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Nail abnormalities

Definition

Nail abnormalities are problems with the color, shape, texture, or thickness of the fingernails or toenails.

Alternative Names

Beau's lines; Fingernail abnormalities; Spoon nails; Onycholysis; Leukonychia; Koilonychia; Brittle nails

Considerations

Just like the skin, the fingernails tell a lot about your health.

  • Beau's lines are depressions across the fingernail. These lines can occur after illness, injury to the nail, during chemotherapy for cancer, or when you do not get enough nutrition.
  • Brittle nails are often a normal result of aging. They can also be due to certain diseases and conditions.
  • Koilonychia is an abnormal shape of the fingernail. The nail has raised ridges and is thin and curved inward. This disorder is associated with iron deficiency anemia.
  • Leukonychia is white streaks or spots on the nails.
  • Pitting is the presence of small depressions on the nail surface. Sometimes the nail is also crumbling. The nail can become loose and sometimes falls off.
  • Ridges are tiny, raised lines that develop across or up and down the nail.

Causes

Injury:

  • Crushing the base of the nail or the nail bed may cause a permanent deformity.
  • Chronic picking or rubbing of the skin behind the nail can cause median nail dystrophy, which gives a lengthwise split or ridged appearance of the thumbnails.
  • Long-term exposure to moisture or nail polish can cause nails to peel and become brittle.

Infection:

  • Fungus or yeast cause changes in the color, texture, and shape of the nails.
  • Bacterial infection may cause a change in nail color or painful areas of infection under the nail or in the surrounding skin. Severe infections may cause nail loss.
  • Viral warts may cause a change in the shape of the nail or ingrown skin under the nail.
  • Certain infections (especially of the heart valve) may cause red streaks in the nail bed ( splinter hemorrhages).

Diseases:

  • Disorders that affect the amount of oxygen in the blood (such as heart problems and lung diseases including cancer or infection) may cause clubbing.
  • Kidney disease can cause a build-up of nitrogen waste products in the blood, which can damage nails.
  • Liver disease can damage nails.
  • Thyroid diseases such as hyperthyroidism or hypothyroidism may cause brittle nails or splitting of the nail bed from the nail plate (onycholysis).
  • Severe illness or surgery may cause horizontal depressions in the nails (Beau's lines).
  • Psoriasis may cause pitting, splitting of the nail plate from the nail bed, and chronic destruction of the nail plate (nail dystrophy).
  • Other conditions that can affect the appearance of the nails include systemic amyloidosis, malnutrition, vitamin deficiency, and lichen planus.
  • Skin cancers near the nail and fingertip can distort the nail. Subungal melanoma is a potentially deadly cancer that will normally appear as a dark streak down the length of the nail.
  • Hutchinson sign is a darkening of the cuticle associated with a pigmented streak and may be a sign of an aggressive melanoma.

Poisons:

  • Arsenic poisoning may cause white lines and horizontal ridges.
  • Silver intake can cause a blue nail.

Medications:

  • Certain antibiotics can cause lifting of the nail from the nail bed.
  • Chemotherapy medicines can affect nail growth.

Normal aging affects the growth and development of the nails.

When to Contact a Medical Professional

Call your health care provider if you have:

  • A new or widening dark streak in the nail
  • Blue nails
  • Clubbed nails
  • Distorted nails
  • Horizontal ridges
  • Pale nails
  • White lines
  • White color under the nails
  • Pits in your nails

If you have splinter hemorrhages, see the doctor immediately.

What to Expect at Your Office Visit

The health care provider will look at your nails and ask questions about your symptoms. Questions may include:

How your nail looks

  • 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?

Diagnostic tests depend on other symptoms. Tests may include x-rays, blood tests, or examination of parts of the nail or the nail matrix in the laboratory.

Prevention

  • Do not bite, pick, or tear at your nails (in severe cases, some people may need counseling or encouragement to stop these behaviors).
  • Keep hangnails clipped.
  • Wear shoes that do not squeeze the toes together, and always cut the nails straight across along the top.
  • To prevent brittle nails, keep the nails short and do not use nail polish. Use an emollient (skin softening) cream after washing or bathing.

Using the vitamin biotin and clear nail polish that contains protein can help strengthen your nails. Ask your health care provider about newer medicines that help with abnormal-appearing nails.

References

Sperling LC, Sinclair RD, El Shabrawi-Caelen L. Alopecias. In: Bolognia JL, Jorizzo JL, Schaffer JV, eds. Dermatology. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 69.


Review Date: 6/19/2013
Reviewed By: Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial Team.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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