Disorders Of The Nails

Examining the nails is an important part of physical examination and certain features may point to the underlying medical disorder. In some cases the nails may have local disease causing a disorder or abnormal findings.
Here we try to give a brief description of some of the nail disorders along with pictures for a better understanding.

1. Absent part: also known as Anonychia . It may be congenital or secondary to severe infection or allergic reaction. It is also seen in self inflicted trauma or in people who have a habit of nail biting.

Partial Anonychia 







                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 Congenital Anonychia 










2. Nail Pitting: characterized by depressions on the surface of the nail is seen in conditions like psoriasis and connective tissue disorders like alopecia aerata and sarcoidosis. Nail pitting in one or two finger nails may be due to local trauma.

                                                Nail Pitting.


3, Clubbing Of the Nails: swelling of the terminal phalanges of the fingers and toes, giving them a “club” appearance; the normal 160° angle between the nail bed and the digit increases to 180°

Causes include:

Lung disease:

• Lung cancer, mainly non-small-cell
• Interstitial lung disease most commonly fibrosing alveolitis
• Complicated tuberculosis
• Lung absces
• Bronchiectasis
• Cystic fibrosis

Heart disease:

• Congenital cynotic heart disease(most common cardiac cause)
• Subacute bacterial endocarditis

Gastrointestinal and hepatobiliary:

• Malabsorption
• Inflammmatory bowel disease (Crohn's disease and ulcerative colitis)                                                           
• Primary biliary cirrhosis                                                

Others:                                                                                                Nail clubbing

• Graves disease (autoimmune hyperthyroidism) 
• Familial and racial clubbing and "pseudoclubbing" (people of African descent often have what appears to be clubbing)

4. Spoon shaped nails: known as koilonychia and seen in iron deficiency anemia. 

 koilonychia 

5. Nail Pigmentation: Longitudinal melanonychia is a pigmented band that runs fro the proximal nail fold to the nail tip. The band, which can be tan, brown, or black, is caused by an increase in melanin pigment in the nail plate.

                                                          Nail pigmentation

6. Splinter Hemorrhages: seen in bacterial endocarditis. 

                                                  Splinter Hemorrhages

7. Brittle nails: Brittleness of the nails, meaning that the nails easily become cracked, chipped, split, or peeled, can be observed as a sign of aging or in response to the long-term use of nail polish or exposure to moist conditions (including frequent swimming or dishwashing). Some diseases are also associated with changes in the nails, which can include brittleness. Thin and brittle nails can be a sign of hypothyroidism.

                                                        Brittle nails