Brief overview
- Causes: Mechanical or chemical action, injury, fungal infections, nutrient deficiencies, systemic diseases such as diabetes, liver disease, chronic heart and lung disease.
- When to see a doctor: For all changes without a known cause (e.g. a nail injury), medical clarification is advisable.
- Treatment: Depending on the cause, e.g. therapy of the underlying disease, correction of nutrient deficiencies, antimycotics for fungal infections.
- Prevention: cosmetic nail care, protection of nails from chemicals and dehydration, balanced diet.
What are nail changes?
Like hair, nails belong to the so-called appendages of the skin. Healthy nails are considered eye-catching and attractive. A flexible, soft texture with a smooth, curved, transparent surface and a light crescent at the base of the nail are characteristics of healthy nails.
Each person has a slightly different nail shape, which is laid in the cradle.
Anyone who has ever hit their finger with a hammer knows that it takes many months for the blue coloration to disappear and a new nail to emerge.
Nail changes say a lot about their wearer and their health. In the simplest case, yellow fingernails or those that are brittle, fragile and torn only appear unkempt and are therefore an aesthetic issue. In the most unfavorable case, serious diseases are behind the nail changes.
Nail changes manifest themselves quite differently.
Grooves – longitudinal or transverse
Fine longitudinal grooves are a normal sign of aging and thus usually harmless nail changes. Deep transverse grooves (“beau reil transverse grooves”) indicate that the growth of the nail was disturbed. Often an incorrect manicure injures the nail bed.
Examples of poisoning are thallium or arsenic. In some cases, certain drugs such as barbiturates, cytostatics or anticoagulants cause nail changes.
Mees streaks are yellowish-white transverse grooves that run across the nail. The cause of these nail changes is, for example, poisoning with arsenic or thallium.
Discolorations
Discolored nails are caused by changes in the nail plate as well as on top of or underneath it. There are several types of discoloration.
In leukonychia, the keratinization of the nail matrix cells is disturbed. The most common form is leukonychia punctata – it is manifested by many white spots scattered over the nail. Leukonychia vulgaris is recognizable by the white transverse stripes that run across the nail.
In both nail changes, the most common reason is manipulation of the cuticle, usually during manicure.
Half-and-half nails: In these nail changes, a white coloration of the half of the nail plate near the body (proximal) and a reddish-brown coloration of the half of the nail plate far from the body (distal) is found. As a rule, they are an indication of chronic kidney weakness (renal insufficiency).
Darkening of fingernails: Brown nails occur after contact with chemicals (for example, wood stains, hair dyes, nicotine and tar in smokers) or in Addison’s disease. Splinter hemorrhages cause reddish-brown spots in the nail bed.
Nail changes in the form of bluish discoloration of the nail bed indicate a lack of oxygen in the tissue (cyanosis). Heart failure or carbon dioxide poisoning are examples of causes. In the case of carbon monoxide poisoning, on the other hand, the nail bed turns cherry red.
In “yellow nail syndrome”, yellowish to gray-green discoloration, thickening and hardening of individual or all nails are typical. The nails grow significantly slower. The syndrome is often accompanied by respiratory diseases (for example, bronchitis, pneumonia) and lymphedema.
Deformations
In a spoon nail (koilonychia), the nail plate sinks inward while the edge bends upward. The nail is concave in shape like a spoon. The spoon nail forms most frequently on the thumb. Iron deficiency or exposure to chemicals are possible causes.
Brittle nails
Some people have extremely brittle nails (onychorrhexis). The nail tears, splits lengthwise or splits from the free edge of the nail. Frequent contact with cleaning agents and chemicals such as nail polish remover is often the reason. These agents dry out the skin and nails.
In onychoschisis, the nail plate usually splits horizontally. Reasons are also here deficiency and malnutrition (vitamins, iron) as well as exaggerated hygiene.
Other nail changes
Sometimes the nail plate partially detaches (onycholysis) from the nail bed – this is a relatively common phenomenon. For example, the nail partially lifts off due to too long exposure to water, soaps, detergents or too intensive nail cleaning. More rare is the total detachment of the nail (onychomadesis).
How do nail changes in children manifest themselves?
Nail changes in children are rarely congenital. In the case of congenital changes, there are usually certain syndromes behind them. For example, the nails are not properly formed.
Sometimes ingrown nails occur in older children and adolescents. This usually affects the nail of the big toe and is often accompanied by inflammation and pain in the lateral area of the nail.
With nail fungus, the nails become discolored and are often brittle. However, nail fungus is rather rare in children.
Various skin diseases are also associated with nail changes in children in some cases, including:
- Psoriasis: Dimples in the nail plate (so-called spotted nails), excessive keratinization with lifting of the nail plate, nail discoloration.
- Neurodermatitis (atopy): If applicable, with hand eczema that spreads to the nails, transverse furrows, wavy nail surface.
As in adults, nail changes in children also occur as a result of injuries or incorrect nail care.
What are the possible causes of nail changes?
Longitudinal or transverse grooves, white spots or deformations – there are different types of nail changes. Various causes are possible. They are often harmless, but sometimes changed nails indicate a serious disease.
For example, the following causes are possible for nail changes:
- Injuries (e.g. bruise under the nail).
- Chemicals that dry out the nail (e.g. cleaning agents)
- Fungal infections
- Febrile infections
- Insufficient supply or absorption of nutrients or trace elements
- Poisoning, e.g. with heavy metals
- Diseases of internal organs, such as kidneys, liver, heart and lungs
- Autoimmune diseases such as psoriasis
When to see a doctor?
Also, nail changes caused by incorrect manicure and injuries to the nail bed do not necessarily require medical treatment. However, it is recommended to visit an experienced beautician, who will show you the correct nail care.
Even in the case of nail discoloration, it is always advisable to consult a doctor to be on the safe side. This is especially true if the discoloration does not grow out.
How can nail changes be treated?
It may be helpful to support the healthy condition of the nail, for example by greasing it regularly.
If nutrient deficiencies have led to nail changes, the doctor will prescribe appropriate preparations to compensate for them.
In the case of nail fungus, antifungal agents (antimycotics) are used.
If internal diseases (such as metabolic, liver, heart and lung diseases) are the cause of the nail changes, their treatment is the focus of therapy.
An experienced doctor reads your nails like a book. Important are color, structure, strength, texture and the shape of the nail.
At the beginning is the patient interview (anamnesis). The doctor asks, for example, how long the nail changes have existed, whether they occurred suddenly, whether you suffer from diseases, take medication or handle chemicals. From your answers, a specialist already draws conclusions about possible causes.
If deficiency symptoms or internal diseases are the reason for the nail changes, there are often other complaints that give the doctor clues for the diagnosis. In most cases, a blood test and a more detailed examination of the diseased organs (such as the heart or lungs) are then performed.
How can nail changes be prevented?
There are some tips on how to prevent nail changes or how to treat them yourself:
- It is best to avoid nail polish remover and other aggressive substances that cause nail changes.
- It is best to file your nails short and grease them sufficiently (greasing nail creams, warm olive oil bath for the fingertips).
- Do not remove the cuticles completely during the manicure, but only push them back carefully.
- In case of a proven nutrient deficiency (e.g. iron, biotin, vitamins, calcium), dietary supplements will help.
- In the case of nail changes due to a lack of fluids, the motto is: Drink enough!
- If you have a nail fungus: Carry out the medicinal therapy consistently, otherwise the infection will flare up again and again.
