Have you ever noticed that when you go to your doctors visit. They always ask you to put your hands out and they look at your nails? Well the reason why they do this is because nail conditions can be a huge indicator of health problems.
Especially, for those of us who live with an Auto-Immune Disease. I am going to go through as many different conditions as I can possibly find and then explain what these things can mean.
First of all, what do normal nails look like? Healthy nails should have a pink color to the nail bed and then nail itself should be clear.
Before trying to look at your nails you should take all nail polishes off even clear-coats as this change how your nails reflect light. This will change appearance of your nails making a proper look impossible.
There are several conditions that can affect the nail, but are completely benign.
Leukonychia are white spots or small white lines that arise from damage to the nail.
Example: Have you ever pinched your finger nail in a door jam? A lot of times the nail turns white in the area damaged.
Vertical Ridges These are very common and occur more frequently as we age. However, just because you are young and have vertical ridging doesnt mean you need to run to the doctor.
Example: Vertical ridging comes from the aging process. As our cuticles lose their lubricating oil the nails start growing in with these vertical ridges. Vertical ridging is often a sign of arthritis so they should not be completely ignored however if you do have arthritis you would most likely know this already.
There are many conditions that can be caused by injury and fungal infection. If you happen to find any of these conditions and cant seem to figure out why you have them it never hurts to get a medical opinion.
FYI Dermatologists are often the specialist that knows the most about nail conditions, however you primary care physical will know if it is necessary or not have a specialist look at you case.
Now lets delve into nail conditions that do mean something!
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Nail finding
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Associated systemic conditions
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Shape or growth change
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Clubbing
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Inflammatory bowel disease, pulmonary malignancy, asbestosis, chronic bronchitis, COPD, cirrhosis, congenital heart disease, endocarditis, atrioventricular malformations, fistulas
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Koilonychia
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Iron deficiency anemia, hemochromatosis, Raynauds disease, SLE, trauma, nail-patella syndrome
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Onycholysis
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Psoriasis, infection, hyperthyroidism, sarcoidosis, trauma, amyloidosis, connective tissue disorders
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Pitting
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Psoriasis, Reiters syndrome, incontinentia pigmenti, alopecia areata
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Beaus lines
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Any severe systemic illness that disrupts nail growth, Raynauds disease, pemphigus, trauma
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Yellow nail
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Lymphedema, pleural effusion, immunodeficiency, bronchiectasis, sinusitis, rheumatoid arthritis, nephrotic syndrome, thyroiditis, tuberculosis, Raynauds disease
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Color change
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Terrys (white) nails
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Hepatic failure, cirrhosis, diabetes mellitus, CHF, hyperthyroidism, malnutrition
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Azure lunula
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Hepatolenticular degeneration (Wilsons disease), silver poisoning, quinacrine therapy
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Half-and-half nails
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Specific for renal failure
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Muehrckes lines
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Specific for hypoalbuminemia
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Mees lines
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Arsenic poisoning, Hodgkins disease, CHF, leprosy, malaria, chemotherapy, carbon monoxide poisoning, other systemic insults
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Dark longitudinal streaks
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Melanoma, benign nevus, chemical staining, normal variant in darkly pigmented people
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Longitudinal striations
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Alopecia areata, vitiligo, atopic dermatitis, psoriasis
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Splinter hemorrhage
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Subacute bacterial endocarditis, SLE, rheumatoid arthritis, antiphospholipid syndrome, peptic ulcer disease, malignancies, oral contraceptive use, pregnancy, psoriasis, trauma
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Telangiectasia
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Rheumatoid arthritis, SLE, dermatomyositis, scleroderma
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Clubbing This condition presents from the thickening of the soft tissue below the nail plate. The nails become convex in appearance.
Koilonychia is the exact opposite of clubbing. Koilonychia is when your nails become concave. It is represented by transverse and longitudinal concavity of the nail, resulting in a spoon-shaped nail.
FYI - This abnormality is sometimes a normal nail variant in infants, but it usually corrects itself within the first few years of life.
Example: Patients with Raynauds disease or Lupus Erythematous (SLE) can have spooning, but it usually is not an isolated finding. When spooning is present without an obvious associated illness, physicians should obtain a complete blood count and ferritin level to help rule out iron deficiency and hemochromatosis.
The water drop test is one way to determine if the nail is in the beginning stages of spooning. You can put a drop of water on your nail plate, and if it doesnt roll off then this shows your nail bed is flattening out.
Once again if you have any spooning of your nail seek medical attention immediately!
More to come later!
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