Introduction:
At the extremity of each finger point, nails are present on the dorsal side. The chief role of nails is to shield and it in addition assists in a good grasp for gripping things. It comprises a hardwearing fairly supple keratinous nail plate that begins from the nail matrix. The nail bed is a tender tissue beneath the nail plate. The nail fold or the cuticle divides the skin and the nail plate. Natural healthy nails are pale pink in hue and they have a convex surface from one side to the other. While in three months fingernails grow 1 cm, toenails take 2 years to reach the same length.
Significance Of Nails In Diagnosing Disease:
The hue, look, shape and quality of nails provide some information regarding the overall well being and cleanliness of an individual. All physicians to gain some indications regarding the possible cause of diseases routinely inspect nails. By simply glancing at nails it is possible to discern an individual’s sense of hygiene. An irregular nail may be present from birth or on account of some disorders. The causative factors for nail changes may range from straightforward explanations to serious ailments. Therefore, it is imperative for a doctor to examine them to identify the cause of the disease. Some atypical results with likely causes are addressed here for broad awareness.
1. Hygiene:
It is very simple to recognize an unhealthy nail. Dirt deposition beneath the nail plate’s distal end can lead to a possibility of pathogen intake while eating. In case nails are not properly trimmed, it could lead to worm problems in kids. When worms creep in the anal opening, kids will scratch, and this causes the worms’ ova to lodge beneath the nails, which will be ingested while eating. Conspicuous nails could also make skin disease problems worse by regular itching. Sharp nails in little children cause small injuries when they kick their feet or wave their hands.
2. Nail Color:
a. When anemic, nails turn pale.
b. In Nephrotic syndrome and unrelieved kidney failure, dense white discoloration (leuconychia) is observed.
c. In hypoalbuminaemia like in cirrhosis and renal disorders, whitening is also observed.
d. Drugs such as anti malarial, sulpha group, antibiotics, and so on can lead to nail discoloration.
e. A black discoloration of the nails is brought about by fungal infection.
f. Nails turn green or black in pseudomonas infection.
g. In vasculitis, particularly in SLE & polyarteritis, infarction of the nail bed happens.
h. Red spots are observed in nails because of splinter hemorrhages in rheumatoid arthritis, sub acute bacterial endo carditis, collagen vascular diseases, trauma, etc.
i. A blunt wound causes hemorrhage, leading to black/blue discoloration of nails.
j. Nails turn brown in renal diseases and in reduced adrenal functioning.
k. In Wilson’s disease, the nail takes on a bluish semicircular tinge.
l. Due to reduction in blood flow, nails turn yellow. Nails also turn yellowish in psoriasis and jaundice.
m. All the nails turn yellow in color with pleural effusion in case of yellow nail syndrome.
3. Nail Shape:
a. Clubbing: In this case, tissues at the bottom of the nails become thick and the incline between the skin and the nail base is destroyed. The nail turns more convex, with the tip of the finger becoming swollen and appearing similar to a drumstick tip. When the condition worsens, the nail appears like the beak of a parrot.
Causes of Clubbing:
Acute chronic cyanosis
Congenital Wounds
Lung diseases such as bronchiactesis, empyema, pulmonary tuberculosis, and carcinoma of bronchus
Abdominal diseases such as polyposis of colon, crohn’s disease, liver cirrhosis, ulcerative colitis and so on
Heart diseases such as sub acute bacterial endocarditis, fallot’s tetralogy, etc.
b. Koilonychia:
In this case the nails turn concave, almost spoon-like. This condition is observed in anemia caused by iron deficiency. The nails, in this condition, turn fragile, soft and emaciated. The usual convex nails become concave.
c. In raynaud’s disease, lengthwise ridging is observed.
d. In dermatomyositis, cuticles become frayed.
e. An indication of systemic sclerosis, SLE, and dermatomyositis is Nail fold telangiectasia.
4. Structure & Consistency:
a. When nails develop fungal infection, they tend to be discolored, misshapen, hypertrophy and atypically fragile.
b. In psoriasis, alopecia aereata and severe eczema, there is thimble pitting of nails.
c. Paronychia refers to cuticle or the nail fold inflammation.
d. Onycholysis refers to the nail bed severance as observed in infection, psoriasis, and after having tetracyclines.
e. The nail is destroyed in cases of epidermolysis bullosa, lichen planus.
f. Nail patella syndrome is a genetic disorder where the nail itself is not present.
g. Nails become easily broken in gangrene and raynauds disease.
h. Nail fall is observed in psoriasis, thyroid diseases, and fungal infection.
5. Growth:
When the blood flow is diminished, the nail growth is affected. Moreover, in case of acute sickness, growth of nails is impacted. Once the symptoms recede, the growth commences once more leading to development of crosswise crinkles. These lines are known as Beau’s lines and facilitate detecting the date when the illness started.
source: MedicalNeeds
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