Nail abnormalities

Alternative names:

Beau's lines; fingernail abnormalities; koilonychia; leukonychia; onycholysis; spoon nails

Definition:

Abnormal color, shape, texture, or thickness of the fingernails or toenails.

Considerations:

Just like the skin, the fingernails are a telling reflection of a person's state of health.

Pitting (the presence of small depressions on the nail surface) is often accompanied with crumbling of the nail. Detachment of the nail can also occur (the nail becomes loose and sometimes even comes off).

Ridges (linear elevations) can develop along the nail, occurring in a "lengthwise" or "crosswise" direction.

Beau's lines are linear depressions that occur "crosswise" (transverse) in the fingernail. They can occur after illness, trauma to the nail, and with malnutrition.

Leukonychia describes white streaks or spots on the nails.

Koilonychia is an abnormal shape of the fingernail where the nail has raised ridges and is thin and concave. This disorder is associated with iron deficiency anemia.

Common causes:

Trauma

• crush injury to base of the nail or the nail bed may produce a permanent deformity
• nail biting can be a sign of anxiety, chronic tension or uncontrollable compulsion
• chronic picking or rubbing of the skin behind the visible portion of the nail can produce a washboard nail
• chronic exposure to moisture or to nail polish can produce brittle nails with peeling of the edge of the nail

Infection

• fungus or yeast produce changes in the color, texture, and shape of the nails
• bacterial infection may cause a change in color (green nails with Pseudomonas) or painful pockets of infection under the nail or in skin surrounding the nail; severe infections can cause loss of the nail plate
• viral warts may cause a change in the shape of the nail or ingrown skin under the nail

Internal diseases

• disorders that affect the amount of oxygen in the blood (such as abnormal heart anatomy and lung diseases including cancer or infection) may produce "clubbing" of the nail, which looks like the back of a teaspoon
• kidney disease that causes a build-up of nitrogen waste products in the blood
• liver disease including chronic liver failure
• thyroid diseases including hyperthyroidism or hypothyroidism may produce brittle nails or splitting of the nail bed from the nail plate (onycholysis)
• infection (especially of the heart valve) may produce splinter hemorrhages (red streaks in the nail bed)
• systemic amyloidosis
• severe illness or surgery may produce horizontal depressions in the nails (Beau's lines)
• vitamin deficiency can cause a loss of luster or brittle nails
• malnutrition of any sort can affect the appearance of the nails

Skin diseases

• psoriasis may produce pitting, splitting of nail plate from nail bed (onycholysis), and chronic destruction of the nail plate (nail dystrophy)
• lichen planus

Heavy metal ingestion

• arsenic poisoning may produce white lines and horizontal ridges
• silver intake can produce a blue nail

Note: This list is not all inclusive and the causes are not presented in order of likelihood. The list of all possible causes can be extensive and include unlikely diseases and medications. Furthermore, the list will vary based on the age and gender of the individual as well as on the specific characteristics of the symptom, such as location, quality, timing, aggravating factors, relieving factors, and associated complaints. Use the Symptom Analysis option to explore the possible explanations for this symptom occurring alone or in combination with other problems.