NAILS IN HEALTH AND DISEASE.
Introduction:
The nails are present at the tip of every finger tip on the dorsal surface.The main function of nail is protection and it also helps for a firm grip for holding articles.It consists of a strong relatively flexible keratinous nail plate originating from the nail matrix. Under the nail plate there is a soft tissue referred to as nail bed.Between the skin and nail plate there is a nail fold or cuticle.Traditional healthy nail is slight pink in colour and therefore the surface is convex from facet to side.Finger nails grow 1 cm in 3 months and toe nails take 24 months for the same.
Importance of nails in disease diagnosis:
The colour ,look,shape and nature of the nails give some data concerning the overall health and hygiene of a person . Nails are examined as a routine by all doctors to induce some clues concerning underlying diseases.Just wanting at nails we tend to will makeout the hygiene of a person.The abnormal nail may be congenital or thanks to some diseases.The cause for changes in the nail extend from simple reasons to life threatening diseases.Hence the examination by a doctor is important for diagnosis .Some abnormal findings with probable causes are discussed here for general awareness.
1) Hygiene:-
We can build out an unhygienic nail very simply .Deposition of dirt underneath the distal finish of nail plate can make a probability for ingestion of pathogens while eating.If nail filing is not done properly it will lead to worm troubles in children.When the worms crawl within the anal orifice youngsters will scratch that lodges the ova of worms under the nails and can be taken in whereas eating.Outstanding nail can conjointly complicate a skin disease by habitual scratching.Sharp nails in small youngsters cause small wounds after they do feet kicking or hand waving.
two) Color of the nails:-
a) Nails become pale in anaemia.
b) Opaque white discolouration(leuconychia) is seen in chronic renal failure and nephrotic syndrome.
c) Whitening is also seen in hypoalbuminaemia as in cirrhosis and kidney disorders.
d) Drugs like sulpha group,anti malarial and antibiotics ect can produce discolouration in the nails.
e) Fungal infection causes black discolouration.
f) In pseudomonas infection nails become black or green.
g) Nail bed infarction occures in vasculitis especially in SLE and polyarteritis.
h) Red dots are seen in nails because of splinter haemorrhages in subacute bacterial endo carditis, rheumatoid arthritis, trauma, collagen vascular diseases.
i) Blunt injury produces haemorrhage and causes blue/black discolouration.
j) Nails become brown in kidney diseases and in decreased adrenal activity.
k) In wilsons disease blue color in semicircle appears in the nail.
l) When the blood offer decreases nail become yellow .In jaundice and psoriasis conjointly nail become yellowish.
m) In yellow nail syndrome all nails become yellowish with pleural effusion.
3) Shape of nails:-
a) Clubbing: Here tissues at the bottom of nails are thickened and therefore the angle between the nail base and the skin is obliterated. The nail becomes a lot of convex and the finger tip becomes bulbous and looks like an finish of a drumstick. When the condition becomes worse the nail appearance like a parrot beak.
Causes of clubbing:-
Congenital Injuries
Severe chronic cyanosis
Lung diseases like empyema,bronchiactesis,carcinoma of bronchus and pulmonary tuberculosis.
Abdominal diseases like crohn’s disease,polyposis of colon,ulcerative colitis,liver cirrhosis ect…
Heart diseases like fallot’s tetralogy,subacute bacterial endocarditis and ect..
b) Koilonychia:-
Here the nails become concave like a spoon.This condition is seen in iron deficiency anaemia.In this condition the nails become thin,soft and brittle.The normal convexity can get replaced by concavity.
c) Longitudinal ridging is seen in raynaud’s disease.
d) Cuticle becomes ragged in dermatomyositis.
e) Nail fold telangiectasia is a check in dermatomyositis ,systemic sclerosis and SLE.
4) Structure and consistancy:-
a) Fungal infection of nail causes discolouration,deformity,hypertrophy and abnormal brittleness.
b) Thimble pitting of nail is charecteristic of psoriasis ,acute eczema and alopecia aereata.
c) The inflamation of cuticle or nail fold is named paronychia.
d) Onycholysis is the seperation of nail bed seen in psoriasis,infection and once taking tetracyclines.
e) Destruction of nail is seen in lichen planus,epidermolysis bullosa.
f) Missing nail is seen in nail patella syndrome.It’s a hereditary disease.
g) Nails become brittle in raynauds disease and gangrene.
h) Falling of nail is seen in fungal infection,psoriasis and thyroid diseases.
five) Growth:-
Reduction in blood supply affects the growth of nails. Nail growth is additionally affected in severe ilness. when the disease disappears the growth starts again resulting in formation of transverse ridges.These lines are known as Beau’s lines and are healpful to this point the onset of illness.
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