Can you Nail the Diagnosis?
You can determine someone's overall health from a fingernail examination. Naturopathic doctors are some of the best trained physicians who perform thorough physical exam including the nails. See if you can guess which condition from malignancy to nutritional status is connected to each nail presentation.
Images courtesy of Wikimedia Commons.
Nail clubbing describes when the angle made by the proximal nail fold and the nail plate is greater than 180 degrees. Nail clubbing is associated with lung and heart diseases. I typically find this condition in long-term smokers, but it can signify cancer, infections, gastrointestinal diseases, liver gallbladder issues and or endocrine disorders.
The arrow is pointing to the lunula in this healthy nail. It's great when patients don't cover their nail with polish for two reasons; one so that I can check their nail health and two they reduce their chemical exposure to toluene and benzene which cause cancer and autoimmune diseases.
Did you notice that the lunula is missing from this nailbed? As a practitioner, I know that I need to order a complete blood count for this patient. A pyramidal lunula might be related to excessive manicures or trauma, a pale blue lunula might indicate diabetes and a red lunula can show cardiovascular disease, blood cancers or another serious condition.
Some might think these are just ugly nails, but this is Yellow nail syndrome. These nails lack a cuticle, grow slowly, are loose and may be pushed out by underlying fungal infection. Yellow nail syndrome is associated with lung disorders and lymphedema. It can also indicate diabetes, median/ulnar nerve damage and trauma.
I have several patients who come in with this nail shape. Hollowed out like a spoon this nail shows iron-deficiency anemia. Many of my undiagnosed celiac patients begin to get this condition called Koilonychia because they have microbleds in the gut. Koilonychia can be caused by iron deficiency, diabetes mellitus, protein deficiency (especially in sulfur-containing amino acids), lupus, exposure to petroleum-based solvents, trauma, and Raynaud's disease.
These nails are called Lindsay half-and-half nails. The proximal portion (closest to the hand) is white and the distal or furthest part is dark red, pink or brown. The white part is related to anemia and edema (swelling). This patient has renal or kidney disease. If there is a brown band caused by increased pigment at the junction of the redness and the free edge of the nail then the condition is more likely a kidney issue versus the absence of a brown band suggests liver disease.
We call these Beau lines. They are transverse depressions in the nail plate caused by temporary cessation of nail growth.
Chemotherapy, nail injury, cold temperatures, chronic illness and severe zinc deficiency can cause Beau lines. The location of the Beau line can indicate the approximate date of the illness associated with it and provide clues about the severity of the illness.
A longitudinal ridge on the nail plate is called onychorrhexis and can be a sign of advanced age. It is also associated with rheumatoid arthritis, peripheral vascular disease, lichen planus and Darier disease. If there is a central vertical ridge or groove from cysts near the nail fold that can be a sign of osteoarthritis.
Splinter hemorrhages are associated with subacute bacterial endocarditis - a serious condition. This patient needs a full workup and treatment.
I see white transverse lines AKA Mee's lines with environmental detox patients. They are classically associated with Arsenic poisoning and heavy metal toxicity, but can come with chemotherapy, carbon monoxide poisoning, Hodgkin's diease, malaria or leprosy. Again, the timing of the event or disease process can be determined from the location of the lines on the nail bed.
I hope you found this blog educational and fun. You'll be looking at everyone's nails and trying to use your skills to nail the diagnosis. If you find something interesting call us. Early diagnosis and treatment means better prognosis.
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