Nails are big business today. But pretty nails don’t always mean good health. Because of their partial transparency, many health conditions are very visible in the nails. Even nail-biting can be an indicator of mental health. People who are more anxious or obsessive compulsive do tend to bite their nails more frequently.
Healthy nails should be semi-transparent, light pink, and intact, with a white lunula (“little moon”) just above the cuticle.
A variety of medical problems affects nail. Watch out for following key changes:
Muehrcke’s nails. The nails have horizontal white lines, most often in the second, third, and fourth fingers due to the abnormal blood supply in the nail bed. The lines disappear if the nail is pressed and blood is squeezed out of the nail bed blood vessels. Because this problem occurs in the nail bed, it will not progress up as the nail grows. Problems associated with this are hypoalbuminemia, liver disease, malnutrition, and nephrotic syndrome.It is also a side effect of chemotherapy.
White nail syndrome. The whole nail appears cloudy or white. This change in nail health indicates heart disease, renal failure, liver cirrhosis, pulmonary tuberculosis, diabetes, or rheumatoid arthritis.
Terry’s nails. There is an increase in connective tissue and a decrease in blood supply in the nail bed. The nail looks white and grainy with a pink or red strip at the top. This change in nail health is found in 80% of patients with liver cirrhosis,congestive heart failure, hyperthyroidism, malnutrition, diabetes, or HIV.
Half-and-half nails. Also known as Lindsay’s nails. The bottom half of the nail appears white while the top half is a darker pink-brown. This is because there is swelling in the nail bed at the bottom and increased melanin skin production at the top. Chronic renal disease or HIV can be the cause of this condition.
Mee’s line. Horizontal white lines appear in the nail due to microscopic fragmentation of the nail after disrupted growth. Mee’s lines can indicate heart failure, Hodgkin disease, renal failure, system-wide infection, or poisoning by arsenic, thallium, or other heavy metals.
Splinter hemorrhages. The thin, dark red or brown vertical lines in the nail bed look like splinters beneath the nail, hence the name. It may be due to cirrhosis, mitral stenosis, oral contraceptive use, pregnancy, peptic ulcer disease, scleroderma, rheumatoid arthritis, systemic lupus erythematosus, vasculitis, and trauma. A classic association is with subacute bacterial endocarditis (infection of the heart valves).
Yellow nail. In this condition, nails appear yellowish-orange and thicken and curve into the cuticle. It is associated with lymphedema (impaired lymphatic drainage), pleural effusions, and bronchiectasis.
Blue nail. Either the lunula or the whole nail can indicate Wilson’s disease, argyria (silver poisoning), or quinacrine therapy (used to treat lupus and other health conditions).
Red lunula. Red can indicate alopecia areata (hair loss), carbon monoxide poisoning, cardiac failure, chronic obstructive pulmonary disease, chronic urticaria (hives), cirrhosis, collagen vascular disease, oral prednisone treatment, or psoriasis.
Vertical brown streaks. These are common among people with dark skin; however, they can indicate melanoma. A benign nevus (overgrowth of cells) or chemical staining (including from some nail polishes) could also be the cause.
Beau’s line. When there is a disruption in nail growth, a deep horizontal groove can appear. This could indicate peripheral artery disease, pemphigus (a skin disease),pemphigus, Raynaud’s disease, systemic infection, or trauma.
Pitting. A small, pinpoint depressions can appear in the nails when there are problems in nail plate layering. This is seen in 10 to 50 percent of people with psoriasis. It can also be caused by alopecia areata, pemphigus, a type of arthritis called Reiter’s syndrome, and sarcoidosis.
Spoon-shaped nails (koilonychia). The nails curl up at the edges and become whiter, fragile, and concave. This can have a variety of causes, including anemia, hemochromatosis, hypothyroidism, malnutrition, nail trauma, constant exposure to petroleum-based solvents, Raynaud’s disease, and systemic lupus erythematosus.
Clubbed nails. The soft tissue around the nail and fingertip becomes enlarged, nails become thicker, harder, shinier, and shaped like a bulb. The flesh below the cuticle gets spongy. Clubbing is usually caused by low oxygen levels in the blood and is associated with lung and heart conditions such chronic obstructive pulmonary disease (COPD), chronic bronchitis, congestive heart failure, and congenital heart disease. It is also seen with liver disease and inflammatory bowel diseases, and can signify cancer, most commonly of the lung and lung lining.
Onycholysis. The nail separates from the nail bed starting at the top portion of the nail. It can signal medical problems including anemia, certain types of cancer, connective tissue disorders, fungal infection, psoriasis or psoriatic arthritis, reactive arthritis, amyloidosis, sarcoidosis, syphilis, systemic lupus erythematosus, and most commonly, trauma. It can also occur with hyperthyroidism, with the fourth and fifth nails possibly becoming brown.
Onychomadesis. The nail separates from the nail bed starting from the base and ends in complete loss of the nail. The most common cause is trauma. Other include fungal infection, Raynaud’s disease, chemical damage, frostbite, hand-foot-mouth disease, poor nutrition, febrile illness, and vascular disease.