What Your Nails Say About Your Health

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Nails Can Reveal Your Health

"By a man's fingernails...a man's calling is plainly revealed." So says Sir Arthur Conan Doyle in a Study in Scarlet, speaking as the famous detective Sherlock Holmes. Besides occupation, the nails may reveal one's habits, anxiety level, and certain health problems.

Example of pale fingernails.

Pale Nails

White nails with a rim of darker color at the tip of the nail is called Terry's nail and rarely a sign of a severe liver disease called cirrhosis. Most people with this nail change are otherwise in good health.

Example of white nails (leukonychia).

White Nails

Although totally white nails present since birth may be an inherited condition with no implications as to general health, if it occurs later in life, it may be a sign of several systemic diseases, including cirrhosis, chronic renal failure, congestive heart failure, diabetes mellitus, chronic hypoalbuminemia, and Hodgkin's lymphoma.

Example of yellow nails.

Yellow Nails

The so-called "yellow nail syndrome" occurs in patients with serious pulmonary disease and lymphedema (swelling of the extremities). In these patients, most if not all of the nails are yellowish.

Example of blue-tinted nails.

Bluish Nails

In this condition, the nails are really normal in color but the nail bed, the tissue that lies beneath the nail plate, is blue. This is commonly called nail bed cyanosis and is a sign of poorly oxygenated blood or more accurately unoxygenated hemoglobin, the oxygen carrying protein in red blood cells.

Example of rippled nails.

Rippled Nails

Nail pitting is a classical sign of psoriasis in the nail. This appears as tiny holes in the nail surface. Rippling of the nail surface is seen in patients with dermatitis of the fingertips. This can be a result of atopic dermatitis, irritant dermatitis, or allergic contact dermatitis.

Example of split or cracked fingernails.

Split or Cracked Nails

Brittle nails, onychoschizia and onychorrhexis, are often a condition of the elderly.

Example of inflammation causing a puffy nail fold.

Puffy Nail Fold

The skin around the edge of the nail can be damaged by many things. It is unusual in that aside from the retina the capillary morphology can be evaluated using magnification. Damaged capillaries caused by certain autoimmune collagen vascular disease can give the skin and cuticle a "moth-eaten" appearance.

Example of dark lines under a fingernail.

Dark Lines Beneath the Nail

There are a number of reasons for the appearance of a linear brown or black streak extending from the cuticle to the tip of the nail. Since it is not possible to visualize the source of the color since it resides in the nail matrix below the nail fold, it is frequently a cause for anxiety in the patients and their doctors. A biopsy may be required in order to be sure it is not a form of skin cancer.

Example of gnawed fingernails.

Gnawed Nails

As with any unpleasant habit, the cooperation of the patient is necessary to modify the behavior. It would be unusual that this sort of addiction would signal the appearance of some deep underlying psychopathology.

Person displaying their healthy, clean finger and toenails.

Nails Are Only Part of the Puzzle

Changes in the nails occasionally may signal a significant systemic disease. Most of the time, nail signs are self-limited and tend to resolve on their own. Patience is a necessity in dealing with nails because their turnover is slow. It may take many months for a damaged nail to replace itself entirely.

Sources:

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  8. “Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology”; Klaus Wolff, Richard Allen Johnson, Dick Suurmond; Copyright 2005, 2001, 1997, 1993 by The McGraw-Hill Companies. All Rights reserved.
  9. “Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology”; Klaus Wolff, Richard Allen Johnson, Dick Suurmond; Copyright 2005, 2001, 1997, 1993 by The McGraw-Hill Companies. All Rights reserved.
  10. Copyright Interactive Medical Media LLC
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REFERENCES:

  • American Journal of Orthodontics and Dentofacial Orthopedics: "Nailbiting, or Onychophagia: A special habit."
  • Clinics in Dermatology: "The nail in the elderly."
  • Current Opinion in Pulmonary Medicine: "Yellow nail syndrome."
  • Dermatologic Therapy: "Management of simple brittle nails."
  • Journal of the European Academy of Dermatology and Venereology: "Growth rate of human fingernails and toenails in healthy American young adults."
  • Journal of Family Practice: "Nail disorders and systemic disease: What the nails tell us"
  • Principles of Medical Physiology
  • Rook's Textbook of Dermatology 6th Edition
  • Seminars in Cutaneous Medicine and Surgery: "Pigmented lesions of the nail unit: Clinical and histopathologic features."
  • The Journal of Dermatology: "Dermoscopy findings of nail fold capillaries in connective tissue diseases."
  • The New England Journal of Medicine: "Acquired Leukonychia Totalis."
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