Nails are a window to your health
I must have gotten it at the nail salon or walking around the shower barefoot at the gym. Though plausible, fungus is not always the cause of unhealthy nails. In fact, your nails might be a clue that you have a more systemic problem in the body.
If that anti-fungal nail lacquer you have so diligently applied to your nails isn’t working, if that oral anti-fungal medication that you had to get blood work done multiple times hasn’t helped, if you’ve even tried zapping those fungal spores with laser therapy and yet they are still there, maybe it’s time to take a closer look. Maybe it’s time to visit your podiatrist.
This happens when the nail lifts up from the nail bed and there is a gap. Many times you will find white discoloration within the gap. This can be caused by trauma, fungus, or even psoriasis. Trauma is usually the diagnosis if it’s an isolated nail such as the big toe or 5th toe. It doesn’t necessarily mean you dropped an object on your nail or that you stubbed it. It can be the repetitive pressure from your shoe that you don’t realize.
Fungus is considered when multiple nails are affected. Remember fungus likes to spread so there is usually an associated fungal infection of the skin or Athlete’s foot as well. Psoriasis should also be considered if there is onycholysis especially if white scaly patches are noted under the nail. These skin patches may also be seen in other parts of the body such as the knees and elbows.
Also known as nail pitting, onychopuncta, is described as small little depressions into your nail plate. This abnormality is most commonly associated with psoriasis as well. Psoriasis is an autoimmune disease that is characterized by skin cells that multiply up to 10x faster than normal. Thus, nails are more brittle with nail pitting. 7% of the time it can result in psoriatic arthritis. Therefore early detection of the skin disorder can prevent further complications. Other causes of onychopuncta could be alopecia areata and lichen planus.
Hippocratic nails, also known as clubbing of the nails, is described as the end of your fingers are enlarged and nails become more curved and rounded at the tip. This generally takes multiple years to develop. It is caused by low levels of oxygen in the blood or decreased blood flow to your nails. Associated medical problems to consider are cardiovascular disease, lung disease, inflammatory bowel disease, liver disease, and AIDS.
More commonly known as spoon nails, koilonychias is described as thin, soft nails with raised edges. These nails look scooped out or concave in shape. This pathology can be seen in patients who have a long-standing iron deficiency anemia (Plummer-Vinson syndrome), heart disease, hemochromatosis, lupus, and hypothyroidism. An easy test to determine this nail type is to squeeze one or two drops of water onto a nail. If the water sits on top of the nail rather than sliding off, the patient has koilonychia.
Transverse indentations or depressions in the nail plate that extend from one side to the other are known as Beau’s lines. They are caused by a transient arrest of nail growth. These are generally a result from malnourishment. They can indicate that patients may have a zinc deficiency.
Beau’s lines also develop when patients have high fevers from illnesses such as pneumonia and Scarlet fever. Other conditions associated with Beau’s lines include uncontrolled diabetes, peripheral vascular disease, or simply increased stress. Beau’s line should not be mistaken for Mee’s lines. Mee’s lines are transverse white lines (not indentations) in the nail plate. Mee’s lines indicate patients may have arsenic poisoning.
Subungual melanoma is a hyper-pigmented growth that occurs in the nail bed but looks as though it’s a discoloration of the nail plate. Patients notice this discoloration and are reminded of the fatal death of Bob Marley. However, a Subungal melanoma is very uncommon and only occurs in 1% of the population. The majority of the time, patients generally have a Subungal hematoma secondary to trauma.
One sign we look for to differentiate between the two is the Hutchinson sign. This sign is associated with a Subungal melanoma and is a vertical discolored band extending from the base of the fail fold to the tip of the nail. As it grows, it may become more irregular, discolored and may ulcerate or bleed. A biopsy is needed for diagnosis of a Subungal melanoma and treatment options will vary but may include an amputation. Generally, a lymph node biopsy is also performed to ensure that melanoma has not spread.
Do not assume that nails that are abnormally shaped, discolored, or thickened are fungus. It could very well be your body trying to tell you something more systemic is going on. We encourage you to get an expert opinion by making an appointment with one of our foot and ankle specialists; (877) 877-9110 or visit us at www.footankleinstitute.com.
Dr. Redkar specializes in foot and ankle pathology and is available for consult at our West Hills location.
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