Nail Disorders: What Nails Say About Your Health

Nailing Your Health Problems

What do dentists, blackjack dealers, and teachers all have in common? They have their nails on display at all times. Your nails reveal more than you might think. When you have a nail disorder, people notice.

That might be a good thing. Being aware of the health of your nails could give you an early warning of a serious problem that needs your attention. It can even save your life in some cases. Learn what your nails may suggest about your health.

When Nails Grow Pale

While they can have many other causes, pale finger and toenails are a common sign of aging. In one survey of patients over age 60, almost 3 in 4 had developed pale, dull nails. However, pale nails can indicate more serious health problems in some individuals. The next slide will discuss some of those. Rather than wonder what caused them, ask your doctor for an examination if you’ve noticed your nails have become pale.

White Nails

There are many reasons why only one nail may be partly or entirely white, including injury, and some of these reasons will be discussed later. In any case, when all your nails change to the same unusual white pattern, this suggests you should go to your doctor for further testing. White nails with a pink band at the top of the nail bed are called Terry's nails, and they may signify a serious health condition.

The white half-moon area at the base of your nail is called the lunula, Latin for "little moon." With Terry's nail, the lunula is indistinguishable from the rest of the nail. When this appears, it suggests your body's veins have changed beneath your nail.

This symptom may indicate the following serious diseases:

• Cirrhosis of the liver
• Chronic kidney failure
• Congestive heart failure

Although Terry's nail may suggest a serious condition, it can also appear in seniors as a normal part of aging. And some people have all-white nails like this throughout their lives, which suggests a harmless genetic trait. To rule out more serious causes, ask your doctor for an examination.

Yellow Nails

Nails can yellow for a wide variety of reasons. The most common cause is fungal infection. Smokers may yellow their nails with tobacco. If they resist treatment, your yellow nails may indicate psoriasis, thyroid problems, or diabetes.

In rare cases, so-called "yellow nail syndrome" (YNS) occurs in patients with serious lung disease and swelling of the extremities (lymphedema). This almost always develops in patients over age 50, though children with the syndrome have been reported. In these patients, most if not all of the nails are yellowish. Sometimes YNS goes away on its own. But if it doesn't, vitamin E may help, as well as medication.

Blue Nails

Nails can take on a blue appearance for lots of reasons. Technically your nail isn't blue—just the nail bed beneath. Your nail bed is free of skin pigment, leaving it vulnerable to blue coloring in several ways.

Silver Poisoning

One cause of blue nails is silver poisoning (argyria). Because your nailbeds have no skin pigment, they can be one of the first places to show signs of silver deposits. This irreversible condition can become worse with increased exposure to silver, and may eventually appear across sun-exposed skin areas. People who work with silver, including silver miners and silverware manufacturers, are at risk of argyria. So too are people who take silver (possibly as silver salts) as an alternative medicine.

Medications

Some medications may leave your nail beds blue. These include drugs used to fight malaria (antimalarials), drugs used to fight psychosis (phenothiazines), and a drug used to regulate heartbeat (amiodarone). At least one case of blue fingernails seemed to result from the rosacea fighting medication minocycline.

Occupational Hazards

Some jobs can leave fingernails blue. Mechanics sometimes get them because of the oxalic acid sometimes used to clean radiators. People who use metal cleaners, paint removers, or who manufacture inks or dyes may also develop blue nails.

HIV Infection

People infected with HIV may develop blue nails in two ways. First, the infection itself seems to cause this distinct sign. Second, some antiretroviral medicine has also been associated with blue nails.

Cyanosis

Cyanosis is a low or lack of oxygen in your red blood cells that may result in the skin underneath your nails and elsewhere like the feet, lips and/or mucous membranes to be a bluish-purple color. Cold temperature exposure or abnormally high hemoglobin levels may cause cyanosis. Cyanosis also may result from an underlying chronic disease like COPD or asthma or occur acutely from an inability of the body to deliver oxygenated red blood cells (pneumonia or pulmonary embolism, for example). Acute cyanosis can be a sign of a medical emergency.

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.

Split or Cracked Nails

Nail brittleness is a common condition of the elderly. Typically, the cause remains undiscovered, partly because there are so many potential causes. Nail brittleness can result from drugs, a trauma to the nail, or a number of diseases or nutrient deficiencies. When brittle nails split, the name your dermatologist uses may depend on how they split. When nails begin to split horizontally, the condition is called onychoschizia. But when they split along the direction the nail grows, this is called onychorrhexis.

Preventing Brittle Nails

It may be difficult to treat your nails by the time they begin splitting and cracking. So, prevention may be your best bet. There are many potential ways to treat this condition. Potentially useful prevention methods include supplements. These may take the form of vitamin supplements (particularly biotin), amino acids, or certain minerals such as zinc.

