Nails - Health and Disease

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Changes in the nails could be sign of a disease. Nail changes are rarely the first clue of serious illness. Subtle variations in the texture, colour provide important clues.

"Just like the eyes are the window to the soul, so are the nails," says Tamara Lior, MD, a dermatologist with Cleveland Clinic Florida.. A number of health problems have an impact on the nails. Subtle variations in the texture or colour or shape can provide important clues to the trained eyes.

Changes in the nails could be a sign of a local disease (like a fungus infection) or a systemic one like anaemia. Patients rarely visit a doctor to report nail problems. Hence most nail changes are noticed during examination of a patient.

What follows is a list of nail changes that could indicate a health problem:

1. Yellow discoloration in fingernails

• Yellow nails occur in a condition called Yellow Nail Syndrome. In this condition, along with yellow nails, the patient also has pleural effusion (collection of fluid within the covering of the lungs) and lymphedema. The pleural effusion may be associated with lung diseases such as chronic bronchitis
• Nails thicken and new growth slows, resulting in discoloration; they may detach from the nail bed in places
• A person may have yellow nails and yet have no serious illness. Yellow nails may also be associated with fungal infection or overuse of nail polish.

2. White nails (leukonychia)

• Conditions like chronic liver disease, nephrotic syndrome, protein malnutrition (kwashiorkor) which cause loss of albumin result in white nails

3. Pitting of nails

• Small depressions in the nails commonly occur in psoriasis; it may also be due to nail injuries
• Conditions where the nail cuticle gets damaged also cause pitting. These conditions include chronic dermatitis of fingers, alopecia areata (an autoimmune disease)

4. Clubbing of nails

• Here tips of the fingers enlarge and nails curve around fingertips.
• Clubbing can be due to a large number of causes affecting various systems of the body, especially respiratory conditions
• Clubbing can also be occupational
• Inflammatory bowel disease, cardiovascular disease and liver disease are other common causes

5. Half-white, half-pink nails may point to a kidney disease

6. Irregular red lines at the base of the nail fold (Nail fold erythema and telangiectasia) signify conditions like systemic lupus erythematosus, other connective tissue diseases and vasculitis

7. Pale or white nail beds are usually due to anaemia

8. Spoon nails (koilonychia)

• Nails look scooped out
• Koilonychia is sign of chronic iron deficiency anemia. Nails become brittle, flat and eventually spoon-shaped

9. Terry's nails

• Nails are opaque with a dark band at the tip
• Terry's nails could be due to aging
• Serious conditions associated with Terry's nails are: Congestive heart failure, diabetes, liver disease, malnutrition

10. Beau's lines

• These are transverse white grooves which appear at the same time on all nails shortly after a severe illness and which move out to the free margins as the nails grow
• They arise due to temporary arrest of nail growth

11. Onycholysis

• Fingernails become loose and separate from the nail bed.
• This could be due to injury or infection, psoriasis, thyroid disease, drug reactions, reactions to nail hardeners or acrylic nails

12. Splinter haemorrhages

• These are small vertical reddish to reddish brown lines seen under the nails.
• Multiple splinter haemorrhages should raise the suspicion of infective endocarditis.
• These are however common in healthy manual workers due to rough use of their hands

13. Fungal infection (onychomycosis)

• This usually causes thickening of nails
• Whitening or yellowing of the nail plate can also occur

Thus it is obvious that there is a connection between nails and disease. "Nail changes are rarely the first clue of serious illness" cautions American College of Physicians spokeswoman Christine Laine, MD, MPH. Nail changes may arise only after serious advancement of a disease. Another vital point to be noted is that, a person may not develop a nail change in spite of having a disease. Conversely, having a change in nail need not signify a serious underlying condition. For example one or two splinter haemorrhages are common in the nails of manual labourers.

When to See a Dermatologist?

If the nail symptoms persist, or get worse (for example, if the nails start to dislodge from the base or you experience pain and swelling) it is best to see a dermatologist (skin specialist). Fungal infections often prove difficult to treat and call for professional help. Long-standing warts around the nails may be due to skin cancers. Conditions like melanoma may produce a dark discoloration involving the cuticle.

References:

1. Macleod's Clinical Examination 12^th Edition
2. Gibson LE (expert opinion). Mayo Clinic, Rochester, Minn. June 11, 2009
3. Gregoriou S, et al. Nail disorders and systemic disease: What the nails tell us. Journal of Family Practice. 2008; 57:509.
4. Tosti A, et al. The nail in systemic diseases. Dermatologic Clinics. 2006; 24:341.