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SINGAPORE - The 75-year-old patient had gone to see Dr Joyce Lee, a consultant dermatologist at the National Skin Centre, about a nail problem. All of his fingernails and toenails had turned yellow and thickened considerably. He ended up being referred to a respiratory physician for a thorough examination, including chest x-rays.
To a layman, it may seem like a bizarre turn of events, but a trained eye can actually pick up warning signs for other health problems just by looking at the nails.
Indeed, changes in the nails may be “invaluable clues to the diagnosis of other underlying medical conditions”, said Dr Lee. For instance, the yellow nail syndrome, which her elderly patient had, is highly associated with underlying respiratory problems.
Warning signs for other medical conditions, such as anaemia, liver cirrhosis, heart failure, kidney failure and thyroid problems, may also show up in the nails, according to Dr Cheong Wai Kwong, a consultant dermatologist with the Specialist Skin Clinic.
“Whitening of the nails or pale nails may be seen in conditions such as anaemia, liver problems, cardiac insufficiency and kidney failure. Brown or black nails may be a sign of underlying malignant melanoma within the nail,” said Dr Cheong.
Normal healthy nails typically have a pinkish tone due to the numerous blood vessels found within the nail bed, said Dr Lee. “Naturally, in conditions such as anaemia, the nails look paler than normal due to the decrease in red blood cells going to the blood vessels of the nail bed,” she explained.
And don’t brush off brittle nails, too.
According to her, they can mean an iron deficiency, circulatory dysfunction or thyroid disease.
Horizontal or transverse lines, called Beaus lines, may also show up across your nails after any severe illnesses like a high fever.
But can you truly trust your nails to detect undiagnosed medical conditions?Although nail changes can indicate other health problems, Dr Stanley Liew, a consultant endocrinologist at Raffles Hospital cautioned about using it as an “infallible, diagnostic sign of related medical conditions”.
For instance, while patients with an overactive thyroid may experience nail clubbing (which results in the nail resembling a bird’s beak), Dr Liew noted that they are also likely to complain of other symptoms such as weight loss, fast heartbeat, hand tremors and heat intolerance, irritability and irregular menstruation.
Also, in many cases, “these conditions are usually in the advanced stages by the time nail changes develop”, said Dr Cheong.
Even so, it is wise not to brush off per persistent nail problems. “Fingernails grow at a rate of 3mm per month while toe nails grow at about 1mm per month. If the nail changes are temporary, the new nails that grow out from the base will be normal. If the nail is eventually restored completely, there is no cause for concern,” said Dr Lee.
"However if the nail change is persistent or the new nail that is growing out is also abnormal, it may be wise to consult a dermatologist.”
POSSIBLE HEALTH PROBLEMS
Dr Lee shared with us some medical conditions that may be associated with nail changes:
Upper half of the nails are brown and lower half of the nails are white: May be associated with chronic renal failure.
Pigmentation of the nail: May be associated with melanoma (skin cancer), or a cancerous mole in the nail region.
Nail clubbing (an increased curvature of the nail, with thickened nail fold at the base of the nail): May be associated with chronic lung diseases, lung cancer, cardiovascular diseases, liver problems.
Yellow nail syndrome (thickened and yellow nails): May be associated with chronic lung diseases.
Brittle nails and whitish discolouration of the nail: May be associated with thyroid disease.
Transverse whitish lines along the nail: May be associated with arsenic poisoning. - TODAY/ar
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