Check Out Those Nails!

March 9, 2011
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A question that I encounter from patients on a near daily basis is: can you really tell the status of a person’s overall health by looking at their nails? The answer, although it seems strange, is yes, to some extent a Podiatrist can understand a lot about a patients overall health just by looking at their toenails and fingernails. 

It seems a little bit crazy! How can you possibly know if a patient has liver disease, kidney disease or lung disease just by looking at their nails? Well, for whatever reason, the body communicates its overall health in various ways and one of those ways is through patterns, lines and color changes in the nails. 

My hope is that this week you will gain a greater appreciation for the look of a person’s nails, while understanding that the appearance may suggest an underlying disease, but is by no means an absolute. Some people’s nails are just “naturally” discolored, ridged etc. Therefore, it might not be the greatest idea to play ‘Doctor’ and inform innocent bystanders of an illness you think they might have, since you’ll be an ‘expert’ in the category of nail appearance after this week! 

Here are a few of the disease conditions that manifest themselves through changes in the appearance of toe- and finger-nails.

Psoriasis:
Psoriasis is an inflammatory disorder that typically manifests on the skin, but as it progresses can lead to Psoriatic Arthritis in many patients. One of the most distinct presentations, which we blogged about in our article on Psoriasis, is nail pitting (small indentations in the nail that are white in color). When found in association with loosening of the edges of the nails (onycholysis) and a yellow-brown discoloration, psoriasis is a likely diagnosis. 

Liver Disease (Cirrhosis):
The manifestation of liver disease in the nails most typically comes in the form of what the medical field call’s Terry’s Nails. This nail presentation demonstrates a pink (normal) coloration on the most distal part of the nail, meaning the furthest area from the foot/hand, while the portion more proximal or closer to the foot/hand is completely white in color. 

Dehydration:
Splitting of the nails at their very ends signifies dehydration of the nail plate. Drink more water!!

Heart/Lung Disease:
Clubbing involves both the nails and the actual toes and fingers (digits) in its appearance: a generalized enlargement of the digits with curving of the nail. The nail thins out and curves itself in order to remain approximated with the digits as they enlarge. Again, clubbing not exclusive to either heart or lung disease but may suggest such an underlying disorder. 

Arsenic Poisoning:
To the CSI and Law and Order Fans out there, this one is for you! Arsenic poisoning in a patient presents as very distinct Mee’s Lines. These are lines across the nail from one side to the other that are white in color and may be single or double in presentation. The next time you’re watching your most favorite episode of a Forensic Science show when they recognize Arsenic poisoning as the cause of death, listen for clues they found in relation to the patient’s nails!!

Peripheral Vascular Disease (PVD):
We had previously blogged about PVD and how it designates a change/alteration in blood flow to the extremities, especially the legs. Changes in blood flow result in a decrease in nutrients and infection fighting cells to the places furthest from the heart, meaning fingers and toes. Therefore, this patient population is more likely to suffer from onychomycosis, which is a fungal infection in the nails, presenting as thickening, deformation and yellow color changes. 

Keep in mind that any nail presentation is not an exclusive diagnosis for an underlying disease condition, but it does signal to us as Podiatrist that we need to investigate your over-all health just little bit more. It may prompt us to ask more questions in our history taking to determine if you have any underlying disorders or it may prompt us, as in the case “PVD nails” to have additional non-invasive studies completed to determine how well the blood is flowing to your extremities. 

Now that you’re a nail expert go out and observe the public, just be sure not to worry any innocent bystanders with your “diagnosis!” 

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