Nail changes can pose serious problems
Nails have not only aesthetic function, but are also functional. They are keratin laminae that cover the fingers and are divided into a matrix, plate adhering to the bed, folds or lateral folds and free edge. The thickness of the nail varies from 0.5 to 0.75 millimeters and its length grows about 0.1 millimeter per day, with some individual variations. This growth decreases with age and can be influenced by skin or systemic diseases.
Pathological changes of the nails are multiform, and may be congenital, hereditary or acquired. The nail matrix absorbs water and its flexibility depends on it. A diseased nail is dry, brittle, dull and more hardened.
"If you notice any disturbances of shape, color or fragility, seek medical attention for a proper diagnostic investigation."
Some changes found directly on the nails can report various diseases such as Twenty-Nail Syndrome. This malady compromises all nails, which have opaque, grayscale and longitudinal grooves. The cause is unknown and there is no treatment indicated.
Many may be nail changes in skin conditions. Among them Psoriasis is one of the most frequent, where deformities of the nails may be the only manifestation of the disease. Its most common features are nail in thimble, rough surface, loss of brightness and color change. Sometimes it can be confused with ringworm, so the doctor can differentiate it through mycological and clinical exams. Lichen Planus may be the only manifestation of the disease, or it may be associated with cutaneous-mucosal involvement.
Punctate or linear depressions, rough and dull surface, or striae and thickening may be signs of Areata alopecia. Brittle nails and the presence of white streaks on the free edge of the cuticle can characterize Darier's disease.
Epidermolysis Bullosa is atrophy or loss of nail through an abnormal and thick scar on the nail bed. On the other hand, nail detachment from below-nail injuries identifies pemphigus and pemphigoid. Grooves and thickenings can also be Pityriasis Rubra Pilaris. Both Toxic Epidermal Necrolysis and Stevens-Johnson Syndrome appear through total detachment and loss of nail. The latter, severe cases, are often associated with drug use.
Among the changes linked to systemic diseases we have:
Cardiorespiratory diseases, characterized as clockwork nails, which have exaggerated convexity and bluish color (cyanosis) in the nail bed, in addition to "drum stick" fingers. The yellow nail syndrome is associated with pulmonary processes such as chronic bronchitis, bronchiectasis, pleural effusion and lung cancer. It is present in cases with chronic respiratory insufficiency and heart disease, the nail is round and curved but less thick. Diseases of the liver, present alterations like detachment of the nail, altered form, stretch marks, fragility and nail in crystal. They are often found in patients with cirrhosis.
Gastrointestinal disorders are exemplified in Crohn's Ulcerative Colitis, polyposis and other non-absorbent diseases, where we find nails with changes in shape, color and detachment.
Renal diseases are accompanied by stretch marks white crosses called "nails half-way". The proximal portion is whitish in color and the distal red is pink or sometimes brown. Changes in shape and color, plus brittle nails are also found in chronic kidney disease.
Endocrine disorders are characterized by large nails in acromegaly. In hyperthyroidism the nails grow rapidly and can become soft, apart from the detachment of the bed, stretch marks and spoon format. On the contrary, in hypothyroidism the growth is slow and the nails brittle. In diabetes, there are nail abnormalities that are secondary to neuropathy or vascular changes of the disease. Bacterial infections or fungi also occur along with deformities in the nails.
Blood disorders show pallor of the nail bed in severe anemia. In mycosis fungoides and in lymphomas there is pruritus (itching), and nail wear.
Psychogenic diseases are observed in patients who eat nails, such as compulsive impulse with gnawing and total or partial destruction. In neurotic excoriations we find nails worn by itching.
Diseases of vessels may be displaced, bluish, with striations and changes in curvature are seen in Raynaud's syndrome.
Deficient or metabolic diseases are seen when on vitamin A nails are thinned, looking like egg shell. In vitamin B12 deficiency, pigmentary changes are described in red and blue vitamin D deficiency.
In the case of alterations related to the use of drugs or toxins, we find transverse white lines in prolonged administration of tetracycline. In this case nails of yellowish color may appear. The administration of isotretinoin can induce excessive growth of granulation tissue at the edges of the nails.
There are a multitude of pathologies that manifest themselves or associated with nail changes. Therefore, if you notice disorders of shape, color or fragility, seek medical attention for an adequate diagnostic investigation.
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