The nails are present at the end of each fingertip on the dorsal surface. The main function of nail is protection and it also helps for a firm grip for holding articles. It consists of a strong relatively flexible keratinous nail plate originating from the nail matrix. Under the nail plate, there is a soft tissue called nail bed. Between the skin and nail plate, there is a nail fold or cuticle. Normal healthy nail is slight pink in color and the surface is convex from side to side. Finger nails grow 1 cm in three months and toe nails take 24 months for the same.
Importance of nails in disease diagnosis:
The color, appearance, shape and nature of the nails give some information about the general health and hygiene of a person. Nails are examined as a routine by all doctors to get some clues about underlying diseases. Just looking at nails we can make out the hygiene of a person. The abnormal nail may be congenital or due to some diseases. The cause for changes in the nail extend from simple reasons to life threatening diseases. Hence the examination by a doctor is essential for diagnosis. Some abnormal findings with probable causes are discussed here for general awareness.
We can make out an unhygienic nail very easily. Deposition of dirt under the distal end of nail plate can increase the risk of ingestion of pathogens or parasites while eating. If nail cutting is not done properly,it can result in worm troubles in children. When worms crawl in the anal orifice children will scratch which lodges the ova of worms under the nails and will be taken in while eating. Prominent nail can also complicate a skin disease by habitual scratching. Sharp nails in small kids cause small wounds when they do feet kicking or hand waving.
Color of the nails:
- a) Nails become pale in anemia.
- b) Opaque white discoloration (leuconychia) is seen in chronic renal failure and nephrotic syndrome.
- c) Whitening is also seen in hypo-albuminemia as in cirrhosis and kidney disorders.
- d) Drugs like sulpha group, anti-malarial and antibiotics etc.,can produce discoloration in the nails.
- e) Fungal infection causes black discoloration.
- f) In a pseudomonas infection, nails become black or green.
- g) Nail bed infarction occurs in vasculitis especially in SLE and polyarteritis.
- h) Red dots are seen in nails due to splinter hemorrhages in sub-acute bacterial endocarditis, rheumatoid arthritis, trauma, and collagen vascular diseases.
- i) Blunt injury produces hemorrhage and causes a blue/black discoloration.
- j) Nails become brown in kidney diseases and in decreased adrenal activity.
- k) In Wilson’s disease, blue color in a semicircle appears in the nail.
- l) When the blood supply decreases nail become yellow. In jaundice and psoriasis, the nail also becomes yellowish.
- m) In yellow nail syndrome, all nails become yellowish with pleural effusion.
Shape of Nails:
A) Clubbing: Here tissues at the base of nails are thickened and the angle between the nail base and the skin is obliterated. The nail becomes more convex and the fingertip becomes bulbous and looks like an end of a drumstick. When the condition becomes worse the nail looks like a parrot beak. Causes of clubbing:
- a) Congenital Injuries
- b) Severe chronic cyanosis
- c) Lung diseases like empyema, bronchiactesis, carcinoma of the bronchus and pulmonary tuberculosis.
- d) Abdominal diseases like Crohn’s disease, polyposis of the colon, ulcerative colitis, liver cirrhosis etc.
- e) Heart diseases like Fallot’s tetralogy, sub-acute bacterial endocarditis etc.
B) Koilonychia: Here the nails become concave like a spoon. This condition is seen in iron deficiency anemia. In this condition the nails become thin, soft and brittle. The normal convexity will be replaced by concavity.
- a) Longitudinal ridging is seen in Raynaud’s disease.
- b) Cuticle becomes ragged in dermatomyositis.
- c) Nail fold telangiectasia is a sign in dermatomyositis, systemic sclerosis and SLE.
Structure and Consistency:
- a) Fungal infections of the nail causes discoloration, deformity, hypertrophy and abnormal brittleness.
- b) Thimble pitting of the nail is characteristic of psoriasis, acute eczema and alopecia aereata.
- c) Inflammation of the cuticle or nail fold is called paronychia.
- d) Onycholysis is the separation of the nail bed seen in psoriasis, infection and after taking tetracyclines.
- e) Destruction of the nail is seen in lichen planus, epidermolysis bullosa.
- f) A missing nail is seen in nail patella syndrome, which is a hereditary disease.
- g) Nails become brittle in Raynaud’s disease and gangrene.
- h) Falling of nail is seen in fungal infection, psoriasis and thyroid diseases.
Reduction in blood supply affects the growth of nails. Nail growth is also affected in severe illness. when the disease disappears, the growth starts again resulting in formation of transverse ridges. These lines are called Beau’s lines and are helpful to date the onset of illness.