By Dr Fuad Usman
Did you know your nails can reveal clues to your overall health? Many a time your nails can point to diseases such as hepatitis, melanoma, emphysema (lung disease), koilonychias (kidney disease), leukonychia (renal disease) and many more. Here’s how nails can be an important indicator in disease detection ...
Pale nail
Your nails might be indicating a sign of anaemia, if the nail beds look pale or white. Anaemia resulting from low levels of iron can lead to inadequate oxygen in the blood, which causes the skin and tissues to become pale, particularly the tissues under the nails. More seriously, pale nails could also be a sign of early diabetes or liver disease, both of which can lead to impaired blood flow. White nails could also be an indicator for liver diseases such as hepatitis. White nails with a rim of darker colour at the tip is called Terry’s nail and often a sign of a severe liver disease called cirrhosis. For liver disease, a trip to the doctor for testing is a must for accurate diagnosis.
Yellowing or thickening
Thickened nails, with or without a yellowish tone, are characteristic of fungal infections that generally traverse the entire nail bed. Your doctor can prescribe an oral medication, which will reach the entire breadth of the infected nail.
Diabetes can also lead to yellowing of both the skin and nails, usually more evident in nails. The colour change is probably caused by glucose connecting with the collagen proteins in the nail. In a country like Qatar where 16% of the population is diabetic, it is crucial to look out for any symptoms of diabetes. When your yellow nails are persistent and you experience other symptoms such as thirst and urination, it is a clear indication of diabetes. We often come across such medical cases and immediately carry out tests to check the blood sugar level of the patient.
Yellow nail syndrome is a rare medical condition that includes pleural effusions, lymphedema and yellow dystrophic nails. It is also associated with chronic sinusitis and persistent coughing.
Dark lines
You are likely to overlook your nails, a place where dangerous melanoma often goes unnoticed. Dark brown or black vertical lines on the nail bed should never be ignored. It could be a hallmark sign of melanoma, which requires early detection and treatment. Melanoma is usually, but not always, a cancer of the skin. Nearly 65% of melanoma cases can be linked to exposure to ultraviolet (UV) rays from natural or artificial sources.
Pitting and grooving
Depressions and small cracks in your nails are known as ‘pitting’ of the nail bed. It is often associated with psoriasis, an inflammatory disease that leads to scaly or red patches all over the body. Individuals who suffer from psoriasis develop clusters of cells along the nail bed that accumulate and disrupt the linear, smooth growth of a normal nail. As these cells are sloughed off, grooves or depressed areas are left behind on the surface. A physical exam is often all you need for a diagnosis, after which your doctor may recommend topical, oral, or injected medications or light therapy.
Brittle, thin or lifted nails
If the nail tips crack at the slightest touch, it could mean your thyroid is amiss. This gland in your neck regulates metabolism, energy, and growth, and low thyroid hormone often leads to hair loss, brittle and thin nails, and nails that grow slowly.
Thyroid disorder also manifests itself by causing your nail plate to separate from the nail bed in a noticeable way. Lifted nails are thought to occur because the increase in thyroid hormone can accelerate cell turnover and separate the nail from its natural linear growth pattern. The presence of onycholysis often occurs with hyperthyroidism. Also known as Plummer’s nail, this condition occurs when a fingernail — most often the ring finger or little finger — or a toenail separates itself from the nail bed.
Reports say that an estimated 5% of the patients in the Middle East have thyroid diseases. Symptoms such as brittle, thin, slow-growing or lifted nails may indicate thyroid disorder and should not be ignored. Lifted nails often lead to bacterial and yeast infections, through the accumulated dirt and moisture under the nail. It is important to consult a doctor as soon as you notice any irregularities on your nail.
White lines
Horizontal white lines that span the entire nail, are paired, and appear on more than one nail are called Muehrcke’s lines. These could be an indication of kidney disease, liver abnormalities, or a lack of protein and other nutrients. They are thought to be caused by a disruption in blood supply to the nail bed because of underlying disease. Shorter horizontal white marks or streaks, however, are the result of trauma to the base of your nail. These may last from weeks to months and usually will disappear on their own.
Blue nails
A blue face is a clear indication that someone’s lacking airflow, and blue nails indicates insufficient oxygen to your fingertips. This could be caused by respiratory disease or a vascular problem called Raynaud’s disease, which is a rare disorder of the blood vessels.
In reality, nail bed is of normal shade, but the tissue that lies beneath the nail is blue. This is commonly called nail bed cyanosis and is a sign of poorly oxygenated blood, especially when exposed to cold temperatures. Meet a physician to check your blood and oxygenation levels if your nails are persistently blue.
Blue nails (particularly when paired with blue lips) can mean that you have an oxygen-related health problem, such as:
l Low hemoglobin
l Asthma
l Chronic obstructive pulmonary disease (COPD)
l Emphysema
In addition to pulmonary problems, blue nails can also indicate certain heart conditions. If your nails have turned blue, regardless of condition, it’s usually a sign that your illness has become severe. Red or black nails may result from a hematoma (a collection of blood) under the nail as a result of trauma.
Most commonly seen cases are the nail becoming thickened and discoloured from an infection called onychomycosis, caused by trichophyton rubrum. It is an infection caused due to common fungi that can be found in air, dust or soil.
This type of fungus has a tendency to infect the skin and is therefore known as a dermatophyte. Avoid the chances for fungus infection by keeping your hands and skin dry.
Pseudomonas is a type of bacteria that infects the nail bed and result in a greenish colour to the nails.
Another very common nail infection in the Middle East is ingrown nail, a condition in which the nails grow cutting into both sides of paronychium (nail bed) most particularly the toe nail.
This condition has been found only in shoe-wearing cultures particularly safety shoes or tight fitting shoes. Signs of infection include redness and swelling of the area around the nail, drainage of pus, and watery discharge tinged with blood.
- Dr Fuad Usman is a dermatologist at Aster Medical Centre in Industrial Area
Brittle thin or lifted nails.
