Nail abnormalities

What are nail abnormalities?

Nail abnormalities are identified through changes in shape, colour, thickness and texture of the finger and toenails. These differences in these characteristics give an indication of the nail disease or an underlying systematic disease in the body.

What do various nail abnormalities signify?

There are different conditions in which nails change their texture and thickness in a period of time. And, every condition has its own significance. It also indicates the change in the fitness of the body. The clubbing of the nail suggests inflammatory bowel disease or lung disease. Koilonychia or spoon-shaped nails may need a work-up for anaemia. Ridges occur when tiny raised lines develop across the nail. Beau’s lines are linear depressions that occur sideways on the fingernail. These lines can occur when the person is malnourished or has recovered from illness or an injury to the nail. These lines may also occur due to the temporary disturbance in nail growth.

Sometimes, changes in the colour of the nail also signify certain serious disorder like –

• Green nails – it is caused due to the Pseudomonas infection.
  
  
• Blue-nails – may occur due to anti-malarial drugs.
  
  
• Black nails – these indicate vitamin B 12 deficiency and post-irradiation. Black streaks may indicate junctional melanocytic naevus or malignant melanoma.
  
  
• White nail (Leuconychia) – may happen due to minor trauma, chronic liver disease, renal failure, fungal infection or lymphoma.
  
  
• Yellow nail – these nails are characterised by the slow, lose and detached growth. Such nails lack cuticles and are mainly associated with lung disorders.
  
  
• Brittle nails - it is the normal sign of ageing. Also, these nails indicate low zinc and iron levels as well as thyroid problem.

What are the causes?

There are a number of reasons for the abnormality in the nails. However, some major listed reasons for the same are:

1. Injury:
   
   • Crushing of the nail base or the nail bed causes permanent deformity of the nail.
     
   • Long-term use of nail paints or enamel and excessive exposure to moisture can cause brittle nails.
     
   • Chronic pricking or rubbing of the skin behind the nail can lead to washboard nail.
   
   
2. Infection:
   
   • Fungus or yeast can cause a change in colour, shape and texture of the nail.
     
   • Bacterial infection on and around the nail can cause change in nail texture or painful areas around and under the nail. Chronic bacterial infections can lead to nail loss as well.
     
   • Viral warts are the usual cause of change in the shape and ingrown skin of the nail.
     
   • Certain chronic infections can cause red streaks in the nail bed.
   
   
3. Diseases:
   
   • Disorders due to the lack of oxygen supply in the blood may cause clubbing of the nails. This includes lung disease, cancer and abnormal heart anatomy.
     
   • Kidney diseases damage the nail by exceeding the nitrogen waste products in the blood.
     
   • Liver disease is also a major cause of damaging nail texture.
     
   • Hyperthyroidism or hypothyroidism may cause brittle nails or splitting of the nail bed from the nail plate.
     
   • Severe illness or surgery can cause horizontal depressions in the nails.
     
   • Psoriasis may cause splitting of the nail plate, pitting, and chronic damage to the nail plate, which ultimately can damage the shape and colour of the nails.
     
   • Other conditions like vitamin deficiency, malnutrition and lichen planus can affect the appearance of the nail permanently.
   
   
4. Poison:
   
   • Arsenic can cause white lines and horizontal ridges.
     
   • Intake of silver can cause blue nails.

What is the treatment?

The treatment of the abnormality of nails is treated after diagnosing the exact cause of the problem as there could be number of reasons involved. If one has clubbed, blue, distorted, pale or white coloured nails then a doctor should be consulted. There may be no need to consult a specialist if the problem is due to nutritional deficiency or injury.

But if there is a splinter haemorrhage (these are tiny lines that run vertically under nails), a doctor needs to be seen immediately.

What is the prevention?

If there is nail abnormality due to nutritional deficiency, a change in diet plan can help preventing the problem. However, proper care is always required to have healthy nails. Do not pick, bite or tear nails. To prevent brittle nails, avoid using nail polish for long and if needed, prefer to use nail paints that contain protein. This will help strengthen the nails. For toenails, cut the nails straight across along the top and wear shoes that do not squeeze the toes together. Use skin softening cream after washing and bathing.