9 Important Nail Symptoms You Need to Know

Nail health can be linked to overall health

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Nails. We often don’t think about them unless it’s when we develop a hangnail or decide they need a color change in the form of a manicure. However, our nails can provide clues for systemic diseases and keep an eye out for any changes can be beneficial to our health.[1] Some nail disorders can be quite easily fixed but others are worth discussing with your healthcare provider to check for a more serious illness.

Some nail signs worthy of a second glance and maybe even a trip to your health care provider include:

 

1) Brittle Nails: Peeling and Crumbling

Brittle nails are weak nails that often split, peel, flake, or crumble.[2] While this can occur in older patients, brittle nails are more common in women than in men.[3,4] These weak nails can be due to vitamin deficiency and the brittle nails usually improve with supplemental biotin and oral bioactive collagen peptide.[5] Topical retinoids have also helped improve the nail surface area; your care provider can help determine which treatment plan is best for your nails.[6]

 

2) Pitting: Dents in the Nails

Pitting refers to small dents or pits that occur in the nail bed. These small notches in the nail bed commonly occur in patients with psoriasis.[7] However, they can occur in other skin conditions and very often can occur without a clear reason or a disease. While oral and injectable medications can help improve symptoms of pitting nails associated with psoriasis, steroids, and vitamin D analogs can be helpful as well.[8]

 

3) Onycholysis: Premature Nail Lifting

Onycholysis is where the nail plate separates from the nail bed. Often referred to as “plummer’s nail,” onycholysis can be related to nail damage caused by systemic conditions including chronic inflammatory diseases and thyroid disease. As onycholysis can have multiple causes, treating the underlying disease can help best improve the loss of nails. In patients with onycholysis due to psoriasis, treatment with a topical vitamin D derivative and steroid combination helped improved the nail appearance and growth.[9]

 

4) Dark Streaks on the Nail: Watch Out for Melanoma

Color variations, such as a dark streak on the nail,[10] can prompt a trip to the doctor. Dark green pigmentation on the nails can be due to a bacterial infection such as Pseudomonas aeruginosa or Proteus.[11] Bleeding underneath the nails can appear as dark spots due to a single instance of injury or multiple, repeated instances of smaller injuries, such as on the toenails.[11] However, sometimes a darker pigment streak, known as melanonychia, can be a sign of a type of skin cancer called melanoma. Therefore, dark streaks on the nails should warrant a visit to your dermatologist in order to distinguish benign cases from cancer.[12]

 

5) Beau’s Lines: A Sign of Stress

Beau’s lines are parallel lines that run from the two sides of the nail in alternating ridges and grooves.[1] They are often from trauma, high fevers, chemotherapy, and Raynaud’s disease, but can occur with any systemic condition.[1,13,14] Usually, the depth and width of Beau’s lines can indicate the severity and duration of an illness.[15] The appearance of lines can help determine when a disease process may have started as nails grow approximately 1 mm every 6-10 days.[15,16] If you have these grooves in your nails, it’s important to speak with your healthcare provider to exclude systemic diseases.[17]

 

6) Koilonychia: A Sign of Inflammation or Nutritional Deficiency  

Also known as “spooning” of nails – is where the nails curve upward like a spoon. The nails are physically curved with raised ridges. These curved nails can be a sign of inflammation in the body such as lichen planus or psoriasis, but also can be related to nutritional deficiencies such as anemia from low iron levels.[18-20]

 

7) Terry’s Lines: A Change in Nail Blood Flow

The nails appear white except for a narrow band of pink near the tip of the nails. Terry’s nails can be related to aging as well as other underlying disease processes. Terry’s nails are attributed to changes in the blood flow in the fingers as well as overgrowths of connective tissue, liver scarring, chronic kidney failure, and inadequate heart function.[14]

 

8) Yellow Nails

Yellow nails occur when the nails grow more slowly than normal, becoming thick and pulling away from the nail bed. While the exact cause is not well understood, yellow nails can be linked to respiratory problems and swelling of legs and arms.[21] Most patients who experience yellow nail syndrome are middle-aged, but the condition can occur in children as well. [22] Exposure to titanium is thought to play a role in developing yellow nail disease. In one case, a child who had swallowed titanium toothpaste later developed yellow nail syndrome.[23,24]

 

9) Clubbing

Clubbing is where the nail thickens and curves around the fingertips, a process that takes years to acquire. Sometimes these nails and the finger changes can be referred to as “drumstick fingers” because of their appearance. This nail disease is often a sign of an underlying disordered process such as the formation of excessive blood vessels.[25] While more common in women than men, clubbing can occur as a result of systemic diseases that affect the oxygen flow to distal body areas such as cystic fibrosis, heart diseases, lung cancers, and autoimmune diseases.[26] In clubbing, the treatment for these nails usually involves treating the underlying disease.[25]

* This Website is for general skin beauty, wellness, and health information only. This Website is not to be used as a substitute for medical advice, diagnosis or treatment of any health condition or problem. The information provided on this Website should never be used to disregard, delay, or refuse treatment or advice from a physician or a qualified health provider.

