Nail & Skin Disorders

The Nail Doctor: Nails Are A Window To Your Client's Health

The stories your client s nails tell might not make you a fortune teller, but they do reveal more about her than the polish color she likes best.

Doctors in training are taught that no physical examination is complete unless it includes an examination of the nails. Nail technicians as well should be especially attuned to any changes in nails that deviate from their normal appearance. It is not unusual for the nail technician to be the first one to detect an abnormality that represents a sign of systemic illness and thus provide clients with an invaluable and important service.

When the half of the nail near the cuticle is white and the other half is pink, it is referred to as the “half-and-half” nail. Fifty percent of these people will have kidney disorders, and a lesser percentage will have liver problems. However, it may also be a normal finding in some individuals, but a medical evaluation is recommended at this point. If the nail becomes all while, liver disease must also be considered, particularly if the client is known to drink alcohol frequently. Along similar lines, nail beds that are very pale (instead of the normal pink color) could indicate low iron levels, or anemia, and this possibility should be examined. Iron deficiency may also be associated with nails that are indented, so-called “spoon nails,” or koilonychia. White bands across the nail bed are referred to as Muehrcke’s lines, which occur when proteins in the blood are markedly below normal levels. Low blood proteins is a factor in many medical conditions, with liver and kidney disease being the most frequent disorders of this nature. If the while bands across the: nail are in the nail plate (as opposed to in the nail bed), heavy-metal intoxication, which can be a result of arsenic or lead poisoning, should be: considered. However, trauma or injury to the nail matrix may also give rise to white lines across the nail. This could be due to something simple such as over-vigorous pushing back of the cuticles. Therefore, do not alarm your clients unnecessarily unless there is some evidence of a more serious problem.

Another nail color change of significance is known as yellow nail syndrome (a condition not related to polish discoloring the nail plates). This disorder persists with yellow discoloration of all 20 nails accompanied by loss of the cuticles. A client may be suffering from edema (swelling of the legs and face) or a lung disease such as pleurisy or associated asthma. Yellow nails also are seen in diabetics and occasionally in clients with fungal infections. In these situations, however, the cuticles are not lost. Sudden appearance of brown or black discoloration of all the nails usually means a medication reaction. Examples of drugs that can cause this include the AIDS drug AZT, the antibiotic minocycline, some tranquilizers, and anti-malaria drugs. A chalky-white fungal infection near the cuticle, referred to as proximal while subungual onychomycosis, is often a sign of HIV infection and the client should get a medical evaluation. A bright cherry red color to the nail beds occurs in some patients with heart disorders and can also be seen as a result of carbon monoxide poisoning.

Changes in the proximal nail fold occur in patients who get lupus, a disorder characterized by inflammation of the skin. The nail folds become red, sometimes puffy, and the capillaries look more prominent, even visible without magnification. Such patients should seek early medical care if they have not already done so. When the nail does not separate normally from the skin underneath, it is referred to as inverse pterygium and could be due to poor circulation or a condition known as scleroderma, where the skin becomes hard and loses flexibility. In this condition, the nails also become curled outwards and resemble a birds beak, a condition called “beaking.”

Another disorder, known as Bazex syndrome, may be a sign of systemic (affecting the entire body) cancer. In this situation, all the nails crumble and may even be lost from the cuticle outward. The proximal nail folds flake excessively, and there is associated scaling of the skin on the ears and tip of the nose. Since the nail changes come before other symptoms, they are important signs a doctor should be alerted. Dermatologic evaluation is essential because Bazex syndrome may resemble nail psoriasis, a more benign disease. Lymph gland cancer that affects the skin, called cutaneous T-cell lymphoma, can give rise to markedly thickened nails which also crumble and have very thick nail beds as well.

Another noteworthy syndrome, often overlooked, is the nail-patella syndrome. The patella (knee cap) may be absent or very small in these patients, and is associated with bone changes in the elbows and hips as well. The changes in the bones have an adverse effect on walking, and these patients waddle like a penguin when they walk. The bone changes often go unrecognized unless an alert dermatologist observes the nail abnormalities. Here, the lunulas change shape and become triangular rather than the normal crescent-shape, and the nail plates split down the middle. Half of the nail is indented, and the other half is destroyed. These patients may eventually develop serious kidney disease later on so that early recognition of this syndrome from the nails is very important.

Chronic swelling of the proximal nail folds associated with indentations of the nail from side to side is referred to as paronychia. When this is consistently associated with yeast (candida) infection, the patient should be checked for diabetes, which may predispose these individuals to this problem. Women should also be checked for vaginal yeast infection. Finally, a client who has nail psoriasis and complains of joint pains should be checked for psoriatic arthritis, which is often overlooked but potentially destructive.

It is thus evident that a wide range of diseases involving many different systems and body organs also affect the nails. The nail technician is in the position of being the first one to note these changes and, hopefully, recognize their significance.

It’s the nail technician’s responsibility to observe the condition of her client’s nails and to point out any deviations from a normal healthy nail. It is also her job to let the client know that sometimes these changes can be indicative of larger health problems. At the same time, it is the nail technician’s responsibility not to scare her clients. Don’t jump to a conclusion about your client’s state of health just because a nail may display a symptom of a serious disorder. Let her know that her nail condition warrants further investigation to rule out a dangerous health condition.

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Hannah Lee has been an editor on NAILS Magazine since 1999, and executive editor since 2005. She oversees the entire editorial production of the...
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