Noah Sinclair
Human nails are protective plates found at the tip of fingers and toes, corresponding to the claws in other tetrapod animals. They are made of a tough, rigid protein called alpha-keratin, which is also found in the claws, hooves and horns of vertebrates. While nails are generally flat, certain conditions can cause them to curve downward, resembling a claw. This condition is known as nail clubbing, which is often associated with underlying health issues, particularly affecting the heart, lungs, liver or digestive system.
| Characteristics | Values |
|---|---|
| Cause | Nail clubbing, also known as "Ram's horn nails", is often associated with diseases of the heart and lungs, such as lung cancer, lung infections, interstitial lung disease, cystic fibrosis, or cardiovascular disease. It can also be caused by digestive conditions like Crohn's disease, liver disease, or celiac disease. In some cases, it may be due to a family history of nail clubbing or a result of aging. |
| Symptoms | Nails become thick, overgrown, and curved downward. They may feel soft and sponge-like, warm to the touch, and form a rounded, bulging shape similar to an upside-down spoon. The fingertips may swell, and the nails may start to feel spongy when pressed. |
| Treatment | Treatment options depend on the underlying cause and may include chemotherapy, surgery, radiation therapy, or medications. For conditions like celiac disease, a gluten-free diet may be recommended. |
| Prevention | There is no known way to prevent nail clubbing. |
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What You'll Learn
Nail clubbing
In some instances, nail clubbing may be hereditary. If your biological parents had clubbed nails, you may also develop them. Nail clubbing can also occur in healthy individuals with no obvious cause. However, as it is often a sign of a serious health condition, it is important to seek medical advice if you notice your nails beginning to curve.
Treatment for nail clubbing is typically directed at the underlying cause. For example, a treatment plan may include chemotherapy, surgery, radiation therapy, or medications for lung cancer. A gluten-free diet may be recommended for those with celiac disease, and heart surgery may be necessary for congenital heart conditions.
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Koilonychia
One of the most common causes of koilonychia is iron deficiency or anaemia. This can be due to various factors such as malnutrition, intestinal blood loss, cancer, or excessive menstruation. Treating iron deficiency through dietary changes or supplements can help correct and prevent spoon nails. Other nutritional deficiencies, such as low folate, protein, vitamin C, or vitamin B, can also contribute to the condition.
In some cases, koilonychia may be associated with certain medical conditions, including diabetes mellitus, heart disease, hemochromatosis (iron overload), lichen planus, lupus, Raynaud's phenomenon, and Plummer-Vinson syndrome. It can also be related to inflammatory skin diseases, such as psoriasis, or occupational exposure to petroleum products, especially among hairstylists.
Additionally, koilonychia has been linked to genetic factors and high-altitude environments. People living at high altitudes tend to have a higher risk of developing spoon nails due to the decreased oxygen levels, which can lead to increased red blood cell production and, consequently, higher iron usage by the body.
While koilonychia itself is not an infection, it can sometimes be accompanied by fungal nail infections, resulting in inflammation or irritation. It is important to note that not everyone with an underlying disease will exhibit koilonychia, and the exact incidence and prevalence of this condition across different age groups and genders are not yet fully understood.
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Onycholysis
The treatment for onycholysis depends on the cause. It may involve ceasing or changing a medication, treating a nail infection, or addressing an associated systemic condition or dermatosis. In the case of an underlying thyroid condition or vitamin deficiency, a doctor may prescribe medication or an oral supplement. To prevent secondary infection, it is recommended to keep the nails short, minimise trauma to the nail and nail bed, and avoid potential irritants such as nail enamel, enamel remover, solvents, and detergents.
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Paronychia
Chronic paronychia is a gradual process that may start in one nail fold but can spread to several other fingers. The cause of chronic paronychia is not fully understood, but it is often associated with dermatitis of the nail fold. It is also more common among people with constantly cold and wet hands, such as bartenders and dishwashers. Symptoms include red and tender skin, with possible white, yellow, or green pus under the cuticle. The nail plate may thicken and become distorted, with transverse ridges.
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Chemotherapy
The impact of chemotherapy on nail health can be surprising to patients. Chemotherapy disrupts the growth cycles of new cells, particularly affecting the keratin-rich cells that make up the skin and nails. This disruption can result in the various nail changes mentioned above. While nail changes may be a side effect of chemotherapy, it is important to note that they are typically short-term, and most patients' nails grow back healthy after completing treatment.
Adjuvant chemotherapy, or chemotherapy received after primary treatment such as surgery, aims to improve the outcome of initial treatment. For example, R-EPOCH is a combination chemotherapy treatment for B-cell non-Hodgkin's lymphoma. Transarterial Chemoembolization (TACE) is a procedure that delivers chemotherapy drugs directly to liver tumours while also restricting blood flow. These specific chemotherapy treatments may carry their own set of side effects, which can include further nail changes.
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Frequently asked questions
Curved nails, also known as nail clubbing, can be a harmless trait that runs in the family. However, it could also be a sign of underlying health issues, especially with the heart and lungs, like lung cancer, lung infections, interstitial lung disease, cystic fibrosis, or cardiovascular disease.
Thick and overgrown nails, also known as Ram's horn nails, can be caused by a variety of factors, including family history, psoriasis, ichthyosis, or circulation problems.
Dents in your nails, known as pitted nails, could indicate a disease that affects your entire body.
Fever, injury, chemotherapy, or major stress can cause nails to grow slowly or stop growing.
Thin, spoon-shaped nails, or koilonychia, may indicate an iron deficiency.
