Nail abnormalities

Considerations:
Just like the skin, the fingernails are a telling reflection of a person's state of health.

Pitting (the presence of small depressions on the nail surface) is often accompanied with crumbling of the nail. Detachment of the nail can also occur (the nail becomes loose and sometimes even comes off).

Ridges (linear elevations) can develop along the nail, occurring in a "lengthwise" or "crosswise" direction.

Beau's lines are linear depressions that occur "crosswise" (transverse) in the fingernail. They can occur after illness, trauma to the nail, and with malnutrition .

Leukonychia describes white streaks or spots on the nails.

Koilonychia is an abnormal shape of the fingernail where the nail has raised ridges and is thin and concave. This disorder is associated with iron deficiency anemia .

Common Causes:
Trauma
  • crush injury to base of the nail or the nail bed may produce a permanent deformity
  • nail biting can be a sign of anxiety , chronic tension or uncontrollable compulsion
  • chronic picking or rubbing of the skin behind the visible portion of the nail can produce a washboard nail
  • chronic exposure to moisture or to nail polish can produce brittle nails with peeling of the edge of the nail

Infection

  • fungus or yeast produce changes in the color, texture, and shape of the nails
  • bacterial infection may cause a change in color (green nails with Pseudomonas) or painful pockets of infection under the nail or in skin surrounding the nail; severe infections can cause loss of the nail plate
  • viral warts may cause a change in the shape of the nail or ingrown skin under the nail

Internal diseases

Skin diseases

  • psoriasis may produce pitting, splitting of nail plate from nail bed (onycholysis), and chronic destruction of the nail plate (nail dystrophy)
  • lichen planus

Heavy metal ingestion

  • arsenic poisoning may produce white lines and horizontal ridges
  • silver intake can produce a blue nail

Note: This list is not all inclusive and the causes are not presented in order of likelihood. The list of all possible causes can be extensive and include unlikely diseases and medications. Furthermore, the list will vary based on the age and gender of the individual as well as on the specific characteristics of the symptom, such as location, quality, timing, aggravating factors, relieving factors, and associated complaints. Use the Symptom Analysis option to explore the possible explanations for this symptom occurring alone or in combination with other problems.

Home Care:
For nail abnormalities due to nail biting, picking, and tearing, stop these behaviors. Get psychological help (in extreme cases) or encouragement to stop as needed. Keep hangnails clipped.

For nail abnormalities due to ingrown toenails, wear shoes that don't squeeze the toes together, and always cut the nails straight across along the top.

For pale nails, clubbed nails, blue nails, distorted nails, white lines and horizontal ridges, or white hue under the nails, consult your health care provider to determine the proper way to treat the underlying cause of the problem.

For splinter hemorrhages : see the doctor immediately!

For brittle nails, keep the nails short and avoid nail polish . Use an emollient (skin softening) cream after washing or bathing.

Call Your Healthcare Provider If:

  • nail abnormalities are unexplained, associated with other symptoms, or persist.



What to Expect:
The medical history will be obtained and a physical examination performed.

Medical history questions documenting your symptom in detail may include:

  • type
    • What is the abnormality?
    • Are the nails an abnormal color?
      • What color are they?
      • Are there red lines running the length of the nail (splinter hemorrhage)?

    • Are they an abnormal shape?
    • Has the texture changed?
    • Has the thickness changed?
    • Are the nails pitted?
    • Are the nails detached?
    • Are there ridged nails?
      • Which direction does the ridging go?

    • Does the whole end of the finger look enlarged?
    • Is there a lack of luster?
    • Are the nails brittle?

  • location
    • Is it the hands?
    • Is it the feet?
    • Is it only on one side?
    • Are both sides the same?
    • Is it only one specific nail?

  • aggravating factors
    • Have you had an injury to the nail?
    • Do you bite your nails?
    • Do you pick your nails or rub the fingers or toes chronically?
    • Are the nails frequently moist?
    • Do you use nail polish ?

  • other
    • What other symptoms are also present?

Diagnostic tests will depend on what other symptoms, if any, exist.

After seeing your health care provider:
If a diagnosis was made by your health care provider related to nail abnormalities, you may want to note that diagnosis in your personal medical record.


These common warts are situated around the fingernails and may grow under the fingernail. Periungual warts are difficult to treat.



Beau's lines (ridges in the fingernails) are caused by any severe interruption of protein formation. This may result from severe illness, chemotherapy, or another damaging event.



Pseudomonas infection around the nail (paronychias) can be caused by many different organisms. Although staph, herpes, and Candida are among the most common causes, other organisms may be involved. The greenish color is classic for Pseudomonas.



The horizontal lines in the nails are called Beau's lines. Beau's lines may develop after any major metabolic condition. They may appear following chemotherapy or, as in this case, as a result of Graft vs. Host disease.



A paronychia is an infection around the nail. Many organisms can cause a paronychia. This particular case is caused by the yeast-like organism Candida. Note the inflammation (red, swollen area) at the base of the nail and the changes that are apparent in the nail itself.



Fungal infections of the nail are referred to as onychomycosis. Candida is a frequent cause of onychomycosis. Other fungi may be involved. This photograph demonstrates discoloration, friability, and crumbling of the nails.



The tinea pedis infection affects not only the skin of the feet, but can cause tissue damage and even loss of the toenails. Five of this individual's nails display evidence of infection (thickening, crumbling, and discoloration). This infection is also known as Athlete's foot.



Pachyonychia congenita - view of the feet: Pachyonychia is a rare, inherited disorder characterized by overgrowth of the nails, as seen in this picture, called nail-bed hypertrophy, and is combined with other skin and mucous membrane manifestations.



Reiter's syndrome is a disease which classically consists of joint inflammation (arthritis), urethral inflammation (urethritis), and eye inflammation. It is more common in adults. Reiter's frequently also has skin manifestations. Note the redness around the nail and the prominent horizontal line through the nail.



Nails may exhibit many different abnormalities. In the condition known as koilonychia, the nails are flattened and have concavities. This condition may be associated with iron deficiency.



In onycholysis the nails become loose. They may even detach from the nail bed. When not held firmly in place, the nails are rapidly damaged and debris collects beneath them.



Infections of the nail folds are referred to as paronychia. They may be caused by bacteria, fungi, or viruses. Structural abnormalities of the nail or nail loss may result.



White nail syndrome may also be called leukonychia. Leukonychia can occur with arsenic poisoning, heart disease, renal failure, pneumonia, or hypoalbuminuria.



Yellow nail syndrome is characterized by yellow nails that lack a cuticle, grow slowly, and are loose or detached (onycholysis). Yellow nail syndrome is most commonly associated with lung disorders, and with lymphedema.



Periungual warts are common warts. They are located around the fingernails and may grow under the fingernails. Periungual warts are difficult to treat. Multiple treatments are available but failure rates are high. This is an unusually severe case.



Internal diseases and nutritional deficits can cause changes in the appearance of the nails.



This is a picture of warts around the fingernails (periungual). These are common warts, but are located around the fingernails and may grow under the fingernail. Periungual warts are difficult to treat.