NAILS: HEALTH AND DISEASE

 NAILS: HEALTH AND DISEASE

NAILS: HEALTH AND DISEASE

 

Introduction:

 On the dorsal surface, nails can be found at the ends of each fingertip. The primary function of the nail is protection, but it also aids in the formation of a tight grasp when holding things. It is made up of a robust yet moderately flexible keratinous nail plate that grows from the nail matrix. The soft tissue beneath the nail plate is known as the nail bed. A nail fold, also known as a cuticle, exists between the epidermis and nails. Normal healthy nails are slightly pink and have a convex surface from side to side. Fingernails grow 1 centimeter in three months, but toenails take 24 months.

Importance of nails in disease diagnosis:

The color, appearance, shape, and nature of a person's nails reveal something about their overall health and cleanliness. All doctors routinely inspect nails to gain insight into underlying disorders. A person's hygiene can be determined simply by looking at his or her nails. Abnormal nails might be congenital or caused by certain conditions. The causes of nail alterations range from basic to life-threatening disorders. As a result, diagnosis requires a doctor's inspection. Some unusual observations with possible causes are reported here for public awareness.

1) Hygiene:

We can immediately identify an unsanitary nail. Dirt deposition under the distal end of the nail plate can increase the risk of pathogen ingestion while eating. If nails are not clipped properly, it might lead to worm problems in children. When worms crawl into the anal opening, children scratch, causing the worms' ova to deposit under their nails and be eaten. Prominent nails might potentially exacerbate a skin illness by frequent scratching. Sharp nails in little children cause minor injuries when they kick their feet or wave their hands.

2) The color of the nails:

 a) Anemia causes pale nails.

 b) Chronic renal failure and nephrotic syndrome are characterized by opaque white discoloration (leuconychia).

 c) Whitening can also occur in hypoalbuminemia, such in cirrhosis and kidney diseases.                    

d) Drugs such as the sulpha group, antimalarials, and antibiotics, among others, can cause discoloration in the nails.         

e) Fungal infections create black discoloration.

f) Pseudomonas infection turns nails black or green.

g) Nail bed infarction occurs in vasculitis, particularly in SLE and polyarteritis.

h) Red dots in nails can be caused by splinter hemorrhages in subacute bacterial endocarditis, rheumatoid arthritis, trauma, or collagen vascular disorders.

i) Blunt damage results in hemorrhage and blue/black discoloration.

j) Brown nails are associated with kidney illness and diminished adrenal function.

k) In Wilson's illness, a blue semicircle forms on the nail.

l) As the blood flow declines, the nail turns yellow. In jaundice and psoriasis, the nails appear yellow.

m) Yellow nail syndrome causes all of the nails to turn yellow due to pleural effusion.

3) Shape of the nails:

a) Clubbing: Tissues at the base of nails thicken, obliterating the angle between the nail base and the skin. The nail becomes increasingly convex, while the fingertip becomes bulbous and resembles the end of a drumstick. When the illness worsens, the nail resembles a parrot's beak.

 Causes of Clubbing:

 Congenital injuries.

 Severe persistent cyanosis

 Lung diseases include empyema, bronchiectasis, bronchial cancer, and pulmonary tuberculosis.

Abdominal diseases include Crohn's disease, colon polyposis, ulcerative colitis, liver cirrhosis, and so on.

 Heart illnesses include fallot's tetralogy, subacute bacterial endocarditis, and so on.         

B) Koilonychia:

The nails become concave, like a spoon. This condition is present in iron deficient anaemia. In this condition, the nails become thin, fragile, and brittle. Normal convexity will be replaced with concavity.

c) Raynaud's illness exhibits longitudinal ridging.

 d) In dermatomyositis, the cuticle becomes ragged.

 e) Nail fold telangiectasia is seen in dermatomyositis, systemic sclerosis, and SLE.

 4) Structure and consistency:

 a) Fungal infection of the nail causes discoloration, deformity, hypertrophy, and abnormal brittleness.

b) Thimble pitting of the nail is a feature of psoriasis, acute eczema, and alopecia aereata.

 c) Paronychia refers to the inflammation of the cuticle or nail fold.

 d) Onycholysis is the separation of the nail bed that occurs in psoriasis, infection, and after taking tetracyclines.

 e) Nail destruction is evident in lichen planus and epidermolysis bullosa.

 f) Nail patella syndrome is characterized by missing nails.It is an inherited disorder.

 g) Raynaud disease and gangrene cause brittle nails.

 h) Nail loss is common in fungal infections, psoriasis, and thyroid problems.

 

5) Growth:

Reduced blood supply has an impact on nail development. Severe illness also affects nail development. When the sickness disappears, growth resumes, resulting in the creation of transverse ridges. Beau's lines are helpful in determining the onset of sickness.