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Health At Your Fingertips

Health at your fingertips

Joyce Teo finds out what your nails can tell about your health

Take a look at your fingernails and check if they are smooth and free of discolouration – these are key signs that they are healthy.

But if your nails have changed in colour, texture or thickness, these symptoms may point to an underlying health condition.

Dr Joyce Lim of Joyce Lim Skin and Laser Clinic said there are times when one’s nails hint at a medical condition that one is not aware of.

“For example, the person may have spoon-shaped looking nails (called koilonychia), which indicates that he has anaemia,” said Dr Lim.

Most of the time, however, the condition of one’s nails is a manifestation of other medical conditions which the patient may already be aware of, she said.

For instance, yellow nails are seen in people with renal disease, while white nails are seen in those with a protein deficiency or liver disease.

“Sometimes, by looking at the nails, we can predict an event that happened a few months ago. For example, there may be horizontal ridges on the nails – known as Beau’s lines – which correspond to an illness or surgery,” said Dr Lim.

“As it takes six months for a nail to grow out, if the beau’s line is in the middle of the nail, it would signify that there was a medical event three months ago.”

Although nail changes accompany many conditions, many of these abnormalities are harmless – for instance, not everyone with white nails has liver disease, pointed out Dr Paul Chia, a specialist in dermatology and a consultant at Raffles Skin & Aesthetics Centre.

And while nail changes are linked to our internal health, they are usually not considered a disease in itself, he added.

The clubbed nail – which occurs when the tips of the fingers enlarge and the nails curve around the fingertips – is not a disease, but it may indicate problems with the bowels, lungs or heart.

“Conversely, certain nail disorders may be part of a skin condition, such as psoriasis,” said Dr Chia. This often causes the nails to be crumbly and have an unsightly yellow tinge.

Such a problem can be treated with creams, injections or medicine, he said.

Fungal infection of the nails, too, can be treated with a variety of methods, including topical anti-fungal cream, oral anti-fungal medication and, less commonly, surgical nail removal, he said.

What the conditions signify

Dr Paul Chia, a specialist in dermatology & consultant at Raffles Skin & Aesthetics Centre, points out 10 abnormal nail conditions and what they can signify.

1. Oncholysis
 A common condition where the nail separates from the nail bed. This usually starts at the tip of the nail.

The most common cause is trauma, including minor, repetitive trauma such as frequent tapping of long fingernails on a keyboard.

Fungal infections and psoriasis – a skin condition characterised by scaly patches on the skin – are also frequent causes, although they are often linked with thickening and yellowing of the nails.

2. Yellow nails
Fungal nail infection is the most common cause. Often, the nails would thicken and feel crumbly, with debris underneath.

In rare cases, yellow nails can indicate a more serious condition, such as severe thyroid disease, lung disease or diabetes.

3. Pale white nails
This can signal an underlying serious illness, such as anaemia (a condition in which your blood has an abnormally low number of red blood cells), heart failure, liver disease and malnutrition.

4. Pitting on the nails
These are small dents or depressions on the nail surface.

It is common in people who have psoriasis. It could also be an early sign of reactive arthritis (joint pain and swelling that develop in response to an infection in another part of your body) or alopecia areata, an autoimmune disease that causes hair loss.

5. Beau’s lines
These are grooves or indentations that run across the nails. They can appear when the growth at the base of the nail is interrupted by injury or a severe illness. The conditions associated with Beau’s lines include:
 an illness (such as scarlet fever, measles, mumps and pneumonia) which started a few months ago;
 chemotherapy;
 a previous injury; and
 a nutritional deficiency.

These grooves tend to be visible a few months after these conditions happen. That is when the nails have grown and the grooves have moved up the nails to become visible.

6. Spoon-shaped nails
Also known as koilonychia, they are usually caused by iron-deficiency anaemia, which occurs when a lack of iron leads to a reduced number of red blood cells in the body.

Other less common causes of this nail abnormality include:
 haemochromatosis, where the body has too much iron;
 Raynaud’s disease, a common condition that affects the blood supply to the fingers and toes, causing them to turn white; and
 Lupus erythematosus, an uncommon condition where the immune system attacks the body’s cells, tissues and organs.

7. Clubbing of the nails
This occurs when the tips of the fingers enlarge and the nails curve around the fingertips, usually over the course of a few years.

It is sometimes the result of low oxygen levels in the blood, and could point to problems with the lungs, bowels or heart.

8. Brittle or crumbly nails
These are often just signs of ageing or long-term exposure to water or chemicals, such as detergents and nail polish.

However, brittle nails can also be caused by a fungal nail infection, thyroid diseases and nail psoriasis.

9. Dark stripes down the nail

This is known as longitudinal melanonychia and is fairly common in people with darker skin.

However, the dark stripes could also be a form of skin cancer that affects the nail bed, called melanoma.

Consult your dermatologist to rule this out.

10. Gnawed nails
Biting your nails is usually an old habit, but in some cases, it points to persistent anxiety. Nail-biting or picking has also been linked to psychological problems, including obsessive-compulsive disorder.

If your nail-biting persists along with anxiety and stress, discuss this with your doctor.

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