Puffy Nail Fold Infection (Paronychia)

The skin around the edge of your nail, known as the nail fold, can be damaged by many things. When it gets puffy and swollen, doctors call it paronychia, which can be either chronic or acute. Acute paronychia usually develops from an infection. But if your nail bed is chronically puffy, you probably have a chemical irritation.

There are other reasons for puffy nail beds, too. People whose hands are frequently soaking in water—dishwashers, food handlers, and swimmers, to name a few—may get it. People with diabetes are more vulnerable to it too, as are those who take certain HIV medications.

Prevention and Treatment

Your treatment options depend on how you developed this condition. Puffy nail beds may respond to certain pills or steroid creams. To know which one to use, consult your doctor. If you want to get rid of paronychia and stay rid of it, consider avoiding water and harsh chemicals on your hands. See if you can use waterproof rubber gloves, for instance. Avoid putting your fingers in your mouth (such as when thumb-sucking). And when you wash your hands, follow up with a moisturizing lotion.

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 necessary to rule out skin cancer.

Chewed Nails

Are you a nail biter? The technical term is "onychophagia," and this common stress-relieving habit is found in both children and adults. It can have both obvious and subtle health consequences. Most obviously, chewing your nails leaves them looking raw and rough. But other health problems may include:

• Intestinal parasites picked up from your nails
• Jaw pain and dysfunction (TMJ)
• Fungal nail infections
• Stomach infections from swallowing nail pieces

As with any unpleasant habit, breaking yourself of nail biting can be difficult. Success may be confounded by several psychiatric disorders associated with this condition, including obsessive-compulsive disorder (OCD) and attentional deficit hyperactivity disorder (ADHD). The cooperation of the patient is necessary to modify the behavior. A multidisciplinary medical team may provide the best shot of beating this habit. Some professionals who may be helpful include dermatologists, psychiatrists, and dentists.

White Spots on Nails

White spots on nails are common and usually harmless. They usually appear on the nails of your fingers. Toenails are less commonly affected, but they can appear there as well. The majority of these cases involve a slight trauma to the nail plate itself (what we commonly refer to simple as "the nail.") If you've rapped your nails against a hard object, or if they've bent but not broken, a white line or spot may develop. In these cases, the treatment is simple: wait for the spot to grow out of your nail, then clip it off.

Sometimes white spots develop at birth in the same place as someone else in the family, indicating the condition can also be hereditary. In rare instances, your entire nail may be all-white, a condition known as total leukonychia. Serious cases like this might indicate an underlying health problem, but they also may not. Your doctor's diagnosis can help settle the matter.

Horizontal Grooves or Gaps (Beau’s Lines)

Do you have a nail that shows one or more depressed bands or gaps that stretch horizontally around the nail? That describes Beau's lines, which are the most common nail problem associated with systemic disease. Unfortunately, it's hard to tell which disease caused it just from the nail. These unsightly lines may form in response to extreme cold, nail trauma, heart attack, or many other extreme stresses like syphilis, mumps, and pneumonia.

Pale Horizontal Bands (Muehrcke's Lines)

If your nails are crossed with one or more pale or white bands from side to side, you may have Muehrcke's lines. Muehrcke's lines are usually absent on thumbnails. They arise out of a lack of albumin in your blood (hypoalbuminemia). Albumin makes up most of the protein in your blood, and its absence may spell serious health consequences. People with these lines may suffer from liver cirrhosis, a kidney disorder called nephrotic syndrome, chemotherapy side effects, or malnutrition, among other causes. Be sure to get a diagnosis from your doctor if you see these bands.

Clubbed Nails

Clubbed nails occur when the ends of your fingers or toes grow bulb-like. It's sometimes known as drumstick fingers. While nail clubbing is most often unrelated to any other condition, there are some potentially fatal diseases that this may alert you to.

Some people with clubbing of the nails have an underlying disease of the heart or lungs. This includes heart disease and lung cancer, as well as more minor conditions. Liver cirrhosis can also cause clubbed nails. Since toe nails and fingernails like this could be harmless or very serious, a doctor's expert diagnosis is important.

Green Nail Syndrome

This can be a frightening discovery—the green on your nails may be a splotch beneath the nail or you may find vivid, dark, completely green nails. These can appear as either finger or toenails, or both.

One common cause is a bacterial infection. The Pseudomonas bacteria may be picked up from working in or otherwise spending time in water. That could mean gardening in wet weather, working as a dishwasher or swimming in poorly chlorinated pools and hot tubs. People whose jobs cause their fingernails to separate may be especially at risk, too. Such occupations include janitors, plumbers, and gardeners.

There are other causes for green nails syndrome. Some factory workers may develop dark green fingernails. This can happen from working with resins used to manufacture electronics without using proper safety equipment. In one case report, a 58-year-old worker developed the nails after working with a common epoxy resin for months using latex gloves, which were deemed unsuitable.

Whether the condition comes from infection or chemicals, there are treatment options available to restore your nails to their normal color.

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.

Nail Disorders: What Nails Say About Your Health

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.
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