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References

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  2. Iorizzo M, Pazzaglia M, M Piraccini B, et al. Brittle nails. Journal of cosmetic dermatology.2004;3(3):138-144; PMID: Link to research.
  3. Dimitris R, Ralph D. Management of simple brittle nails. Dermatologic therapy.2012;25(6):569-573; PMID: Link to research.
  4. Lubach D, Cohrs W, Wurzinger R. Incidence of Brittle Nails. Dermatology.1986;172(3):144-147; PMID: Link to research.
  5. Hexsel D, Zague V, Schunck M, et al. Oral supplementation with specific bioactive collagen peptides improves nail growth and reduces symptoms of brittle nails. J Cosmet Dermatol.2017;10.1111/jocd.12393PMID: 28786550 Link to research.
  6. Sherber NS, Hoch AM, Coppola CA, et al. Efficacy and safety study of tazarotene cream 0.1% for the treatment of brittle nail syndrome. Cutis.2011;87(2):96-103; PMID: 21416778 Link to research.
  7. Sobolewski P, Walecka I, Dopytalska K. Nail involvement in psoriatic arthritis. Reumatologia.2017;55(3):131-135; PMID: 28769136 Link to research.
  8. Psoriasis | DynaMed Plus. 2017; Link to research.
  9. Rigopoulos D, Gregoriou S, Daniel Iii CR, et al. Treatment of nail psoriasis with a two-compound formulation of calcipotriol plus betamethasone dipropionate ointment. Dermatology.2009;218(4):338-341; PMID: 19212110 Link to research.
  10. Lipner SR, Scher RK. Evaluation of nail lines: Color and shape hold clues. Cleve Clin J Med.2016;83(5):385-391; PMID: 27168515 Link to research.
  11. Haneke E, Baran R. Longitudinal melanonychia. Dermatologic Surgery.2001;27(6):580-584; PMID:
  12. Baran R, Kechijian P. Longitudinal melanonychia (melanonychia striata): diagnosis and management. Journal of the American Academy of Dermatology.1989;21(6):1165-1175; PMID:
  13. Lin X, Wu S. Beau’s lines. QJM: An International Journal of Medicine.2017;10.1093/qjmed/hcx122:hcx122-hcx122; PMID: Link to research.
  14. Patel LM, Lambert PJ, Gagna CE, et al. Cutaneous signs of systemic disease. Clin Dermatol.2011;29(5):511-522; PMID: 21855727 Link to research.
  15. Huang T-C, Chao T-Y. Mees lines and Beau lines after chemotherapy. Canadian Medical Association Journal.2010;182(3):E149-E149; PMID:
  16. Baran R, de Berker DA, Holzberg M, et al. Baran and Dawber's diseases of the nails and their management. John Wiley & Sons; 2012.
  17. DynaMed Plus - Beau Line. 2017; Link to research.
  18. Walker J, Baran R, Velez N, et al. Koilonychia: an update on pathophysiology, differential diagnosis and clinical relevance. J Eur Acad Dermatol Venereol.2016;30(11):1985-1991; PMID: 27531645 Link to research.
  19. Kumar V, Aggarwal S, Sharma A, et al. Nailing the diagnosis: koilonychia. Perm J.2012;16(3):65; PMID: 23012603 Link to research.
  20. Iron deficiency anemia in adults | DynaMed Plus. 2017; Link to research. Accessed October 20, 2017.
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  22. Nordkild P, Kromann-Andersen H, Struve-Christensen E. Yellow nail syndrome--the triad of yellow nails, lymphedema and pleural effusions. A review of the literature and a case report. Acta Med Scand.1986;219(2):221-227; PMID: 3962735 Link to research.
  23. Decker A, Daly D, Scher RK. Role of Titanium in the Development of Yellow Nail Syndrome. Skin Appendage Disord.2015;1(1):28-30; PMID: 27172293 Link to research.
  24. Hsu TY, Lin CC, Lee MD, et al. Titanium Dioxide in Toothpaste Causing Yellow Nail Syndrome. Pediatrics.2017;139(1)PMID: 27940507 Link to research.
  25. Spicknall KE, Zirwas MJ, English JC, 3rd. Clubbing: an update on diagnosis, differential diagnosis, pathophysiology, and clinical relevance. J Am Acad Dermatol.2005;52(6):1020-1028; PMID: 15928621 Link to research.
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