like antimalarials or monicycline.


8. Brown Nails

Brown Nails is associated with thyroid disease, pregnancy, and frequent use of nail polish or malnutrition


9. Red or Yellow drop

Red or yellow drop under the nail has been seen in psoriasis of the nails.


10. Half White-Half Brown Nails

Half white (white near the base) and half brown nails has been seen in patients with kidney failure, in some patients with AIDS and can be seen after chemotherapy.

About 40% of patients with kidney failure have “half and half nails”. The exact mechanism of this discoloration of nails has not been understood but some says it is because of chemical changes in the blood as a result of kidney failure, encourages melanin to be released into nail bed.

Whereas some studies suggest increase in number of tiny blood vessels in nail bed in patients with kidney disease can result in half and half nails.


11. White Nails

Also called as terry’s nails are characterized by ground glass appearance with most of the nails appear white with a narrow band of pink color at the tip and no lacuna.

It is thought to be due to decrease in vascularity of the nail bed or a sign of fungal infection.

Wide range of diseases is associated with terry’s nails:

  • Cirrhosis of liver
  • Diabetes
  • Congestive heart failure
  • Chemotherapy
  • Iron deficiency anemia
  • Malnutrition
  • Hyperthyroidism


12. Brittle Nails

Excessive moisture or dryness is the most common contributing factors for brittle nails, according to American osteopathic college of dermatology. Other causes are:

  • Excessive washing
  • Genetic predisposition
  • Dryness
  • Aging
  • Chemical exposure in form of nail enamels, cleaning agents as these agents rob nails of moisture necessary to keep them supple
  • Nutrition deficiency as in iron and vitamin A deficiency


13. Thickened and Overgrown Nails

Most commonly it is associated with fungal nail infection, which makes them discolored and crumbly. Other causes include:

  • Psoriasis
  • Long term pressure from shoes
  • Reactive arthritis


14. Loose Nails

Loose nails or onycholysis is a condition when fingernails become loose and separated from nail bed. The loose part becomes opaque with white, green or yellow coloration. More commonly it is a result of injury to the nail or over-manicuring or cleaning under the nails with the sharp object

However, following health conditions may also pose risk to develop loose nails:

  • Psoriasis
  • Overactive thyroid disease
  • Sarcoidosis
  • Amyloidosis
  • Raynaud’s disease
  • Warts
  • connective tissue disorders

You should cut back a loose nail from where it is detached, allowing it to reattached with time.


15. Melanonychia

Melanonychia is characterized by brown or black discoloration of the nail, most commonly seen in dark skinned people, and is considered normal.

However, it’s not a sign to ignore if it is seen in a single finger or toe nail as it sometimes signifies subungual melanoma, a form of skin cancer.


16. Leukonychia or Milk Spots

Leukonychia or Milk Spots is a medical term for white discoloration of nails which is most commonly due to injury at the base of the nail matrix. , it is commonly held to be due to calcium deficiency and is generally considered harmless and disappears as the nail grows.


17. Muehrcke’s Nails

Muehrcke’s Nails are the white lines that are not grooved unlike beau’s lines, which run parallel to lacuna. As such these lines don’t move with the nails growth as they lie in the vascular nail bed.

These are most commonly associated with decreased protein synthesis during periods of metabolic stress (after chemotherapy) and in nephritic syndrome.


18. Onychorrhexis (Longitudinal Ridging)

Onychorrhexis (Longitudinal Ridging) can hereditary and can come with age. Not too much of a medical concern.


Having any of the above-mentioned signs is not a proof of any systemic illness. However, abnormalities in nails should prompt an evaluation for underlying causes.

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