Friday, April 24, 2009

Nail as a diagnostic tool PART 1

The appearence of the fingernails and toenails may suggest an underlying systemic disease. Some diseases are very frequently accompagnied with nail problems. Examples of these high frequency nail disease problems are psoriatic arthritis, rheumatioid arthritis, psoriasis, and diabetes. In general nail disorders are frequently observed in cardiovascular diseases,circulatory problems, gastrointestinal diseases, endocrine disorders and viral or bacterial diseases.

In Clubbing, nail itself loses its longitudinal ridges and become convex above downwards as well as side to side.Clubbing occurs in patients with neoplasm of lung and pleura. It may also accompany with other pulmonary diseases like bronchiectasis, lung abscess, empyema, pulmonary fibrosis, and cystic fibrosis.It may also occur in patients with cirrhosis,celiac diseases, congenital heart diseases,arterio-venous malformation or fistulas and endocarditis.

Discoloration of nails may be seen with the effect of certain drugs like antimalarials,antibiotics, and phenothizines.Discolouration and deformity, hypertrophy and abnormal brittleness may result in fungal infection.

Koilonychia are soft, thin brittle and spoon shaped nails commonly seen in iron deficiency anaemia.This abnormality is sometimes a normal nail variant in infants, but it usually corrects itself within the first few years of life.Koilonychia may result from trauma, constant occupational exposure of the hands to petroleum based solvents.In case of spooning of nail without an obvious associated illness, physicians should obtain a complete blood count and ferritin level to rule out iron deficiency and hemochromatosis.

Pitting is caused by defective layering of superficial nailplate.Pitting may be caused by variety of systemic diseases , Reiter's syndrome ,connective tissue disorders, sarcoidosis, pemphigus, and alopecia areata.Moreover any localized growth that distrupts the orderly growth also cause pitting.

Onycholysis occurs by the separation of nail plate from nail bed results in white discoloration of the affected area.Onycholysis may also result from hyperthyroidism(plummer’s nails),warts(periungual warts) ,trauma and onychomycosis.Hyperthyroidism also can cause brown discoloration of nails.

References :

Huchisons clinical method

Davidson’s Principles and practice of medicine

The journal of family practice- Nail disorders and systemic disease: What the nails tell us

Glossary of nail conditions

No comments:

Post a Comment