NAIL CHANGES
There are various types of nail changes, such as thickening
(onychogryposis), thinning, deformity, and separation from the nail bed
(onycholysis). Whenever a peculiarity of the nail exists, the mnemonic
VINDICATE will help to recall all the causes.
V—Vascular disease includes the anoxic disorders that cause
clubbing , iron deficiency
anemia that causes spoon nails or koilonychia, Raynaud disease, vasculitis
(periarteritis nodosa), and peripheral arteriosclerosis, which causes
dystrophy or onychogryposis of the nails.
I—Inflammatory diseases that involve the nail bring to mind
fungus infections causing onychia (nail bed inflammation), paronychia,
syphilis (which can cause almost any nail change), subacute bacterial
endocarditis (SBE), and trichinosis, which causes splinter hemorrhages of
the nail.
N—Neoplasms do not usually cause nail changes, with the exception
of clubbing and pallor from secondary anemia. Chondromas, melanomas, and
angiomas are a few neoplasms that do. Intestinal polyposis may cause nail
atrophy. The N, however, can be used to recall neurologic
disorders such as peripheral neuropathy (dystrophy or onychogryposis),
syringomyelia, and multiple sclerosis.
D—suggests deficiency diseases such as avitaminosis
(B2 and D).
I—Intoxication includes arsenic (white lines and transverse
ridges across the nails) and radiodermatitis.
C—Congenital disorders include psoriasis, congenital ectodermal
defects, absence of nails (onychia), micronychia, and macronychia.
A—Autoimmune disorders suggest scleroderma, periarteritis nodosa,
eczema, and lupus.
T—Trauma causes the familiar subungual hematoma that turns
the nail to turn dark red or
black.
E—Endocrine disorders are probably some of the most important
causes of nail changes. Hypothyroidism produces nail dystrophy, brittleness,
and onycholysis; similar changes, plus spooning of the nails, occur in
hyperthyroidism. In hypopituitarism, these may be dystrophy, loss of the
subcuticular moons, and spooning. Thickening and transverse grooving of the
nails may be seen in hypoparathyroidism.
Approach to the Diagnosis
The diagnosis of nail abnormalities begins by correlating the nail
changes with other findings (e.g., neurologic and endocrinologic).
Laboratory workup depends on the particular disease or diseases suggested by
the nail changes (see Appendix A).
Other Useful Tests
-
Complete blood count (CBC) (iron deficiency anemia)
- Sedimentation rate (chronic infectious disease)
- Blood cultures (SBE)
- Trichinella antibody titer (trichinosis)
- Free thyroxine (FT4) and sensitive thyroid-stimulating
hormone (S-TSH) levels (hyperthyroidism,
hypothyroidism)
- Serum parathyroid hormone (PTH) (hypoparathyroidism)
- Serum growth hormone, luteinizing hormone (LH),
follicle-stimulating hormone (FSH) (hypopituitarism)
- Computed tomography (CT) scan of the brain (pituitary tumor)
- Chest x-ray (neoplasm, tuberculosis, bronchiectasis)
- Arterial blood gas (pulmonary disease, heart disease)
- Hair analysis for arsenic (arsenic poisoning)
- Antinuclear antibody (ANA) analysis (collagen disease)
- Glucose tolerance test (diabetic arteriolar sclerosis)
Pictures
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Nail symptoms
Read excerpts from these other book chapters related to Nail symptoms:
Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.
More About Causes of Nail symptoms
» Next page: PALLOR OF THE FACE, NAILS, OR CONJUNCTIVA (Differential Diagnosis in Primary Care)
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