What your nails say about your health


Dr. Steven Rotter is a Vienna, Virginia Board Certified Dermatologist who is fervent about making people aware that changes in skin and nails must be given the same level of attention and scrutiny as other physical symptoms men and women experience within their body. All too often, we only see a doctor for symptoms we can feel such as stomach or back pain. Visible changes to nails and skin can be indicative of conditions such as skin cancer or other systemic issues. As always, early detection is best with any condition. “When in doubt always seek guidance from a physician,” says Dr. Rotter.  Dr. Rotter shares some key red-flags for skin and nails that may signal more serious health issues.

A perfectly manicured hand is one where the nails are strong and smooth, with no discoloration, jagged cuticles or other signs of abuse. But what about nails that are less than perfect? Since many health problems have an impact on the nails, it’s worth listening to what your hands have to say.
Skin cancers are a serious concern.  They can develop in the nail bed, matrix, or nail folds.  Malignant melanoma, the deadliest form of skin cancer, may first be observed as a long pigmented band of black or dark brown in the nail plate, most often on the thumb or big toe.  And wart-like lesions on the nail fold or in the nail bed could be squamous cell carcinomas.

So how do you protect these guardians of your fingers from the ravages of the sun? Dr. Rotter suggests the following:
         Moisturize daily.  This is the best way to keep nails from flaking and cracking.  Dr. Rotter recommends lactic acid creams in 5 -12 percent concentrations.
         Wear gloves.  European and American women used to wear gloves whenever they went outside to keep their hands soft and protected.  Although that may not be practical these days, cold weather dries out the nails, so wear gloves when the elements demand it.  Use rubber gloves when working with cleansers, detergents or solvents.
         Leave the cuticle alone.  The cuticle is a seal that protects the nail matrix, and disturbing this seal increases your risk of inflicting permanent damage.  Never remove the cuticle, and don't trim it or push it back. If you have a wart near your nail, do not pick at it as it can transform into squamous cell carcinoma.  See a doctor if it doesn’t go away in a few months.
Beware of dangerous UVA Rays at the nail salon.  Women who visit beauty salons to have their nails done could be increasing their risk of skin cancer, according to a UK report. Doctors raised the alarm after two women developed tumors on their hands from exposure to ultra-violet lamps used to fix artificial nails. The lamps can also be bought for home use. But experts now fear the high dose of UVA rays - the most dangerous form of ultra-violet light they produce could be damaging skin cells.

“Regular users should have their hands and fingers inspected for signs of cancerous growths,” says Dr. Rotter. Most salons specialize in nail extensions which can be fixed on to a customer's own nails, then painted or decorated. But there have already been concerns that poorly trained nail technicians may be putting customers' health at risk by using cheap but potentially hazardous chemicals. Because the matrix originates under the cuticle, getting a manicure can harm it if the equipment isn't sterilized.  And when a drill is inserted under the cuticle to smooth it, the matrix cells can be ground up so badly that they cannot regenerate.  Nail sculpture chemicals can also drip down into the matrix, causing damage.  "When the matrix cells are damaged, they may never grow properly again, and the nail will always be deformed," says Dr. Rotter.
It’s the Pits.  When the normally smooth surface of the fingernail has several small dents or pits in it, that can be a signal that something is going on beneath the nail. Most often, the cause of those dents is psoriasis. The inflammatory skin condition—it shows up as red, scaly patches on the skin—can also affect the skin cells in the nails. Instead of growing out smoothly, the surface of the nail takes on a dented appearance. Once the psoriasis is treated and under control, nails will slowly return to normal. Since nails only grow about a millimeter per week, it will take a few months for the old, pitted nail to fully grow out and be replaced with a healthy one.

