NAILS IN HEALTH AND DISEASE.
Introduction:
The nails are present at the top of every finger tip on the dorsal surface.The main function of nail is protection and it also helps for a firm grip for holding articles.It consists of a robust relatively flexible keratinous nail plate originating from the nail matrix. Under the nail plate there's a soft tissue called nail bed.Between the skin and nail plate there's a nail fold or cuticle.Normal healthy nail is slight pink in colour and therefore the surface is convex from side to side.Finger nails grow 1 cm in three months and toe nails take 24 months for an equivalent .
Importance of nails in disease diagnosis:
The colour ,appearance,shape and nature of the nails give some information about the overall health and hygiene of an individual . Nails are examined as a routine by all doctors to urge some clues about underlying diseases.Just watching nails we will makeout the hygiene of an individual .The abnormal nail could also be congenital or thanks to some diseases.The cause for changes within the nail extend from simple reasons to life threatening diseases.Hence the examination by a doctor is important for diagnosis .Some abnormal findings with probable causes are discussed here for general awareness.
1) Hygiene:-
We can figure out an unhygienic nail very easily .Deposition of dirt under the distal end of nail plate can make an opportunity for ingestion of pathogens while eating.If manicure isn't done properly it may result in worm troubles in children.When the worms go to bed the anal orifice children will scratch which lodges the ova of worms under the nails and can be taken in while eating.Prominent nail also can complicate a disease of the skin by habitual scratching.Sharp nails in small kids cause small wounds once they do feet kicking or hand waving.
2) Colour of the nails:-
a) Nails become pale in anaemia.
b) Opaque white discolouration(leuconychia) is seen in chronic kidney failure and nephrosis .
c) Whitening is additionally seen in hypoalbuminaemia as in cirrhosis and kidney disorders.
d) Drugs like sulpha group,anti malarial and antibiotics ect can produce discolouration within the nails.
e) mycosis causes black discolouration.
f) In pseudomonas infection nails become black or green.
g) Nail bed infarction occures in vasculitis especially in SLE and polyarteritis.
h) Red dots are seen in nails thanks to splinter haemorrhages in subacute bacterial endo carditis, atrophic arthritis , trauma, collagen vascular diseases.
i) Blunt injury produces haemorrhage and causes blue/black discolouration.
j) Nails become brown in kidney diseases and in decreased adrenal activity.
k) In wilsons disease blue color semicircle appears within the nail.
l) When the blood supply decreases nail become yellow .In jaundice and psoriasis also nail become yellowish.
m) In yellow nail syndrome all nails become yellowish with pleural effusion.
3) Shape of nails:-
a) Clubbing: Here tissues at the bottom of nails are thickened and therefore the refore the angle between the nail base and the skin is obliterated. The nail becomes more convex and therefore the finger tip becomes bulbous and appears like an end of a drumstick. When the condition becomes worse the nail seems like a parrot beak.
Causes of clubbing:-
Congenital Injuries
Severe chronic cyanosis
Lung diseases like empyema,bronchiactesis,carcinoma of bronchus and consumption .
Abdominal diseases like regional enteritis ,polyposis of colon,ulcerative colitis,liver cirrhosis ect...
Heart diseases like tetralogy of Fallot ,subacute bacterial endocarditis and ect..
b) Koilonychia:-
Here the nails become concave sort of a spoon.This condition is seen in iron deficiency anaemia.In this condition the nails become thin,soft and brittle.The normal convexity are going to be replaced by concavity.
c) Longitudinal ridging is seen in raynaud's disease.
d) Cuticle becomes ragged in dermatomyositis.
e) Nail fold telangiectasia may be a check in dermatomyositis ,systemic sclerosis and SLE.
4) Structure and consistancy:-
a) mycosis of nail causes discolouration,deformity,hypertrophy and abnormal brittleness.
b) Thimble pitting of nail is charecteristic of psoriasis ,acute eczema and alopecia aereata.
c) The inflamation of cuticle or nail fold is named paronychia.
d) Onycholysis is that the seperation of nail bed seen in psoriasis,infection and after taking tetracyclines.
e) Destruction of nail is seen in lichen ruber planus ,epidermolysis bullosa.
f) Missing nail is seen in nail patella syndrome.It is a genetic disease .
g) Nails become brittle in raynauds disease and gangrene.
h) Falling of nail is seen in mycosis ,psoriasis and thyroid diseases.
5) Growth:-
Reduction in blood supply affects the expansion of nails. Nail growth is additionally affected in severe ilness. when the disease disappears the expansion starts again leading to formation of transverse ridges.These lines are called Beau's lines and are healpful so far the onset of illness.
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