All About Nails.
NATIONAL JOURNAL OF HOMOEOPATHY 1995 Nov / Dec VOL VI NO 6.
Asrani C H. 

Hair, nails, sebaceous and sweat glands are considered appendages of skin. Adults have two types of hair - Vellus and Terminal. Vellus hair is short, fine, inconspicuous and unpigmented, white Terminal hair is coarse, thick, more conspicuous and usually pigmented. Scalp hair and eyebrows are examples of Terminal Hair.

Examination of hair - Note its quantity, distribution, pattern of hair loss, identify nits (eggs of lice), differentiate it from dandruff over the scalp. Part the hair at several places and look for scaliness, lumps or other lesions.

Few examples - Fine hair is Hyperthyroidism, coarse hair in Hypothyroidism, Tiny ovoid nits adherent to hairs; loose white flakes of dandruff.

NAIL DISORDERS:

Changes in nail are generally not diagnostic of a specific systemic or skin disease. All of the nail changes of systemic disorders may be seen without systemic diseases. Nail disorders can be classified into three groups -

1. Local
2. Congenital
3. Those associated with systemic or generalized skin disease.

1) LOCAL

1. Onycholysis - this simply means distal separation of nail plate from nail bed. It is generally caused by excessive exposure to water, detergents, soaps etc. (common in housewives and maids). Candidal infection of nail folds and subungal area and nail hardeners may also cause Onycholysis.
2. Distortion of nails - result of trauma and chronic inflammation of the nail matrix.
3. Discoloration and pithy changes accompanied by a musty odor are seen in ringworm infection.
4. Allergic reaction to chemicals in polishes and nail glues are characterized by Onycholysis and grossly distorted, hypertrophic and misshapen nails.

2) CONGENITAL:

1. Longitudinal nail groove may occur as a result of genetic or traumatic defect.
2. Congenital nail atrophy.
3. Congenital nail clubbing.

3) CHANGES ASSOCIATED WITH SYSTEMIC OR GENERALIZED DISEASES:

1. Beaus lines - transverse furrows may follow any serious systemic disease.
2. Atrophy may follow trauma, vascular or neurological disease.
3. Clubbing can be due to several causes (discussed separately).
4. Flat nails (Platynychia) and Spoon nails (Kolionychia) in Iron deficiency anemia.
5. Stippling or pitting of nails in Psoriasis
6. Changes may also occur with Alopecia Areata and Lichen Planus.

CLUBBING:

Clubbing is best appreciated viewing the side of a flexed thumb (profile sign) as shown on page no. 350. As a rule the degree of clubbing may follow severity of the primary disease. Clubbing may at times disappear completely with recovery.

Mechanism of Clubbing - Precise mechanism not known. It is believed to be Nail Hypoxia. Because of hypoxia circulation increases to provide adequate oxygen leading to hypertrophy. Most of the excess blood flow occurs through deep arterio-venous anastomosis.

Causes of Clubbing -

(1) Symmetrical acquired -

1. Pulmonary - pleural, mediastinal or pulmonary disease due to compression, infection or neoplasm. Rarely in Tuberculosis.
2. Cardiac - Cyanotic congenital heart disease, Subacute Bacterial Endocarditis, occasionally congestive failure.
3. Liver - Cirrhosis
4. Gastrointestinal - conditions accompanied acute Diarrhoea
5. Miscellaneous - Myxoedema.

(2) Hereditary may also be unidigital. (Diagrams - next page)

Abnormalities and Variations of the Nails

CLUBBING OF THE NAILS

NORMAL

The angle between the normal finger nail and nail base is about 160 degree. When palpated the nail base feels firm.

EARLY CLUBBING

In early clubbing the angle between nail and nail base straightens out. The nail base gives a springy or floating sensation when palpated. You can simulate this by squeezing your middle finger from each side between your thumb and ring finger of the same hand, just behind the nail. Then palpate the nail base with the index finger of the opposite hand.

LATE CLUBBING

In late clubbing the base of the nail becomes visibly swollen and the angle between nail and nail base exceeds 180 degree.

Clubbing has many causes, including hypoxia and lung cancer.

CURVED NAILS

Curved nails, a variant of normal, should not be confused with clubbing. Here, although the nails show a convex curve as they may in clubbing, the normal angle between nail and nail base is preserved.

SPOON NAILS (koilonychia)

Spoon nails are characterized by concave curves. Spoon nails are sometimes seen in iron deficiency anemia, although they are not specific for this disorder.

BEAUS LINES

Beaus lines are transverse depressions in the nails associated with acute severe illness. Appearing some weeks later, they grow out with the nail gradually over several months.

PARONYCHIA

The term paronychia refers to inflammation of the skin around the nail. It is characterized by swelling and sometimes redness and tenderness.

SPLINTER HEMORRHAGES

Splinter hemorrhages are red or brown linear streaks in the nail bed, parallel to the long axis of the fingers. Although traditionally associated with subacute bacterial endocarditis and trichinosis, they are nonspecific, often occurring with minor trauma or without apparent cause.

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