What Do Spoon-shaped Nails Indicate?  A healthy nail has a specific shape—slightly raised in the middle, then curving down a bit at the tip. So when you see a nail with the exact opposite configuration, that should be a clue that all is not right. “Dark nails or thin, flat, spoon-shaped nails are a sign of iron deficiency anemia,” says Dr. Rotter.  As with many health problems, it can take months of iron deficiency before the problem shows up in the nails. And when the anemia is corrected, it will take awhile for normal-shaped nails to re-grow.
Peeling Nails?  Why It’s Happening.  The nail plate is made up of several layers of keratin (a protein). Ideally, those layers are sealed together to form a unified, strong nail. But when nails aren’t protected—your hands are in water a lot, or exposed to cold, dry air—those layers tend to delaminate. The result is nails that are likely to peel. Besides being an indication that you need to take better care of your nails—polish can help seal the layers and moisturizing them several times a day will keep the layers supple—peeling nails can mean a diet that’s lacking in linoleic acid. The easiest way to up your intake is to increase your use of vegetable oils. 
Brittle Nails.  By some estimates, about 20 percent of women suffer from a condition called “brittle nail syndrome.” While it may sound like just a fancy name for nails that break easily, the causes go deeper than that. Brittle nails are ones that can’t hold on to moisture, so the layers of the nail plate dry out and crack. Medically speaking, it’s possible for an under-active thyroid to cause both dry skin and brittle nails. Nutritionally, a diet low in iron can cause nails to become thin, brittle and easily broken (eating more green, leafy vegetables, red meat and eggs will help boost your iron intake). Biotin supplements (a B-complex vitamin) have also been shown to improve the condition of brittle nails. The main culprit of brittle nails? Excessive exposure to water. Constantly wetting and drying your hands (and nails) can make brittleness worse.
It’s Not Easy Being Yellow.  A healthy nail (with healthy skin beneath its bed) has a soft, pinkish hue. When it doesn’t, that may be a reason to worry. “When all of the nails turn yellow it can be a sign of lung disease or diabetes,” says Dr. Rotter. “Yellow spots on the nails can be an indicator of fungus or psoriasis.” Since any of these conditions warrants treatment by a doctor, it’s worth seeing a dermatologist if yellow nails persist. Women who frequently wear very dark nail polish for long periods of time (especially without using a protective basecoat underneath it) may also notice a slight yellowing of their nails, but it’s no reason to panic. The nails are merely stained from the polish and will return to their normal shade if they are left unpolished for a while.

Yellowish Skin, Orange Palms and Soles.  The cartoonish skin hues of carotenemia can be the unfunny result of an underactive thyroid gland -- hypothyroidism -- which causes increased levels of beta-carotene in the blood. Beta-carotene is an antioxidant, found in fruits and vegetables that normally gets processed by the thyroid. When there's a thyroid problem, the gland doesn't metabolize the vitamins as quickly, so beta-carotene accumulates. You can also get Technicolor skin due to beta-carotene buildup thanks to a diet heavy on carrots, carrot juice, sweet potatoes, and squash.  According to Dr. Rotter, “Carotenemia is caused by a skewed diet isn't serious and resolves itself when a broader range of foods is consumed. Hypothyroidism, however, is a medical condition that can lead to such complications as heart problems, so a combination of skin changes plus fatigue warrants attention from a doctor.” 

Breaking Out In Hives In The Sun.  Being truly allergic to the sun is pretty rare (although this kind of immune system response can happen in some people). A more likely explanation for going outside on a sunny day and coming back with an itchy rash that looks like hives or eczema is having taken a photosensitizing drug. A chemical in the medication causes changes that increase the person's sensitivity to light. "It's common in the Northeast to have no problem all winter long, and as soon as the weather gets nice and folks are outside less bundled up, the rash appears," says Dr. Rotter.  Check the labels of your prescription medications. Look for phrases such as "may cause chemical photosensitivity."   Dr. Rotter advises to use a high-SPF sunscreen or sunblock but know that this may not prevent the rash; the best advice is to wear sunglasses and a broad-rimmed hat, cover the skin, and limit sun exposure.   Tell your doctor, too; a switch in medicines may prevent further rashes.
Long Dark Lines in the Palm.  A palm-reading mystic might have her own interpretation, but to a physician, a deepening of the pigment in the creases of the palms or soles is a symptom of adrenal insufficiency, an endocrine disorder also known as Addison's disease. Hyperpigmentation may also be visible around other skin folds, scars, lips, and pressure points (knees, knuckles). Addison's sufferers have low blood pressure, which falls further when the person stands. Salt loss can lead to a craving for salty food. The disease affects men and women equally but is found most commonly between ages 30 and 50.  According to Dr. Rotter, it's important to mention this visible symptom to a doctor, as skin changes may be the first symptoms seen before an acute attack (pain, vomiting, dehydration, and loss of consciousness, a cascade known as an Addisonian crisis). Lab tests to measure cortisol (which is produced by the adrenal gland) provide a diagnosis.

Large, Dusky Blue Leg Veins.  Some of your veins are no longer working properly when you spy ropy, blue-to-purple lines snaking up your legs. Venous disease -- a.k.a. varicose veins -- can be a mere cosmetic annoyance or can cause pain, cramping, and difficulty walking. Veins rely on one-way valves, like shutters, to keep blood circulating; when they stop working, blood leaks back into the vein and pools there.  Varicose veins are also sometimes mistaken for spider veins, a web-like network of smaller blue or red veins closer to the skin's surface. Varicose veins tend to be larger, darker, and sometimes raised, with a twisted appearance. Half of all people over age 50 have varicose veins, especially women. They often first appear in pregnancy.  “Exercise, compression stockings, and avoiding constricting postures - like crossing your legs when seated - can help ease discomfort, but they won't make varicose veins disappear,” says Dr. Rotter.  Not all faulty veins cause problems. However, if the veins cause pain or become warm and tender to the touch, tell your doctor. Severe venous insufficiency can lead to dangerous blood clots. Treatments with good success rates include sclerotherapy (injecting a solution to shut the vein) and surgery -- also options if you just can't bear how your legs look at the beach.

