Short or long, deep red or rosy pink, manicured or all natural, our nails can be a reflection of our personal tastes, our lifestyles, even our career choices. Nails help us manipulate small objects with our hands, and protect the soft tissues of our fingers and toes.
But perhaps most importantly and surprisingly, our nails can often give the first indication of an underlying disease or medical condition in the body.
According to Joshua Fox, M.D., a leading NY-area dermatologist and founding director of Advanced Dermatology and The Center for Laser and Cosmetic Surgery, changes in the appearance of our nails can indicate anything from a mild infection in the nail bed itself to the possibility of heart disease.
"Because the nails offer such a unique window into the health of our bodies, more and more physicians are making nail examinations part of their regular patient check-up routines," Dr. Fox says.
Dr. Fox notes that about 10% of all skin disorders involve the nails, and that most of these are simple problems. Some conditions, like white spots at the base, or matrix, of the nail or minor bruising or bleeding beneath the nail, usually resolve themselves and require no treatment.
Other problems, like ingrown nails or cracked cuticles, often benefit from professional treatment in order to avoid infection.
Nail infections, either bacterial or fungal, may also require a visit to the dermatologist, Dr. Fox advises. "Swelling or pain at the nail site -- and cracking or peeling of the nails, especially the toenails -- can suggest an infection is present," he says.
The best prevention for nail infections is to keep the nail area clean and dry, and to avoid nail-biting. "Biting the nails can introduce bacteria from the fingers into the mouth, which can cause illness; however, the reverse is also true.
Biting the nails can transfer harmful organisms from the mouth into the nail area, making the nails and the surrounding susceptible to infection or it can transfer harmful elements like lead from the nail into our body as well," Dr. Fox notes.
Beyond simple infections
The color, texture and appearance of nails and surrounding tissue can be a warning sign of more serious health concerns than infection, Dr. Fox explains. Dark lines beneath the nail, for example, may simply be the result of small blood vessels that have broken. But they may also indicate the presence of melanoma, the most serious of all skin cancers.
Other color or texture changes to the nail bed and nail plate that warrant a visit to the dermatologist besides infection, fungus and psoriasis include:
Telling the difference
- White Nails, which could be a sign of liver diseases like Hepatitis
- Half-white, half-pink nails, which could indicate kidney malfunction
- Red nail beds, which may suggest heart disease
- Yellowing, thickening nails, with slowing growth, which can be caused by restricted circulation to the nails; it's sometimes caused by lung diseases like COPD or emphysema
- "Clubbing," which is best described as the inversion of the nail itself so that it begins to resemble a teaspoon; it can also indicate lung problems
- Pale whitish nail beds, which might mean anemia
- A slight blush at the base of the nail, which could be a warning sign for diabetes
- "Pitting" or rippling in the surface of the nail, which can be a symptom of psoriasis or inflammatory arthritis
- Painful lumps at the matrix or under the surface of the nail, which may be a sign that a wart or tumor is growing, and should be tested and/or removed
- Irregular red lines at the base of the nail fold, which may be a sign of Lupus or connective tissue disease.
"It is difficult for patients to tell the difference between a harmless nail condition and one requiring further investigation," Dr. Fox admits. "And the fact is that, because our nails are so exposed and so often used during the course of daily living, they do undergo changes in color and appearance that are often perfectly normal," he adds.
Dr. Fox advises patients that notice a change like those mentioned above, which persists for more than a day or two, to contact their primary care physician or a dermatologist to have the nails examined.
"Dermatologists are well-trained in deciphering between innocuous and serious nail conditions, as well as determining when a change requires further testing," he says.
Joshua L. Fox, M.D. is a leading authority in the field of dermatology with an expertise in skin cancer, cosmetic surgery, and laser procedures. He is an official spokesperson for the American Academy of Dermatology and the American Society of Dermatologic Surgery.
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