FAILS IN DISEASE AND HEALTH

Introduction:

On the dorsal surface, the tips of each finger include nails. Nails serve as protection primarily, but they also facilitate a solid grip when holding objects. It comprises a robust yet pliable keratinous nail plate from the nail matrix. The nail bed is the soft tissue located beneath the nail plate. The cuticle, or nail fold, is between the skin and the nail plate. A typical, healthy nail has a somewhat pink hue and a convex surface that curves in both directions. Toenails take 24 months to develop the same distance as fingernails, which grow 1 cm in 3 months.

Nails' significance in the diagnosis of illness:

A person's overall health and cleanliness can be inferred from their nail color, look, shape, and nature. Every doctor routinely examines patients' nails to obtain information about underlying illnesses. It is possible to infer a person's hygiene only by glancing at their nails. The malformed nail could be a birth defect or the result of an illness. Changes in the nail can be caused by anything from minor illnesses to serious medical conditions. Therefore, a doctor's examination is necessary for diagnosis. For the sake of general knowledge, a few aberrant findings and their likely explanations are explained below.

1) Personal cleanliness:

An unsanitary nail is quite easy to spot. Mud buildup beneath the distal end of the nail plate increases the possibility of pathogen ingestion after eating. Children who have their nails clipped improperly may develop worm problems. Children will scratch as the worms crawl through the anal opening, causing the worms' eggs to get lodged beneath the nails and be consumed when eating. A prominent nail may also make a skin condition worse if it is frequently scratched. Little children with sharp nails can sustain minor cuts when they stomp their feet or wave their hands.

2) The shade of the nails:

a) Anaemia causes pale nails.

Leuconychia, or opaque white discoloration, is observed in nephrotic syndrome and chronic renal failure.

c) Whitening is observed in cases of cirrhosis, kidney diseases, and hypoalbuminemia.

d) Medicines such as antibiotics, antimalarials, and sulfur-containing compounds, among others, can cause nail discoloration.

e) Black discoloration is brought on by a fungal infection.

f) Pseudomonas infections cause nails to turn green or black.

g) Vasculitis, particularly SLE and polyarteritis, can cause nail bed infarction.

h) Splinter hemorrhages in subacute bacterial endocarditis, rheumatoid arthritis, trauma, and collagen vascular disorders cause red spots to appear in the nails.

i) Blunt damage results in bleeding and discoloration that is blue or black.

j) Reduced adrenal function and kidney disorders cause dark nails.

k) Wilson's disease causes the nail to turn blue in a semicircle.

A decrease in blood flow causes the nail to turn yellow. Psoriasis and jaundice can also cause yellowing of the nails.

m) Pleural effusion and yellowing of all nails are symptoms of yellow nail syndrome.

3) Nail shape:

Clubbing: In this condition, the tissues at the base of the nails swell and the angle between the skin and nail base is destroyed. The fingertip gets bulbous and resembles the end of a drumstick as the nail becomes more convex. The nail takes on the appearance of a parrot's beak as the illness worsens.

Reasons behind clubbing:

a) Birth Traumas

severe long-term cyanosis

lung conditions include pulmonary TB, bronchiectasis, empyema, and cancer of the bronchus.

Conditions affecting the abdomen, such as Crohn's disease, colon polyposis, ulcerative colitis, liver cirrhosis, etc.

Heart conditions such as subacute bacterial endocarditis, Fallot's tetralogy, and others.

b) Koilonychia:

The nails here take on the shape of a spoon. Iron deficiency anemia is a disorder that manifests this way. The nails in this disease get brittle, fragile, and thin. Concavity will take the role of typical convexity.

c) Raynaud's illness is associated with longitudinal ridging.

d) Rough cuticle in cases of dermatomyositis.

e) Systemic sclerosis, SLE, and dermatomyositis can all be indicated by nail fold telangiectasia.

4) Coherence and organization:

a) Nail fungal infections result in aberrant brittleness, hypertrophy, deformity, and discoloration.

b) Nail-thin pitting is a sign of alopecia aerate, psoriasis, and severe eczema.

c) Paronychia is the term for the inflammation of the cuticle or nail fold.

d) Onycholysis, a condition where the nail bed separates, is observed in cases of psoriasis, infection, and tetracycline use.

e) Epidermolysis bullosa and lichen planus both cause nail destruction.

f) Nail patella syndrome is associated with missing nails. It is an inherited illness.

g) Gangrene and Raynaud's illness cause brittle nails.

h) Thyroid disorders, psoriasis, and fungal infections can cause nail falling.

5) Growth: 

Reduced blood flow has an impact on nail development. Severe sickness also affects the growth of nails. Transverse ridges emerge as a result of growth restarting when the sickness goes away. Beau's lines are useful for determining when a disease first manifested.