Nails have a role in health and disease

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The nails are situated at the top of every fingertip on the dorsal surface.The main function of the nail is to provide protection, and it also provides a firm grip for holding articles.It is composed of a robust, relatively flexible keratinous nail plate originating from the nail matrix. There is a soft tissue called the nail bed under the nail plate.There is a nail fold or cuticle between the skin and the nail plate.The normal healthy nail is pink in colour, and therefore the surface is convex from side to side.The growth of fingernails is estimated to be 1 cm in three months, whereas the growth of toe nails is estimated to take 24 months.

The color, appearance, shape, and nature of the nails can provide some information about an individuals overall health and hygiene. All doctors examine the nails as a routine to seek clues about underlying diseases.By observing nails, we can discern the level of hygiene of an individual.An abnormal nail could also be congenital or due to some diseases.The causes of changes in the nail range from simple to life-threatening diseases.Hence, the examination by a doctor is important for diagnosis.Several abnormal findings with probable causes are discussed here for general awareness.

Hygiene is the most important aspect of hygiene.

We are able to determine an unhygienic nail very easily.The presence of dirt under the distal end of the nail plate can create an opportunity for pathogens to be inhaled while eating.If the manicure is not done properly, it may result in worm problems in children.When the worms go to bed, children will scratch the anal orifice, which will lodge the ova of the worm under the nails. This can be taken in while eating.A prominent nail can also complicate a disease of the skin by causing habitual scratching.Sharp nails in young children can result in minor wounds when they engage in foot kicking or hand waving activities.

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The nail color.

• The appearance of nails becomes pale during anaemia.
• Leuconychia, an opaque white discolouration, is seen in chronic kidney failure and nephrosis.
• It is also seen in hypoalbuminaemia, cirrhosis, and kidney disorders
• Drugs such as sulphate group, anti-malarial and antibiotics can cause discolouration within the nails.
• Mycosis causes black discolouration, caused by mycosis.
• In pseudomonas infection, nails turn black or green.
• Nail bed infarction is a common occurrence in vasculitis, particularly in patients with SLE and polyarteritis.
• Red dots can be seen in nails due to splinter haemorrhages in subacute bacterial endocarditis, atrophic arthritis, trauma, and collagen vascular diseases.
• Blunt injury causes hemorrhage and causes blue/black discoloration.
• Nails become brown in kidney diseases and decreased adrenal activity.
• The semicircle of blue color appears within the nail in Wilson's disease.
• When the blood supply decreases, the nails will turn yellow.In jaundice and psoriasis, the nail also becomes yellowish.
• In yellow nail syndrome, all nails become yellowish with a pleural effusion.

The form of the nails.

1. Here, tissues at the bottom of nails are thickened and thus the angle between the nail base and the skin is obliterated. The convexity of the nail leads to a bulbous appearance of the finger tip, resembling that of a drumstick. When the condition becomes worse, the nail looks like a parrot's beak.

Clubbing causes:

• Congenital injuries can lead to congenital injuries.
• Chronic severe cyanosis.
• The diseases of the lungs, including empyema, bronchiactesis, carcinoma of the bronchus, and consumption. Abdominal diseases such as regional enteritis, polyposis of colon, ulcerative colitis, liver cirrhosis, and ect.
• Heart diseases like tetralogy of Fallot, subacute bacterial endocarditis, etc.

2. Koilonychia is a Greek island.

Here, the nails become convex, like a spoon.This condition is found in iron deficiency anaemia.In this condition, nails become thin, soft, and brittle.The conventional convexity will be substituted by concavity.

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3. Raynauds disease is characterized by longitudinal ridging.

4. The cuticle becomes ragged with dermatomyositis.

5. The nail fold telangiectasia may be a sign of dermatomyositis, systemic sclerosis, and SLE.

Structure and consistancy of the structure and consistancy.

1. Mycosis of nail causes discolouration,deformity,hypertrophy and abnormal brittleness.
2. Thimble pitting of nail is charecteristic of psoriasis, acute eczema and alopecia aereata.
3. The inflamation of cuticle or nail fold is named paronychia.
4. Onycholysis is that the seperation of nail bed seen in psoriasis,infection and after taking tetracyclines.
5. Destruction of nail is seen in lichen ruber planus, epidermolysis bullosa.
6. Missing nail is seen in nail patella syndrome.It is a genetic disease.
7. Nails become brittle in raynauds disease and gangrene.
8. Falling of nail is seen in mycosis, psoriasis and thyroid diseases.

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.