Nails in Relation to Health and Disease

Nails in Relation to Health and Disease

 

Nails are located at the tips of each finger on the dorsal side. Their primary role is to provide protection, while also aiding in the ability to grip objects securely. Each nail is composed of a robust yet flexible keratin-based plate that develops from the nail matrix. Beneath this plate lies a soft tissue known as the nail bed. The area between the skin and the nail plate is referred to as the nail fold or cuticle. A healthy nail typically exhibits a slight pink hue and has a convex shape from side to side. Fingernails grow approximately 1 cm every three months, whereas toenails require about 24 months to achieve the same growth.

 

Significance of nails in the diagnosis of diseases:

The color, appearance, shape, and condition of nails can provide valuable insights into an individual's overall health and hygiene. Physicians routinely examine nails to gather information about potential underlying health issues. Observing nails can reveal a person's level of hygiene. Abnormalities in nails may arise from congenital factors or various medical conditions. The reasons for changes in nails can range from minor issues to serious health concerns. Therefore, a thorough examination by a healthcare professional is crucial for accurate diagnosis. This discussion highlights some abnormal findings along with their possible causes for general awareness.

 

1) Hygiene:-

 

It is quite easy to identify an unclean nail. The accumulation of dirt beneath the tip of the nail plate increases the risk of pathogen ingestion during meals. Improper nail trimming can lead to parasitic infections in children. When worms enter the anal area, children may scratch, transferring worm eggs under their nails, which can then be ingested while eating. Additionally, prominent nails can exacerbate skin conditions due to frequent scratching. In young children, sharp nails can cause minor injuries during activities such as kicking or waving their hands.

2) Colour of the nails:-

1. In cases of anemia, nails may appear pale.

 

2. Chronic renal failure and nephrotic syndrome can lead to opaque white discoloration known as leuconychia.

 

3. Whitening of the nails can also occur in hypoalbuminemia, particularly in conditions such as cirrhosis and kidney diseases.

 

4. Certain medications, including those from the sulfa group, antimalarials, and antibiotics, can result in nail discoloration.

 

5. Fungal infections can lead to a black discoloration of the nails.

 

6. Nails may turn black or green in the presence of a Pseudomonas infection.

 

7. Nail bed infarction can occur in vasculitis, particularly in systemic lupus erythematosus (SLE) and polyarteritis.

 

8) Red spots on the nails may indicate splinter hemorrhages associated with subacute bacterial endocarditis, rheumatoid arthritis, trauma, or collagen vascular disorders.

 

9. A blunt force injury can lead to bleeding, resulting in a blue or black discoloration of the nail.

 

10. Brown discoloration of the nails can occur in cases of kidney disease and reduced adrenal function.

 

11. In Wilson's disease, a blue hue may be observed in the semicircular area of the nail.

 

12. A decrease in blood supply can cause the nails to turn yellow. Additionally, yellowing of the nails can be seen in conditions such as jaundice and psoriasis.

 

13. Yellow nail syndrome is characterized by a yellowish appearance of all nails, often accompanied by pleural effusion.

 

3) Shape of nails:-

a) Clubbing: This condition is characterized by thickening of the tissues at the base of the nails, resulting in the loss of the angle between the nail base and the surrounding skin. The nails become increasingly convex, and the fingertips take on a bulbous appearance, resembling the end of a drumstick. As the condition progresses, the nails may take on a shape similar to that of a parrot's beak.

Causes of clubbing:-

Congenital Injuries

 

Significant persistent cyanosis

 

Respiratory conditions such as empyema, bronchiectasis, bronchial carcinoma, and pulmonary tuberculosis.

Gastrointestinal disorders including Crohn's disease, colon polyposis, ulcerative colitis, and liver cirrhosis, among others

 

Cardiovascular issues like Tetralogy of Fallot, subacute bacterial endocarditis, etc.

 

b) Koilonychia:-

 

Nails may develop a concave shape resembling that of a spoon, a condition often associated with iron deficiency anemia. In this scenario, the nails tend to become thin, soft, and brittle, with the typical convex shape being replaced by a concave form.

 

c) Longitudinal ridges are observed in individuals with Raynaud's disease.

 

d) The cuticle appears frayed in cases of dermatomyositis.

 

e) Nail fold telangiectasia is indicative of dermatomyositis, systemic sclerosis, and systemic lupus erythematosus (SLE).

 

4) Structure and consistency:-

a) A fungal infection of the nail leads to discoloration, deformity, thickening, and increased brittleness.

 

b) Thimble pitting of the nail is a distinctive feature of psoriasis, acute eczema, and alopecia areata.

 

c) Inflammation of the cuticle or nail fold is referred to as paronychia.

 

d) Onycholysis refers to the detachment of the nail bed, which can occur in conditions such as psoriasis, infections, and as a side effect of tetracycline use.

 

e) Nail destruction is observed in conditions such as lichen planus and epidermolysis bullosa.

 

f) Nail absence is characteristic of nail patella syndrome, which is a genetic disorder.

 

g) In Raynaud's disease and gangrene, nails tend to become brittle.

 

h) Nail loss can occur due to fungal infections, psoriasis, and thyroid disorders.

5) Growth:-

A decrease in blood circulation impacts nail growth. Additionally, severe illnesses can hinder this growth. Once the illness resolves, nail growth resumes, leading to the development of transverse ridges. These ridges, known as Beau's lines, are useful for determining the onset of the illness.

 

  FAQs

- What's the connection between nail health and overall wellness?

- Can nail changes predict chronic diseases?

- What nail changes occur in psoriasis patients

- Can nail fungus indicate underlying health issues?

- How do thyroid disorders impact nail health?

- Can nail biting/picking signify health issues?

- What role do nails play in diagnosing systemic diseases?

- How do nutritional deficiencies affect nail growth?

- Can healthy nails prevent disease?