Brownish Spots On The Shins.  The fronts of the legs along the shins tend to bang and bump into things a lot. For someone with diabetes, the damage to the capillaries and small blood vessels that are characteristic of the disease will cause them to leak when traumatized, leading to brown discoloration known as diabetic dermopathy.  The brownish patches may also be rough, almost scaly (although they don't open up), and tend to form ovals or circles. They don't hurt. Another common skin change of diabetes to look for: An open, unhealed sore on the foot. Diabetics lose the perception of pain, temperature, and touch on their feet, making them unlikely to notice common foot blisters -- which then go untreated and may become infected.  There's no health danger from diabetic dermopathy, and no need for treatment. But if someone who hasn't been diagnosed with diabetes shows these signs, it's worth checking for other signs of diabetes, such as thirst, excessive urination, tiredness, or blurry vision.
Persistent Rash that You Want To Scratch Raw.  Dermatitis herpetiformis (DH) -- clusters of small, ferociously itchy blisters that show up repeatedly in the forearms near the elbows, the knees, the buttocks, the back, or the face or scalp -- are a hallmark of celiac disease, or an allergy to gluten. As many as one in four people with celiac disease have DH.  The rash appears on both sides of the body. Itching and burning are so intense you can hardly quit scratching. People with DH don't usually have the digestive symptoms of celiac disease, but they're intolerant of gluten just the same. DH often shows up between ages 30 and 40, and most often in people of northern European heritage.  “Report the rashes to your regular doctor or a doctor who specializes in skin disorders to evaluate and rule out other causes,” recommends Dr. Rotter.  Blood tests and a biopsy of tissue from the small intestine are used to diagnose DH. A gluten-free diet for life is usually advised to keep symptoms at bay; this includes banishing foods, beverages, and medications that contain wheat, barley, rye, and sometimes oats. Drugs may help control the rashes.
If It Looks Like A Bruise, It May Not Be Just a Bruise… What looks a bit like a bruise but tends to hang around longer may not exactly be a bruise. It has several possible causes, ranging from a bleeding disorder to scurvy (vitamin C deficiency). But in adults over age 65, in whom it's common, the main explanation is thin skin, often made even more fragile by years of sun damage and weakened blood vessels. "A substantial excessive intake of aspirin, nonsteroidal anti-inflammatories, vitamin E, or ginkgo biloba, which older adults often take to boost memory, can worsen the condition," says Dr. Rotter. Extensive or persistent bruises should always be evaluated by a doctor, as should someone who seems to bruise easily. It's important to rule out underlying causes such as a bleeding disorder.

Intense Itchiness Without Rash.  Feeling itchy in more than one specific spot can have many causes, but when there's no accompanying visible skin change, it may be pruritis, one of the first symptoms of lymphoma (cancer of the lymph system). In fact, it's known as the "Hodgkin itch" (the two main types of lymphoma being Hodgkin's disease and non-Hodgkin's lymphoma).  The itchiness is more intense than that caused by ordinary dry skin. It can be felt generally or, most commonly, in the lower legs. Less often, the skin also looks reddish and inflamed. Another common symptom of both Hodgkin's disease and non-Hodgkin's lymphoma is swelling of the lymph nodes in the neck, armpit, collarbone, or groin. (Note that lymph nodes can swell because of common infections as well.)  Report persistent, intense itching to your doctor.
Tingling Skin Followed By a Rash On Only One Side of The Face or Body.  An often painful condition called (herpes zoster) announces itself in this distinctive way. Shingles is caused by the same virus that gives people chicken pox. In eight out of ten people who get chicken pox, the virus retreats to the body's sensory nerves and stays there. But stress, infection, certain medications (such as those used in chemotherapy and after transplants), or an aging immune system can reactivate the virus years later, producing shingles.  A burning sensation and sensitivity to touch often precede the shingles rash by days or weeks (or, in some lucky people, the pain may be mild).  The rash itself first looks like raised red bumps, not unlike chicken pox, appearing in a band or strip on the trunk, legs, face, neck -- but only on the left or the right side. Within a few days, the bumps turn into fluid-filled pustules, which crust over a week to ten days later.  “See a doctor as soon as you feel the pain, if you suspect you're in a high-risk group,” says Dr. Rotter.  Starting antiviral medication within 72 hours of the rash's appearance can reduce the severity of the disease and lower your odds of developing a complication called post-herpetic neuralgia (PHN). In PHN, the searing pain of shingles can continue for weeks, months, or even years. People older than age 70 are most likely to develop PHN, but anyone can.


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